ERC - Babies At Birth

Question 1

A baby is born and doesn’t immediately breathe, what is your first step

Answer 1

Dry them - provides tactile stimulation which is often enough to stimulate breathing

Question 2

What temperature should a baby just born be kept at

Answer 2

36.5-37.5

Question 3

How do you measure the heart rate in a newborn baby

Answer 3

ECG is first choice or…
With a stethoscope over the apex beat
Pulse ox

Question 4

What signs indicate that a newborn baby needs resuscitation

Answer 4

Gasping, not breathing, HR <100

Question 5

A newborn baby is not breathing or has a HR <100, what now

Answer 5

Open the airway using jaw thrust with the head in a neutral position
5 rescue breaths maintained for 2-3 seconds each

Question 6

How do you open the airway in a newborn

Answer 6

Keep the head in a neutral position and do a jaw thrust

If they have poor tone consider OPA

Question 7

Why is suction not recommended unless absolutely necessary in a newborn baby

Answer 7

Can stimulate vagal induced bradycardia

Question 8

What is the diving reflex seen in newborns

Answer 8

On flexion of the neck (pressing too hard on mask) the baby goes bradycardic and apneoic

Question 9

You have given 5 breaths to a newborn baby and there HR increases but they aren’t breathing adequately, what do you do

Answer 9

Ventilate at 30/minute with inflation time of 1s

Question 10

The newborn baby is not improving after after the 5 initial rescue breaths, what do you do

Answer 10

Recheck the airway
try 2 person technique
Further 5 rescue breaths

Question 11

The newborn baby has a heart rate <60 or no detectable heart rate despite adequate ventilation, what do you do

Answer 11

Start CPR on a ratio of 3:1 (90 compressions to 30 ventilations in a minute)

Question 12

Simple airway manoeuvres are still not working in your newborn baby, what other steps can you take

Answer 12

PEEP may be needed if apnoeic
Intubate
PPV with 21% O2 (although can be increased if absolutely necessary)

Question 13

Under what conditions would you start CPR in a newborn

Answer 13

HR <60 or not detectable despite adequate ventilation

Question 14

What can lead to false positives and false negatives on ETCO2 in a newborn baby

Answer 14

+ve: contamination with surfactant, adrenaline or atropine

-ve: tracheal obstruction, poor pulmonary flow

Question 15

Describe how you would perform CPR in a newborn baby

Answer 15

Wrap your hands around the torso with 2 thumbs placed on the lower half of the sternum
Compress 1/3 of the AP diameters
Ratio of 3:1
Aim for 90 compressions to 30 ventilations/ minute

Question 16

When might you not do the standard 3:1 newborn compression:ventilation ratio

Answer 16

If you suspect the cause to be cardiac (eg known cardiac abnormality on antenatal scans) can do 15:2

Question 17

How would you deliver drugs to a newborn baby

Answer 17

Via an umbilical vein catheter

Question 18

Describe a cross section of an umbilical cord

Answer 18

1 vein

2 arteries

Question 19

When would you give bicarbonate to a newborn

Answer 19

If all else has failed in a prolonged arrest you can give bicarb

Question 20

What does bicarbonate do to a newborns myocardial and cerebral function and why

Answer 20

reverses intracellular acidosis which could improve myocardial function but
causes hyperosmolaity and creates CO2 therefore reducing cerebral and myocardial function

Question 21

If giving blood to a newborn, what type does it need to be

Answer 21

O
Rhesus -ve
Leukocyte depleted
Irradiated

Question 22

When would you stop resuscitation efforts in a newborn

Answer 22

10 minutes of no improvement

Question 23

How long would you expect it to take for a newborn to pink up

Answer 23

Maximum 30 seconds

Question 24

A preterm baby is in respiratory distress, what do you need to do

Answer 24

CPAP

Question 25

A newborn baby is breathing, has a good HR but is cyanotic, what could be going on

Answer 25

Congenital cyanotic heart disease
Diaphragmatic hernia 
Surfactant deficiency
Pneumothorax
Pneumonia

Question 26

When would you consider suction in a newborn infant

Answer 26

Only if there is thick, viscous meconium causing an airway blockage

Question 27

what needs to happen for fetal to neonatal transition

Answer 27

Clear fetal lung fluid
Aerate the lungs
Establish a pattern of breathing

Question 28

What happens to the HR when there is immediate cord clamping and why

Answer 28

Bradycardia
The reduced pulmonary vascular resistance on taking a breath leads to increase pulmonary blood flow and an immediate decrease in heart size before after a few cardiac cycles it increases again as blood is returned from the pulmonary circulation

Question 29

When should the cord be clamped

Answer 29

> 1 minute

Question 30

What happens to a newborns arterial oxygen tension if they get cold and what happens as a result

Answer 30

Reduced arterial oxygen tension

Metabolic acidosis

Question 31

How can we help to maintain a new born babies temperature

Answer 31

Warm towels to dry
Put them onto mum
No air conditioning 
Closed windows
Polyethylene wraps and under a heater if <32 weeks

Question 32

A pre-term infant requires ventilatory support, what % O2 should this be with

Answer 32

ideally air (21%) but up to 30% and if this still isn’t working you can titrate up

Question 33

what inflation time should be used when performing 5 rescue breaths in a newborn

Answer 33

2-3 seconds

Question 34

state the tracheal tube lengths by gestational weeks

Answer 34

all lengths given in cm
23-24: 5.5
25-26: 6
27-29: 6.5
30-32: 7
33-34: 7.5
35-37: 8
38-40: 8.5
41-43: 9

Question 35

What PEEP should be given for preterms receiving PPV

Answer 35

5cm H2O

Question 36

what is the combined APGAR score

Answer 36

scores the interventions needed + the parameters are also scored but regardless of the interventions that are required to achieve these parameters