Page 1094 - TNFlipTest

P60 Pediatrics
Neonatology
Toronto Notes 2019
Apgar Score
Appearance (colour)
Pulse (heart rate)
Grimace (irritability)
Activity (tone)
Respiration (respiratory effort) Or: “How Ready Is This Child?”
Use of 100% Oxygen in Neonatal Resuscitation
Circulation 2015;132(suppl 2):S543–S560.
Findings from animal and theoretical studies
have suggested potential adverse effects with
the administration of 100% oxygen. However,
given available data is limited in general and only obtained from newborn samples, the 2015 neonatal resuscitation guidelines have provided the following recommendation: “Since an oxygen saturation of 100% may correspond to a PaO2 anywhere between ~80 and 500 mm Hg, in general it is appropriate
to wean the FIO2 for a saturation of 100%, provided the oxyhemoglobin saturation can be maintained ≥94%.” (Class IIb, LOE C).
Corrective Actions for PPV in Neonatal Resuscitation
MR SOPA
Mask readjustment Reposition airway Suction mouth and nose Open mouth
Pressure increase Alternative airway
Targeted Preductal SpO2 After Birth
Neonatal Resuscitation
• assessApgarscoreat1and5min
• if<7at5minthenreassessq5min,until>7
• donotwaittoassignApgarscorebeforeinitiatingresuscitation
Table 25. Apgar Score
Sign
Heart Rate Respiratory Effort Irritability
Tone
Colour
0
Absent Absent
No response Limp
Blue, pale
1
<100/min
Slow, irregular
Grimace
Some flexion of extremities
Body pink, extremities blue (acrocyanosis)
2
>100/min Good, crying Cough/cry Active motion Completely pink
Initial Resuscitation
• anticipation:knowmaternalhistory,historyofpregnancy,labour,anddelivery • stepstotakeforallinfants
■ pre-delivery team debriefing including assigning roles, checking equipment, and discussing possible complications and management plan
■ warm (radiant heater, warm blankets) and dry the newborn (remove wet blankets) ■ position and clear airway (“sniffing” position)
■ stimulate infant: rub lower back gently or flick soles of feet
■ assess breathing and heart rate
■ if no response to stimulation: bag and mask ventilation. Continue until HR >100 and breathing spontaneously
■ if HR <60: chest compressions
■ if meconium present: A team with advanced resuscitation skills should be present. If the newborn is
hypotonic with ineffective respirations, routine intubation for tracheal suction is not suggested. Do initial resuscitation and administer PPV as required
Table 26. Interventions Used in Neonatal Resuscitation
Intervention
Epinephrine
(adrenaline)
Fluid Bolus
(NS, whole blood,
Ringer’s lactate)
Schedule
0.1-0.3 mL/kg/dose of 1:10,000
(0.01-0.03 mg/kg) IV
0.5-1 mL/kg/dose of 1:10,000 (0.05-0.1 mg/ kg) endotracheally can be considered while awaiting IV access (IV preferred)
Can be repeated q3-5 min prn
10 mL/kg
May need to be repeated
Avoid giving too rapidly as large volume rapid infusions can be associated with IVH
Indications
HR <60 and not rising
Evidence of hypovolemia
Comments
Side effects: tachycardia, HTN, cardiac arrhythmias
Approach to the Depressed Newborn
• adepressednewbornlacksoneormoreofthefollowingcharacteristicsofanormalnewborn ■ pulse >100 bpm
■ cries when stimulated
■ actively moves all extremities
■ has a good strong cry
• approximately10%ofnewbornbabiesrequireassistancewithbreathingafterdelivery
Table 27. Etiology of Respiratory Depression in the Newborn
1min 2min 3min 4min 5min 10 min
60-65% 65-70% 70-75% 75-80% 80-85% 85-95%
Etiology
Respiratory Problems
Anemia (severe) Maternal Causes
Congenital Malformations/Birth Injury
Shock CHD Other
Examples
RDS/hyaline membrane disease Pulmonary hypoplasia
CNS depression
MAS
Pneumonia Pneumothorax
Pleural effusions Congenital malformations
Erythroblastosis fetalis Secondary hydrops fetalis
Drugs/anesthesia (opiates, magnesium sulphate) DM
Maternal myasthenia gravis
Nuchal cord, perinatal depression Bilateral phrenic nerve injury Potter’s sequence
Antepartum hemorrhage
Transposition of the great arteries with intact ventricular septum
Hypothermia Hypoglycemia Infection