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19 Cards in this Set
- Front
- Back
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What is hypoxia? |
Too little oxygen to cells of the body |
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What is the Apgar score? |
1)Heart Rate 2)Respiratory Effort 3) Presence or absence of central and peripheral cyanosis 4)Muscle tone 5)Response to stimulation Given score of 0,1,2 Normal = 7-10 Determined at 1 and 5 minutes |
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What causes low apgar? |
1) Foetal distress 2) Maternal general anaesthesia/recent analgesia 3) Preterm infant 4) Difficult or traumatic delivery 5) Excessive suctioning of pharynx after delivery 6) Severe respiratory distress |
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Which infants need resusc? |
All who do not breathe well at birth 1) Signs of foetal distress 2) Delivery before 37 weeks of gestation 3) Abnormal presentation of foetus 4) Difficult or traumatic delivery 5) General Anaethesia or recents analgesia (pethidine or morphine) |
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What do you need for resusc? |
Suction apparatus Oxygen Ventilation bag and mask Endotracheal tubes Laryngoscope Naloxone AdrenalineClcok Gloves Steth |
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How do resusc an infant? |
(Rub to stimulate breathing) A = Airway: Open B = Breathing: Ventilate C = Circulation = chest compressions Drugs |
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When does an infant need ventilation? |
Not breathing at all or breathing poorly Central Cyanosis Heart rate below 100bpm |
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What is adequate ventilation and when do you stop? |
Mask ventilation or bag ventilation at rate of 40 breaths pm Stop when heart rate is above 100 bpm |
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What is a good rate for chest compressions |
90 times a minute |
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What does adrenaline do and how should it be administered? |
Stimulates myocardium and increases heart rate. Indicated in HR less than 60bpm after 1 minute of chest compressions 1ml IV to term infants 0.5ml IV to preterm infants Repeated every 3-5 minutes |
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What is Naloxone and how should it be administered? |
Reverses the effects of morphine/pethidine 0.1mg/kg (0.25ml/kg) IM injection in thigh |
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When is resusc successful and when is it hopeless? |
Successful: Pulse rate above 100bpm Good cry and breathing efforts Pink tongue Keep in post resusc care for 4 hours. Do not bathe Hopeless: Repeat apgar score every 5 minutes wtih continued resusc until about 29 minutes, if there are no signs of life after 10 it may be stopped |
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What is meconium and why is it dangerous?
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Dark green substance forming the first faeces of a newborn infant Meconium contains enzymes from foetal pancreas that can damage alveoli if aspirated |
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How do you reduce risk of meconium aspiration and what is th epost delivery treatement? |
Suction before delivery of shoulders. Should not take more than 30 second. PDT: Intubation and suctioning. Meconium gastritis can be prevented by washing stomach out with normal saline and 2% sodium bicarb (only heavily stained babies: require nursery care after) |
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What organs of neonate are commonly damaged by hypoxia? |
Brain Kidneys: haematuria, proteinuria and decreased urine output Heart: Hepatomegaly, Resp distress and poor peripheral perfusion = HF Gut: necrotising enterocolitis Lungs: Pulm artery spasn |
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What types of brain damage can occur due to hypoxia? |
1) Neonatal encephalopathy: presents in 72 hours, baby is near to term 2) Intraventricular haemorrhage: preterm infants, present in 1st 48 hours. Can be asymptomatic or have apnoea, shock and death. Dx on USS 3) Infarction: present with spastic diplegia, convulsions, mental impairment and cerebral palsy 4)Blindness, deafness and learning disabilities |
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What are the clinical signs of neonatal encephalopathy? |
1) Altered level of consciousness 2) Altered tone 3) Poor feeding or abnormal breathing with apnoea (cessation of breathing) 4) Convulsions or abnormal movements 5) Abnormal reflexes |
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What are the outcomes of neonatal encephalopathy? |
Return to normal Permanent brain damage Death |
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How do you manage neonatal encephalopathy? |
1) General supportive care to prevent hypocglycaemia or further hypoxia. Refer to level 2/3 care 2) Prevent hyperthermia (abdo: 35.5, axilla:36) 3) Restric fluid intake 4) Control fits with 20mg/kg phenobarbitone 5) Ventilate 6) Monitor signs and look out for damage to other organs 7) Follow up survivors |
