Neonatal Resuscitation Program

If a high-risk delivery is anticipated, what is the least number of skilled persons, whose only responsibility is resuscitation and the management of the baby, who should be present at the delivery?

*2*

During the initial stages of neonatal resuscitation, at what rate should breaths be delivered when providing positive pressure ventilation?

*60 to 80 breaths per minute*

Targeted pre-ductal SpO2 after birth at 3 minutes of life?

*70-75%* - Preductal SpO2 targets rise gradually from birth to up to 10 minutes post-parturition. - From immediately after birth to 1 min the target is 60-65%. - Subsequent targets are 65-70% at 2 minutes, 70-75% at 3 minutes, 75-80% at 4 minutes, 80-85% at 5 minutes, and 85-95% at 10 minutes.

What is the targeted pre-ductal SPO2 level 5 minutes after birth?

*80-85%* - Preductal SpO2 targets rise gradually from birth to up to 10 minutes post-parturition. - From immediately after birth to 1 min the target is 60-65%. - Subsequent targets are 65-70% at 2 minutes, 70-75% at 3 minutes, 75-80% at 4 minutes, 80-85% at 5 minutes, and 85-95% at 10 minutes.

If a newborn has copious secretions coming from the mouth, how should they be cleared?

*bulb syringe*

Where should pressure be applied when performing compressions on the newborn?

*lower third of the sternum* - Chest compressions on the newborn should apply pressure to the lower one-third of the sternum, typically in line with the nipples. - Downward pressure should be applied perpendicular to the chest wall to depress the sternum about one-third of the anteroposterior diameter of the chest, followed by release of pressure to allow for refilling of the heart. - Providers should avoid direct pressure to the xiphoid, which can result in liver injury.

The pulmonary blood vessels in babies who were hypoxemic and/or academic around the time of birth may remain constricted. What is this condition called?

*persistent pulmonary hypertension of newborn* - Persistent pulmonary hypertension of the newborn (PPHN) results from abnormal elevation of pulmonary vascular resistance after birth, causing right-to-left blood shunting via routes of fetal circulation. - The result is severe hypoxemia that may not respond to traditional respiratory support.

What kind of apnea responds to stimulus?

*primary* - At the initiation of respiratory compromise, newborns experience an initial period of attempted rapid breathing followed by primary apnea. - Primary apnea results in a reduced oxygen saturation, resulting in a lower heart rate. - Stimulation will usually assist a newborn in the required respiratory transition, however if a newborn does not start breathing immediately following stimulation, he/she is likely experiencing secondary apnea. - Further stimulation will not help, and the newborn require positive-pressure ventilation.

What kind of apnea does not respond to stimulus?

*secondary* - At the initiation of respiratory compromise, newborns experience an initial period of attempted rapid breathing followed by primary apnea. - Primary apnea results in a reduced oxygen saturation, resulting in a lower heart rate. - Stimulation will usually assist a newborn in the required respiratory transition, however if a newborn does not start breathing immediately following stimulation, he/she is likely experiencing secondary apnea. - Further stimulation will not help, and the newborn require positive-pressure ventilation.

Which device should be readily available as a backup wherever resuscitation may be needed, in case a compressed gas source fails?

*self-inflating bag* - Unlike other bag-mask ventilation methods, self-inflating bags reinflate when released due to a pressure-release, or pop-off valve. - Valves are typically set by the manufacturer to release at 30 to 40 cm H2O of pressure. - This makes them the only method usable when compressed gas sources are not available. - It's important to note that for newborns who have not yet taken their first breath, occlusion of the pop-off valve may be necessary to generate sufficient pressure to inflate the nonaerated lungs. However, care must be taken to avoid overinflation and creation of a pulmonary air leak.

Every delivery should be attended by at least ____ skilled person.

1

About _____% of newborns will require extensive resuscitation to survive.

1%

About ____ % of newborns will require some assistance to begin regular breathing?

10%

The air that fills the baby's lungs during normal transition contains _____ % O2.

21

The newborn compression/respiration ratio is

3:1

Chest compressions in infants are indicated when heart rate remains less than _______ bpm despite __________ seconds of effective PPV.

60, 30

If a baby enters a stage of secondary apnea, her heart rate will _______, and her blood pressure will _______.

Fall Fall

What are 3 things needed for temperature regulation of a newborn?

Towels or warm blankets plastic bag thermoregulated incubator.

When there are twins expected, there should be _______ number of skilled clinicians in the room for resuscitative care.

at least 4 ( 2 per kid)

In neonates, a persistent heart rate under 60 beats per minute despite chest compressions and adequate ventilation, is indication for

epinephrine administration - Epinephrine should only be initiated after establishing adequate ventilation to avoid myocardial injury, as it increases myocardial oxygen consumption and workload. - Guidelines recommend IV epinephrine at a dose of 0.01 to 0.03 mg/kg at a dilution of 1:10,000. - Epinephrine can be given every 3 to 5 minutes with the heart rate below 60 bpm.

Before birth, the alveoli in the baby's lungs are ______ and filled with ______.

expanded fluid

Air that leaks from inside the lung and collects in the pleural space is called a ________.

pneumothorax - A pneumothorax is air present between the parietal and visceral pleura. = Pneumothorax in infants may be asymptomatic, however respiratory distress can manifest as tachypnea, pallor and cyanosis. - Early indication of pneumothorax can often be a rapid reduction in QRS voltage on EKG. - Physical exam findings can include an asymmetric chest larger on the side of pathology, decreased breath sounds on that side, and a point of maximal impulse shift away from that side.

Restoration of adequate ventilation usually will result in a _______ improvement in heart rate...

rapid

If a baby does not begin breathing in response to stimulation, you should assume she is in _____ apnea and you should provide _____.

secondary PPV

Symptomatic pneumothorax should be treated emergently with thoracentesis using a

syringe attached to a 23 or 25-gauge scalp vein needle or 18 to 20-gauge angiocather - The procedure may be used as the lone intervention in infants not requiring mechanical ventilation, or as a temporizing measure.

Where do you administer resuscitation drugs in a neonate?

umbilical catheter

The most important step when resuscitating a compromised infant is to

ventilate the lungs