1
Q
What should the FIO2 be if over 32 weeks gestation?
A
21%
2
Q
What should the FIO2 be if 28 to 31 weeks gestation
A
21-30%
3
Q
What shhould FIO2 be if under 28 weeks
A
30%
4
Q
What should PEEp be
A
5cmh2o
5
Q
What should PIP be for a term baby
A
30
6
Q
What should PIP be for a preterm baby
A
25
7
Q
What should be assessed once cord is clamped
A
colour, tone, breathing, heart rate
8
Q
What should be considered in a preterm baby to ensure airway maintains open
A
CPAP
9
Q
Once the baby’s chest is moving continue ventilation breaths.
If heart rate is under 60 bpm after 30 seconds ventilation, what should be done?
A
Synchronise 3 chest compressions to 1 ventilation
Increase oxygen to 100%
Consider intubation if not already done (or laryngeal mask if not possible)
10
Q
What should be done if the heart rate remains under 60 bpm? afterc chest compressions
A
Vascular access and drugs
Consider other factors like pneumothorax, hypovolaemia, congenital abnormality
11
Q
How should the baby be handled if preterm (under 32 weeks)?
A
Placed undried in plastic wrap and radiant heat
12
Q
it is not uncommon to find an umbilical cord ph less than
A
7.25
13
Q
at what cord ph do the number of babies who require resus increase
A
7.0
14
Q
how to estimate the weight of a baby
A
knowing the gestation in weeks and using the 50th centile weight for that gestation
15
Q
HIE management
A
if >36 weeks, therapeutic hypothermia, seek secomnd opinion if <36 weeks
16
Q
fluid bolus
A
10mls/kg
17
Q
when should we uuse fluid bolus in neonates
A
It is suggested that a 10 mL kg-1 fluid bolus is tried as part of the resuscitation of the unresponsive baby reaching the stage of requiring drugs and who has not responded to adrenaline as there may have been an occult (hidden) blood loss. Further boluses should be avoided if there is no response to that bolus.
18
Q
why do we avoid using repeated use of boluses of fluid in babies
A
f a baby is severely compromised by hypoxia there is likely to be an element of myocardial ischaemia. This can impair cardiac function and the heart is unable to cope with the pre-load of large volumes of ‘resuscitation fluid’. In the period following resuscitation, uncontrolled volumes of fluid may result in fluid overload due to hypoxic damage to the kidneys resulting in renal failure due to acute tubular necrosis. Remember most babies who appear to need fluid resuscitation are not fluid depleted.
19
Q
Assisting transition
A
delayed cord clamping whilst attending to thermal control, opening the airway, and perhaps inflating the lungs and is termed “assisting transition”.
20
Q
umbilical venous access vs peipheral
A
drugs used in newborn resuscitation need to reach the myocardium and central circulation to be effective - giving them centrally is far more effective than giving them peripherally, and the easiest and most effective way to achieve this is by umbilical venous catheterisation. An alternative route (perhaps more familiar to those staff who work in an Emergency Department) is the intraosseous route.
Giving drugs via a peripheral cannula would not result in sufficient quantities reaching the central circulation or myocardium to be effective.
21
Q
problems with umbilical venous catheterisation
A
Whilst umbilical venous catheterisation can be associated with problems (e.g. sepsis, portal venous thrombosis, etc.) most of these are due to long-term use
22
Q
meconium stained liquor
A
Most babies born through meconium-stained liquor will not have inhaled any particulate material into their lungs.
- meconium staining of liquor is relatively common - occurring in 10 - 15% of deliveries
- meconium can be found below the vocal cords in 5 - 6% of deliveries
- meconium aspiration syndrome occurs in 0.1 - 0.15% of deliveries
The priority is to begin effective resuscitation as soon as possible and therefore do not delay giving inflation breaths. If you don’t see chest movement during these inflation breaths after you perform airway opening manoeuvres then consider whether the trachea is blocked. If you can intubate you can use a tracheal tube and meconium adaptor as a suction catheter (or a wide bore suction catheter). If you cannot intubate and help is not available consider using higher pressures and longer inflation breaths (whilst this may push meconium further into the lungs it might open up some of the previously blocked airways to allow life-saving gas exchange).
23
Q
Rate of agonal gasps
A
Agonal gasps are driven by primitive spinal centres, which are normally suppressed by the higher breathing centres. They are shuddering whole body gasps that occur every 5 - 8 s. This means that the overall rate is about 8 - 12 min-1.
24
Q
how to check if the tube is in the correct position
A
- Checking the heart rate – is it increasing?
- Checking that the exhaled CO2 detector confirms intubation?
- Listen at the mouth – is there a large, and audible leak?
- Look at the chest – are both sides moving equally?
- Listen to both sides of the chest including the axillae – is air entry equal?
25
caution of exhaled co2 detector
They should be used in context of the wider clinical picture as they may be inaccurate in situations where there is a very low cardiac output (and read negative if tube ic correctly placed) or may be in right main bronchus (and read positive although the tube is incorrectly placed)
26
How to ensure baby's head is in enutral position
Place a small (2cm) thick pad under the baby's shoulders
27
How to minimise pneumothorax
Limit the inflation pressure used in positive pressure ventilation. But pneumothorax is rare and can also occur spontaneously.
28
What happens in prolonged hypoxia
During prolonged hypoxia, the respiratory centre stops functitoning after a couple of minutes. Breathing ceases and the fetus or baby enters absent respiration called 'primary apnoea'. This is followed by a period of 'agonal' gasps and then finally terminal apnoea.
29
What drug can be given by the tracheal tube?
Adrenaline, but this can interfere with absorption making this route unreliable. The foetal lung luid also meas that a higher dose may need to be given
30
What is the standard dose of adrenaline
20 micrograns/kg
31
How is naloxone given
Through IM, after ABC established, and if baby is apnoeic secondary to maternal opiates
32
Should cord milking be performed
Intact cord milking is more beneficial than cut cord milking, which in turn is more beneficial than immediate cord clamping.
Intact cord milking is harmful in babies born before 28 weeks due to the transmission of the compressive milking forces through the circulation to the cerebral vessels. tHIS CAUSES FLUCTUATIONS IN FLOW and pressure which baby cannot cope with.
33
Preterm babies born before 28 weeks
Thermal care - babies should be placed in a polythene bag under a radiant heater immediately
Consider CPAP in spontaneously breathing babies
If not breathing start with:
* Inspiratory pressures – start with lower inflation pressures of 25cm water
* Expiratory pressures – use a PEEP of 5 cm water
Initial oxygen concentration should Start with 30% for <28 weeks.
34
What to do if delayed cord clamping is not practical
Cord milking (intact or cut cord) is an option in babies >28 weeks' gestation. Cord milking should not be practiced in babies born earlier than 28 weeks gestaiton.
35
Situations where DCC is not advisable
Cases with interruption of the placental blood flow/oxygenation: maternal haemorrhage, maternal seizure or cardiac arrest, placenta abruption, vasa praevia, cord avulsion.
- Foetal hydrops due to any underlying cause
- Twin to twin transfusion syndrome
36
Blood gas in a baby truly requiring resuscitation
There will be a mixed acidosis.
Because:
- there will be accumlation of co2, which is converted to carbonic acid.
- Lactic acid accumulated as cells switch to anaerobic metabolism due to ongoing hypoxia, causing lactic acidosis.
37
How long does it take for pulse oximetry to give a signal
wITHIN 30-60 SECONDS
38
After resuscitation, how can you tell if a baby is responding
Babies who are in primary apnoea and are resuscitated are more likely to breathe in response to that resuscitation.
A tiny minority may respond by gasping initially.
All babies who are in terminal apnoea, and who are responding to resuscitation, will be seen to gasp in response to resus with regular breathing appearing later
39
How much glucose in a preterm baby
2.5mls /kg of 10% glucose is enough.
40
Should the shape of a occiput have an impact on the baby
In most newborn babies, the occiput is prominent and if such a baby is placed on its back (supine) the large occiput causes the neck to flex and airways to become occluded. To correct this, the head should be placed in the neutral position with the neck neither extendedd nor flexed. A small pad or rolled towel (-2cm thick) under the baby's shoulders can help achieve this.
41
What affects the duration of primary apnoea
Several factors such as anaesthetics and opiate analgesics given to the mother
42
When to use laryngeal masks over face masks
Face masks are the mode of choice but laryngeal masks to be used when:
- Face mask ventilation by skilled practitioners is found to be difficult.
- A degree of airway security is needed (e.g. during a prolonged resuscitation) and intubation is not possible (e.g. no-one available who is suitably trained or the intubation is technically difficult).
- The attendant is less experienced in providing mask ventilation to term and near-term babies (e.g. in a pre-hospital environment).
43
Agonal gasps
shuddering whole body gasps, involve all accessory muscles of respiration and occur every 5-8 seconds.
44
CPAP in preterm vs term babies
CPAP helps preterm babies
But can be harmful in term babies
45
Difference between newborn babies and adults from oxygen deprivation
Baby conserves energy by shutting down the circulation to all but most vital organs
After a latent period called primary apnoea, automatic, spinally generated gasping activity appears
The newborn baby's heart can utilise glycogen as an alternaive fuel to provide adequate circulation in the face of profound hypoxia.
46
Simplified algorith for baby resuscitation at birth
Dry and cover the baby
Assess the situation and consider umbilical cord management
Airway
Breathing (inflation breaths, then ventilation breaths)
Circulation
Drugs
47
Recommended initial oxygen concentrations and gestation >32 weeks, 28-32 weeks, <28 weeks
>32 weeks = air
28-32 weeks = 21-30%
<28 weeks = 30%
48
Heart rate not improving despite effective ventilation
Increase oxygen concentration, and if giving chest compressions, increase to 100% oxygen
49
Acceptable pre-ductal saturations after birth art 2 mins, 5 minutes and 10 minutes
2 minutes is 65%
5 mins is 85%
10 mins is 90%
50
how often should adrenaline doses be repeated
Every 3-5 minutes
51
What is the optimal tactile method
Unknown but tactile stimulation is better in preterm babies
52
What can immediate cord clamping do to the heart rate
It can cause the heart rate to temporarily decrease. This is not seen in delayed cord clamping
53
Ways of measuring heart rate
1. Stethoscope
2. Pulse oximeter
3. ECG = ONLY registrs the electrical signal, not whether there is any effective cardiac output
54
What do preductal saturations represent
Oxygen going to the brain. This is measured in right arm
55
What is a pulse oximeter?
a small, electronic device that non-invasively measures the amount of oxygen in your blood (SpO2) and your pulse rate
56
What can cause airway obstruction
Neck is Too flexed, too extended, tongue falling back into airway due to loss of pharyngeal tone. These mechanisms are more likely to be he cause of airway problem than any mechanical obstruction from blood, thick mucus or lumps of vernix or meconium.
57
Inflation breatjs
help clear lung fluid in an unresponsive baby
For a term nanu. start at 30cm water, with inflation breaths sustained for2-3 seconds. Five inflation breaths should be sufficient to inflate the lungs.
<32 week babies start at 25cmH20, again 2-3 seconds.
58
What to do in a bradycardic baby born through meconium liquour
Stabilise airway
Inflate the lungs within first minute of birht
Do not inspect the oropharynx or suction the trachea until you have attempted and been unable to inflate the chest despite standard airway opening manouevres
Routine suction after delivery is not recommended
59
Normally, how long are chest compressions given before the heart rate starts to improve
20-30 seconds
60
generous chest movement with ventilation breaths
pressures can be reduced
61
Risk factors for advanced resuscitation at time of delivery (antepartum)
Antepartum factors affecting the foetus, including:
- prematurity <37 weeks gestation
- Intrauterine growth restriction
- Multiple pregnancy
- foetal anaemia or isoimmunisation (including hydrops)
- Oligo or polyhyramnios
- serious congenital abnormalities
62
Risk factors for advanced resuscitation at time of delivery (Maternal antenattal)
Maternal sepsis and fever
Gestational diabetes
Pregnancy induced hypertension
Pre-eclampsia
High BMI
Short stature
Lack of antenatal steroids (pre-term deliveries)
63
Risk factors for advanced resuscitation at time of delivery (Intrapartum factors)
Evidence of foetal compromise (eg. non-reassuring ctg, PATHOLOGICAL ctg)
Meconium stained amniotic fluid
Vaginal breech delivery
Instrumental delivery (forceps/vacum)
Significant maternal haemorrhage
C-section before 39 weeks
Emergency C section
General anaesthesia
64
Management of encephalocoele
The breathing of babies with encephalocoele may be impaired because of airway obstruction or central apnoea In meningocele, the neck may become flexed and the airway compromised when in supone position.
Therefore, place the baby in a prone or side-lying position and cover the lesion with sterile saline-soaked gauze and plastic wrap covering
65
Management if exomphalos and gastroschisis
Thermoregulation and fluid loss are concerns.
A sterile plastic bag is placed over the lower extremities and trunk to the level of the nipple line.
If positive pressure ventilation is required, consider passing a NG tube to minimise intestinal distension and expedite elective tracheal intubation.
66
Describe Potter's sequence
a pattern of fetal and newborn abnormalities caused by a severe lack of amniotic fluid (oligohydramnios), leading to compressed development and often fatal outcomes
67
Benefits of delayed cord clamping
Avoidance of bradycardia
Improved peak haemoglobin in first 24 hours
Improved iron stores in infancy
Improved survival
Improved early haematological indices:
Lower requirement for blood transfusion
Improved BP, and cvs stability in first 24 hours.
68
Describe the procedure of umbilical cord milking from an intact cord
Umbilical cord is gently grasped as far away from the baby as possible, that hand then gently milks the cord towards the baby, usually 3-5 times. This can result in a faster blood flow than occurs with passive blood return ( which is driven by contractions). After milking, the cord is clamped and cut and the baby is taken to the resuscitaire.
69
How much milk does an infant receive with milking
During 3-5 of milkings, a term infant may receive 50mls of blood.
70
Describe umbilical cord milking from a length of cut cord
The cord is clamped as far away from the baby as possible. In a term baby this is about 25cm of cord (less in a preterm baby where cords are shorter). The baby is taken to the resuscitaire immediately and milking, occurs during resus.
71
contraindication to cord milking
shOULD NOT be undertaken in infants <28 weeks gestation as it can cause marked haemodynamic fluctuations in arterial blood pressure and cerebral blood flow.
72
Alternatives if DCC is not possible
Cord milking in babies >=28 weeks
Resus with an intact cord if equipment training allows
ICC may be necessary in some cases
73
What are common reasons for difficulty in breathing at birth
1. Loss of respiratory drive
- Acquired depression of the neurological centres responsible for initiating breathing in the unconscious baby
- perinatal stress and hypoxia
- drugs eg. maternal sedation/analgesia
- infection
1. Congenital brain abnormality
2. Mechanical obstruction of the airway
- loss of muscle tone eg. unconscious baby
- foreign body eg. meconium, vernix, blood
- anatomical abnormality eg. pierre robin
3. inability to breathe
- lung immaturity eg. preterm birth
- Neurological and muscular conditions affecting the ability to breathe
74
Why are newborn airways more likely to get mechanical obstruction
Tongue is larger
Pharynx tendeds to collapse
Tongue falls back obstructing the airway of baby lying on its back
75
how to give chin support
Support the chin using a finger on the bony part of the chin near the tip. Avoid pressing on the soft tissue under the chin as this may push the tongue base backwards and worsen the situation
76
How to open airway
1. Hold head in neutral position with chin and jaw support
2. Move the jaw forward using a two-handed jaw thrust
77
How much fluid in the lungs at birth
100mls in term baby
78
Management of semi-conscioys or conscious baby trying to breathe
Chin support and jaw thrust usually sufficient to help with lung inflation and breathing
79
Describe the pressures to help a newborn breathe
A newborn first creates strong suction (−30 cm H₂O) to pull air into the lungs.
Then, by crying and pushing (up to +90 cm H₂O), they help expand and clear the lungs so normal breathing can start.
80
Pressure in newborn compared to adult
So, compared to a newborn, whose first breaths may reach −30 cm H₂O just to open the lungs,
a healthy adult only uses −5 to −10 cm H₂O for normal breathing — much gentler.
81
Physiology of positive pressure
When ventilating using posiitve pressure, gas will not enter the lung until it reaches a pressure above the opening pressure of the lungs. Theoretical calculations from measurements in isolated lungs, as well as newborn babies, suggest that the opening pressures in babies needing resus is 15-30cm water, with a mean of 20cm water.
82
What to do with pressures once opening pressure has been overcome
Proactively reduce pressure to avoid barotrauma.
83
Equipment for positive pressure ventilation
Either a T piece resuscitator device or self-inflation bag may be used to provide the flow of gas through the mask to the baby
84
What to never connect with device
Never connect device directly to a wall or cylinder-mounted flowmeter without a suitable blow-off valve in the circuit
85
T piece vs self inflating bag
T piece will deliver a more reliable PEEP and PIP
But is gas driven and relies on a source of pressurised gas being available, not good in environments witht high pressure gas to allow T piece to work,
Self inflating bag
- harder to use than the T-piece, even with a PEEP valve attached it will not deliver consistent PEEP.
86
Essential pre-requisites for T piece or a bag valve mask
An open airway
A good seal between mask and baby's face
87
Self inflating bags
These can be used to deliver inspiratory pressure in much the same way as a T piece. They can be used where there is no piped or pressurised gas supply
88
Choosing the correct face mask
Silicone masks make it easier to obtain a seal
Anatomical masks with a cushion can work as well
89
What is the most common reason for failure of mask ventilation?
Over estimating the size of the mask
90
The three Ps to minimise face mask leak
1) Position: rolling the mask onto the face (align, rolle, check), for a correct mask position
2) Pressure: balancing the pressure exerted on the mask by the finger and thumb
3) Pull: lifting or pulling the jaw upwards into the mask
Having done this, recheck head is still in neutral position then give inflation breaths
91
.Mask size for 39 weeks and >3500g
60mm
92
Ways to hold the face mask
Two point top hold
The C grip hold
The encircling hold
93
What is the first response to successful lung inflation and aeration?
An increase in heart rate
94
What to do if heart rate increases after lung inflation
If hear rate increases successfuly then no further inflation breaths are required. If baby is not breathing, may need continued respiratory support wwith ventilation breaths.
95
No increase in heart rate
If chest movement but no increase in heart rate, move onto ventilation breaths at a rate of 30 per min, and then re-assess
If no chest movement seen, then recheck head position and facemask placement and repeat the inflation breaths
96
Most common reason for no chest movement after second set of 5 inflation breaths
most likely reason is airway is obstructed either because the head is not in the neutral position or because the jaw has not been drawn forwards. Two person airway control or airway adjuncts can be helpful at this point.
97
Laryngeal mask (supraglottic airway)
Laryngeal mask airway (LMA) or igel, have been used with good effect in babies whose weight is >200g or who are over a gestational age at birth of around 34 weeks.
98
How to laryngeal masks work?
They work by providing a seal around the supraglottic opening, allowing a more direct application of ventilatory gas-flow into the trachea. Most laryngeal masks use an inflatable cuff to create a seal within the airway and prevent leak.
The igel has a deformable mask shape which, when warmed by the surrounding tissue, gently moulds to the airway to create the seal. Once in place, laryngeal masks can be fixed in a way similar to a tracheal tibe to provide a more secure airway for a prolonged resuscitation.
99
Laryngeal masks
Laryngeal masks should be used when:
Face mask ventilation by skilled practioner is difficult
Airway security is needed (during a prolonged resuscitation) and intubation is not possible
Attendant is less experienced in providing mask ventilation
To secure the airway whilst moving the baby (e.g transfer to NNU, transfer into hospital from home).
100
size of laryngeal masks
For babies, the correct size of laryngeal mask will be size 1 (for both LMAs and i-gels).
Both devices are inserted din the same way with the mask opening facing upwardds, and the device inserted in the same orientation in which it is to lie once in the baby's pharynx.
101
What to do if unsuccessful attempt at laryngeal mask
If mask has not been successfully inserted after 30s of trying, the baby should be ventilated using a face mask before re-attempting laryngeal mask insertion
102
How to choose the size of a guedel
The flange in the middle of the lips (below tip of the nose), the end of the airway should reach the angle of the jaw
103
Risk of blindly inserting a suction catheter into the mouth
Stimulation in the region of the posterior pharynx and larynx should be kept to a minimum because it easily induces adduction of the vocal cords and profound vagal bradycardia
104
Suction devices
A tracheal tube attached to a meconium aspirator should be used as a suction device. Otherwise, use the widest bore suction catheter available, a 12 or 14 french gauge suction catheter, passed directly into the trachea.
105
How to manage stiff lungs
Increase the peak inflation pressure in increments of 2-5 cm H20, rarely above 40cmH20
106
Self inflating bags and oxygen concentrations
If oxygen available, increase the inspired oxygen to different levels (70% without using a reservoir bag and nearly 100% if a reservoir bagg is used). If oxygen is not available, use air.
107
NPA
Used in conditions such as Pierre robin sequence (obstruction of the nasal passages or posterior nasal space).
A tracheal tube can be used.
108
Risk of CPAP in term and near term babies
Pneumothorax
109
Second repeat of 5 inflation breaths
Consider different technique/2 person technique
Consider seal
Airway adjunct
Obstruction to airway (?suction and laryngoscopy)
Does history suggest stiff lungsconsider increasing inspiratory pressure in 2-5cm water
110
Third repeat of 5 inflation breaths
Consider deep tracheal obstruction even in the absence of meconium, consider intubation if trained to do so
111
Percentages for babies breathing, and requiring chest compressions and or drugs
85% babies breathe spontaneously
10% respond to drying, stimulation, opening airway and/or applying CPAP or PEEP
5% breathe following positive pressure ventilation
Intubation rates from 0.4 to 2% and <0.3% of babies receive chest compressions and 0.05% receive adrenaline
112
Delivery of chest compressions
Synchronise efforts so that you provide a cycle of 3 compressions to one ventilation breath at a rate of about 15 cycles every 30 seconds
Use a 2 handed technique for compressions if possible
Check for response every 30s (or continuously if a pulse oximeter is available)
If the heart rate remains very slow or absent, continue with a ratio of 3 compressions to one breath and secure the airway if not done already (consider intubation, if competent, or use a laryngeal mask)
Titrate the inspired oxygen concentration against sats probe once reliable signal is achieved
113
What is the fraction of cardiac output that can be achieved with best performed chest compressions
only 1/3
114
What is more superior, 2 finger or two thumb technique
2 thumb technique but if on own use two finger
115
Location of chest compressions
Compress the sternum over its lower third
Place thumb or fingers on the sternum just below an imaginary line joining the nipples
Compress 1/3 depth of the chest. A depth of less than 1/3 is inadequate
116
do chest compressions cause rib fracutres
Not in newborns unless rare severe bone disease eg. osteogenesis imperfecta, but even then it is not inevitable and should not defer from proceeding with chest compressions.
117
How fast to press on the chest
A ratio of 3:1, to achieve 90 compressions and 30 breaths (120 events) in one minute. (once cycle complete in 2 seconds). A Allow time after each compression for the chest to refill, by allowing it to re-expand fully
118
Are continued asynchronous chest compressions advised in newborns
no, always ventilate. Use 15:@ if that is what people more familiar with or if arrest is believed to be f cardiac origin
119
How long to continue chest compressions for
Heart rate should respond quickly to effective chest compressions, usually within 20-30s.
Recheck the heart rate every 30s to detect any response.
If no response, move on to administration of drugs and consider reasons for lack of a response.
If the heart rate is >60bpm, chest compressions can be stopped.
Chest compressions should be restarted if HR drops below 60
120
Causes of no response to chest compressions
Most commonly because lungs have not been effectively aerated.
Before moving drugs, check that the chest is definitely moving in response to ventilations delivered by face mask.
121
When to use drugs
If no response to adequate chest compression combined with effective lung inflation and ventilation, resus drugs should be used.
If you reach the point of requiring drugs, consider other factors which may impact on the response to resuscitationn such as equipment failure, pneumothorax, hypovolaemia and congenital abnormalities.
122
Routes of administering drugs
Drugs are unlikely to reach the heart after peripheral venous administration when there is complete circulatory arrest, even with good quality basic life support.
Umbilical vein offers rapid central vascular access
IO access can be used if abnormal umbilical cord or emergency access
123
What are the drugs needed in resus
Adrenaline should be the first resuscitation drug given, and repeated every 3-5 minutes
Dextrose is likely
Bicarb in a prolonged resuscitation
124
Administering adrenaline, dose if intra tracheal
100micrgrams/kg
If intra-tracheal ineffective, then IV/IO access should be sought
125
Administering adrenaline
IV access is preferred.
20mcg/kg or 0..2mls kg of 1:10,000 or 10000micgrograms in 10mls
A dose range of 10-30 micgrograms/kg is acceptable if based on weight
Intratracheal access is find at 100mcg/kg
126
Administering glucose
To be administered in prolonged resus to reduce likelihood of hypoglycaemia
Give IV or IO
Give 250mg/kg bolus (2.5mls /kg of 10% dextrose solution)
Glucose must never be given down the trachealtube.
127
Sodium bicarbonate
May be given in a prolonged unresponsive resuscitation with adequate ventilation, to reverse intracardiac acidosis.
Can be given IV or IO
1-2mmol/kg sodium bicarbonate by slow iV injection
128
DDose of sodium bicarbonate
1-2mmol/kg sodium bicarbonate (2-4ml per Kg of 4.2% solution) by slow iV injection.
10mls in a 4.2% solution
129
Volume replacement in babies
10mls per Kg of group O (RHD) negative blood or 0.9% of sodium chloride, give as a slow bolus over 2 minutes
130
What happens if no response to a dose of adrenaline
It may be worth giving a dose of bicarbonate as adrenaline does not work well in low pH
131
Symptomatic hypoglycaemia
better managed with infusion of 10% glucose rather than repeated boluses
132
Term babies
37+0 to 41+6
133
Extremely preterm
<28 weeks
134
Very preterm
Between 28 and 31 +6 weeks
135
Moderately preterm
Between 32 and 33+6 weeks
136
Late preterm
Between 34 and 36+6 weeks
137
Post term
Born at or after 42 weeks
138
When should you use altered approach to resuscitation
Altered approach at <32 weeks and between 23-33 weeks
Term approach at 33-42 weeks
139
CPAP and PEEP from birth for preterm babies
If baby is breathing spontaneously, then applying CPAP using face mask or nasal prongs will ease work of breathing and help prevent alveolar collapse in expiration.
Many pre-term babies can be stabilised on CPAP at birth without any intubation.
Suitable CPAP levels are 5-8cm water,
Appropriate PEEP is 5cm water
140
What is a newborn babys tidal volume
4-8mls /kg
141
wHAT IS THE BEST GUIDE AS TO WHETHER LUNG INFLATION is being maintained
A sustained increase in heart rate , if the heart rate does not improve then maybe increas ethe degree of chest expansion
142
What to do if a preterm baby appears to need continued ventilation rather than CPAP
Connect them to a ventilator as soon as possible and adjust settings to avoid excessive tidal volume
143
Surfactant
Any baby of 30 weeks or less who has a tracheal tube placed shoould receive surfactant
144
How to administer surfactant without intubation
Using lISA passing a small catheter through the vocal cords whilst maintaining nasal CPAP
Suurfactant may also be given via a laryngeal mask
145
Surfactant therapy
Should be given prophylactically for babies <30 weeks gestationsde
146
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