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Single most important concept from course?
Ventilation of the baby's lungs is the most important and effective action in neonatal resuscitation.
What percentage of newborns require some assistance at birth?
10% (90% of newborns are totally fine)
What percentage of newborns require extensive resuscitative measures to survive?
3 major changes to allow baby to get oxygen to their lungs
- 1) fluid in the alveoli is absorbed by lymphatics and replaced by air
- 2) umbilical arteries constrict and then the umbilical arteries and vein are closed/clamped.
- 3) blood vessels in the lung relax, decreasing resistance to blood flow
What allows fetal blood to bypass the lungs in uteri?
The patent ductus arteriosus (less resistance than the pulmonary arteries, so blood bypasses the lungs)
Problems that may disrupt normal transition to get O2 in their lungs?
- Lungs may not fill with air - inadequate ventilation
- Pressure may not rise as expected (hypotension)
- Pulmonary arterioles may stay constricted after birth (persistent pulm hypertension of newborn)
*If a baby does not begin breathing immediately after being stimulation, he or she is likely in secondary apnea and will require positive-pressure ventilation (continued stimulation will not help)
What is the difference between primary and secondary apnea?
- Perinatal stress results in rapid breathing, which is followed by a period of apnea - during 1º apnea stimulation will resume breathing.
- If cardioresp compromise continues, the baby has more gasping breaths and then secondary apnea
3 questions to ask yourself when baby is born?
- Term? Breathing or Crying? Good tone? --> if yes to all three, stays on mom
- if no, then continue initial resuscitation steps
A - Initial steps to establish an airway?
- warmth - towel and skin-to-skin or radiant heater
- position the head to open airway
- dry skin, stimulate to breath and reposition
- No more than 30s total
A - How to evaluate success of block A?
- If not breathing (apnea or gasping) or HR < 100 - immediate PPV and O2 monitoring
- If laboured or cyanotic breathing - CPAP and O2 monitoring
B - How to evaluate success?
- If appropriate ventilation - HR should > 100
- If HR < 60 - Block C
C - circulation - chest - steps?
- If HR < 60 - start chest compressions
Evaluation of Block C?
If HR < 60 still, despite CPR and ventilation, proceed to block D (drugs)
D - steps in drugs?
Admin Epi while doing chest comrpessions and ventilation
What happens when HR rises above 60 again?
stop chest compressions
When to stop ventilation?
When HR > 100 and baby breathing well
Antepartum risk factors for needing neonatal resuscitation?
GDM, GHTN or preeclampsia, chronic HTN, fetal anemia or isoimmunization, previous fetal or neonatal death, bleeding in T2/T3, maternal infection, maternal cardiac/renal/pulm/thyroid/neurology disease, polyhydramnios, oligohydramnios, premature rupture of membranes, fetal hydrous, post-term, multiple gestation, size-date discrepancy, drug therapy, adrenergic agonists, maternal substance abuse, fetal malformation or anomalies, diminished fetal activities, no prenatal care, mother older than 35 yrs
Intrapartum risk factors for needing neonatal resuscitation?
Emergent C-section, Forceps/Vacuum, Breech or AbN presentation, Premature labor, Precipitous labor, Chorioamnionitis, Prolonged rupture of membranes (>18h), Prolonged labour (>24h), macrosomia, category 2/3 fetal heart rate patterns, use of general anesthesia, uterine tachysystole with fetal heart rate changes, narcotic within 4 hrs of delivery, prolapsed cord, meconium in fluid, abruptio placentae, placenta prevue, significant intrapartum bleeding
Equipment check list - what are the 8 headings for the checklist?
- Clear the airway 3 ways
Equipment check - warm?
- preheat warmer
- towels or blankets
Equipment check - Clear Airway
- Bulb syringe
- 10F or 12F suction catheter set at 80-100mmHg
- Meconium aspirator
APGAR Score - 5 features
- Color - pink
- Heart Rate - > 100
- Reflex irritability - cry or active withdrawal
- Muscle tone - active motion
- Respiration - good/crying
When to continue APGARs?
- Done at 1 and 5 minutes, but if < 7 at 5 min
- Continue q5min up to 20 min