Flashcards in Neonatal Resuscitation Deck (48)
What is hypoxia?
What is anoxia?
Severe hypoxia; absence of oxygen
What is apnoea?
Absent respiratory effort
What is asphyxia?
Give 10 events that lead to hypoxia
1. Hypoxia in uterus
2. Foetus attempts to breathe
3. Foetus loses consciousness
4. Neural centres in brainstem that control breathing efforts cease to function
5. Primary apnoea
6. HR decreases by half as myocardium reverts to anaerobic metabolism
7. Lactic acid released, adding to respiratory acidosis from accumulation of carbon dioxide
8. Shuddering agonal gasps initiated by primitive spinal reflexes
9. Failure to aerate lungs results in secondary/ terminal apnoea
10. Worsening acidosis, reducing substrate for anaerobic metabolism and on-going anoxia lead to impaired cardiac function and then heart failure
What is the most effective way to keep the foetus alive?
What are the potential causes of neonatal respiratory distress related to the mother?
- Heavy sedation
- Chronic illness
- Drug addiction
- Diabetes mellitus - surfactant production if premature
- Severe pregnancy induced hypertension or pre-eclampsia
- Antepartum haemorrhage
What are the potential causes of neonatal respiratory distress related to the foetus?
- Preterm <34/40
- Post term >42/40
- Multiple pregnancy
- Intrauterine infection
- Growth restriction
- Rhesus isoimmunisation
- Reduced foetal movement
- Abnormal presentation
What is polyhydramnios and oligohydramnios?
Polyhydramnios = excess amniotic fluid
Oligohydramnios = deficiency of amniotic fluid
What are the potential causes of neonatal respiratory distress related to delivery?
- Suspected foetal compromise
- Prolonged rupture of membranes
- Intrapartum haemorrhage
- Assisted deliveries
- Emergency LSCS
- Prolapsed cord
- Prolonged/ difficult labour
- Thick meconium stained liquor
What must be prepared for all births?
- Equipment (familiar, available, working, turned on)
- Warm room and towels
- Check history (any risk factors?)
What must be prepared for high risk births?
- Inform labour ward coordinator
- Consider second midwife for delivery (may be mandatory in some units)
- If high risk, inform SCBU/NNICU
What is the sequence of actions following apnoea?
1. Keep infant warm and assess
4. Chest compressions
How should significantly preterm infants be placed after birth?
In polyethene wrapping under a radiant heater, without drying
What must the temperature be after birth?
36.5 - 37.5 degrees C
What should be done if the baby is breathing well after birth?
Put skin to skin with mother and encourage BF
What does a healthy infant look like?
- Blue with good tone
- Will cry within a few seconds of delivery
- Good HR within a few mins (120-150min-1)
What does a less healthy infant look like?
- Blue with poor tone
- Slow HR (<100min-1)
- May not establish breathing by 90-120 seconds
What does an unwell infant look like?
- Born pale and floppy
- Not breathing with a very slow/ undetectable HR
How should the baby be assessed following birth?
- Cover infant with dry towels and a hat
- Assess infant's breathing and HR (and colour and tone)
- Reassess breathing and HR every 30 secs during resuscitation; increasing HR is most important
- Use stethoscope to read HR and pulse oximeter where possible
What should be done about the airways?
- Open airway (place infant on back with head in neutral position)
- If infant is floppy, may need jaw thrust
- Airway suction necessary for airway obstruction with direct visualisation
- Tracheal obstruction requires intubation and suction during withdrawal of the endotracheal tube
How many inflation breaths should be given?
- 5 inflation breaths
- 30cm water for 2-3 secs or 20-25cm water in preterm infants
If heart rate increases after inflation breaths, what can be assumed?
Lungs have been successfully aerated
What should be done if heart rate increases but infant is not breathing?
Continue ventilations 30-40min-1 until infant starts breathing
What should be considered if the lungs are not aerated?
- Check infant's head is in neutral position
- Check if there's a face mask leak
- Jaw thrust/ 2 person approach needed?
- Longer inflation time needed?
- Obstruction in oropharynx?
- Will an oropharyngeal airway assist?
- Is there a tracheal obstruction?
What can be assumed if the lungs do not move with inflation breaths?
There is an airway obstruction
When should chest compressions be started?
If HR remains slow after 5 effective breaths and 30 seconds of effective ventilation
What do infants require if they are showing signs of respiratory distress?
CPAP of 5cm water
What do preterm infants that are not breathing adequately require?
PEEP with inflation breaths to prevent the lungs collapsing