- 1. Fewer than ______% of babies requiring resuscitation will need epinephrine to stimulate their hearts
- 1% 2% 3% 4%
- Most newly born babies are vigorous. Only about 10% require some kind of assistance and only 1% need major resuscitative measures (intubation, chest compressions, and/or medications) to survive
-
- 2.If the baby appears to be in shock, there is evidence of blood loss, and resuscitation is not resulting in improvement, you should consider giving _______ mL/kg of _______ by what route?
- 15m/kg,volume expander,umb.vein
- 10ml/kg ,volume expander,umb .vein
- 20ml/kg, volume expander ,umb.vein
- 25ml/kg,volume expander,umb vein
- 3.About _________% of newborns will require some assistance to
begin regular breathing. - 10% 15 % 20% 25%
- If a baby does not begin breathing in response to stimulation, you
should assume she is in ___________ apnea and you should
provide _____________________. - secondary apnea, epinephrine
- secondary apnea, chest compression
- secodary apnea, positive pressure ventilation
- secondary apnea, free flow oxygen
- KEY POINTS
- The most important and effective action in neonatal resuscitation is to ventilate the baby’s lungs.
- The steps of neonatal resuscitation are as follows:
A. Initial steps.
• Provide warmth.
• Position head and clear airway as necessary.*
• Dry and stimulate the baby to breathe.
• Evaluate respirations, heart rate, and oxygenation.
B. Provide positive-pressure ventilation with a resuscitation
positive-pressure device and apply pulse oximeter.*
C. Provide chest compressions as you continue assisted ventilation
and insert emergency umbilical venous catheter.*
D. Administer epinephrine as you continue assisted ventilation
and chest compressions.*
*Consider intubation of the trachea at these points
- If meconium is present and the newborn is not vigorous, suction the baby’s trachea before proceeding with any other steps. If the newborn is vigorous, suction the mouth and nose only, and proceed with taking the baby to the mother for your further assessment.
2. “Vigorous” is defined as a newborn who has strong respiratory efforts, good muscle tone, and a heart rate greater than 100 beats per minute - A fetus has an oxygen saturation of approximately 60%, and it may take up to 10 minutes for a healthy newborn to increase saturation to the normal range of over 90%.
. Acceptable methods for administering free-flow oxygen are
• Oxygen mask held firmly over the baby’s face
• Mask from a flow-inflating bag or T-piece resuscitator held
closely over the baby’s mouth and nose
• Oxygen tubing cupped closely over the baby’s mouth and nose - If the baby’s condition continues to deteriorate or fails to improve, and the heart rate is below 60 bpm despite 30 seconds of effective PPV (defined by audible bilateral breath sounds and chest movement
with ventilation), your next step will be to begin chest compressions. - If the heart rate is more than 60 bpm but less than 100 bpm, continue to administer PPV as long as the baby is showing steady improvement
- Indications for positive-pressure ventilation are • Apnea/gasping • Heart rate below 100 beats per minute even if breathing • Persistent central cyanosis and low Spo2 despite free-flow supplemental oxygen increased to 100%
- If you cannot detect audible bilateral breath sounds and see no perceptible chest expansion during assisted ventilation, check or correct the following:
• M: Mask adjustment.
• R: Reposition airway.
• S: Suction mouth and nose.
• O: Open mouth.
• P: Pressure increase.
• A: Airway alternative - The most important indicator of successful PPV is rising heart rate.
- Chest compressions are indicated whenever the heart rate is below 60 beats per minute, despite at least
30 seconds of effective positive-pressure ventilation (PPV). - Weight (g) Gestational Age (wks) Tube Size (mm)
(inside diameter)
Below 1,000 Below 28 – 2.5 ET SIZE
1,000-2,000 28-34 – 3.0 ET SIZE
2,000-3,000 34-38 -3.5 ET SIZE
Above 3,000 Above -38 3.5-4.0 ET SIZE - Epinephrine is a cardiac stimulant that also increases blood pressure. Preferably, it should be given by umbilical venous catheter. Its administration is indicated when the heart rate remains below 60 beats per minute despite 30 seconds of effective assisted ventilation, and administration should be followed by another 45 to 60 seconds of coordinated chest compressions and ventilations.
- Recommended epinephrine
• Concentration: 1:10,000 (0.1 mg/mL)
• Route: Intravenously. Endotracheal administration may be considered while intravenous access is being established.
• Dose: 0.1 to 0.3 mL/kg of a 1:10,000 concentration solution (consider higher dose, 0.5 to 1 mL/kg, for endotracheal route only)
• Rate: Rapidly—as quickly as possible - Recommended volume expander
• Solution: Normal saline, Ringer’s lactate, or O Rh-negative blood
• Dose: 10 mL/kg
• Route: Umbilical vein
• Preparation: Correct volume drawn into a large syringe
• Rate: Over 5 to 10 minutes
Superintendent, ICH.