NEONATAL RESUSCITATION - Question & answer
What is the most important aspect of AIRWAY, AIRWAY, AIRWAY
1 neonatal resuscitation?
A. Breathing
B. Airway
C. Circulation
What is the maximum concentration
it of oxygen that a self-inflating
anaesthesia bag NOT connected to an
oxygen reservoir can deliver?
A. 90%
B. 21%
C. 40%
What are the approximate
É endotracheal tube sizes that would be
appropriate for premature infants
Weighing less than 1000 grams?
A. 3 mm
B. 2.5 mm
C. 2 mm
Doting
Before radiographic verification, how
ÉI far should an ET tube be inserted to
be in the appropriate position for
infants weighing 1000 grams?
A. 6-7 cm
B. 7-8 cm
C. 8-9 cm
is
Does the vigorous neonate born with
thick meconium amniotic fluid need to
have the trachea suctioned to remove
meconium that may have been
aspirated?
An
• Managing the airway is always the most critical aspect of resuscitation.
• Most neonates who require support in the delivery room will respond to stimulation,
opening of the airway, and gentLe ventilation with bag and mask
• Only about 40 percent of oxygen can be delivered without a reservoir.
• Each time a self-inflating bag is squeezed, room air is drawn into the bag, diluting any
oxygen that is connected.
• When a reservoir is connected, concentrations up to 90% or more of oxygen may be
delivered.
• One of the limitations of the self-inflating bag is that the desired concentration of
oxygen cannot be altered easily.
<1000 grams, use 2.5 mm ID (Internal Diameter)
1000-2000 grams, use 3 mm ID
2000-3500 grams, use 3.5 mm ID
>3500 grams, use 4 mm ID
• The ET tube should slide easily into the airway, and a small leak should be audible
around the ET tube when pressures of 25-30 cm H20 are exceeded
• An ET tube that is too big may lead to tracheal inflammation and stenosis, whereas
an ET tube that is too small simply may not allow adequate gas delivery to the
lungs.
The "tip-to-lip" rule for placement is the distance from the ET tube tip to the
centimetre marking on the tube itself. Good approximation are as follows:
• 1000 grams, 6-7 cm
• 2000 grams, 7-8 cm
• 3000 grams, 8-9 cm
• 4000 grams, 9-10 cm
No.
Compared with expectant management, intubation and suctioning of the apparently
vigorous meconium-stained infant does not result in a decreased incidence of
meconium aspiration syndrome (MAS) or other respiratory disorders.
In addition, it may provoke airway injury, especially if the child is active and moving
after delivery.
 Which of the following is currently Answer: C
IEEE recommended by the neonatal Other therapies have their advocates however most studies have not shown them to
resuscitation program? be effective adjuncts for neonatal resuscitation
A. Calcium chloride for Asystole
B. Atropine for bradycardia
C. Epinephrine for heart rate below 60
D. 5% Albumin for hypovolemia

Name some historical figures who

t
Voltaire, Samuel Johnson, Johann Wolfgang von Goethe, Thomas Hardy, Pablo Picasso,
needed resuscitation after birth. Franklin D. Roosevelt
• life would have been dull without these individuals having received the benefit of
resuscitation.
• Remember, there were no neonatal nurses or board-certified neonatologists until
the mid-1970's (young specialty indeed!)

Who was the first to use a mechanical James Blundell, a Scottish Obstetrician, used a "silver tracheal pipe" that had a blunt
Eto device for intubation and distal end with two side holes. He would slide his fingers over the tongue to feel the
resuscitation of neonates? epiglottis and guide the tube into the trachea. Blundell would blow air into the tube
approximately 30 times per minute to ventilate the baby.

What three characteristics can be Term Gestation

II used to identify infants who do not

require resuscitation?
Crying or breathing
Good muscle tone

1. Thermal management; infant should be dried and kept warm

in
Name the initial steps in neonatal
resuscitation 2. The airway should be assessed and cleared of fluid and birth debris if there are
signs of obstruction
3. The infant should receive tactile stimulation
A. Baby's bottom should NOT be spanked; instead use gentle stroking and
rubbing of the skin of the legs and buttocks
 What is primary apnea?
I'll How is it distinguished from
secondary apnea?
I2
How much pressure does it take to
inflate the lungs of a healthy infant
at the moment of birth?
A regular sequence of events occur when an infant becomes hypoxemic and acidemic.
• Initially, gasping respiratory efforts increase in depth and frequency for up to 3
minutes, followed by approximately 1 minute of primary apnea.
• If oxygen (along with stimulation) is provided during the apnea period, respiratory
function spontaneously returns.
• If asphyxia continues, gasping then resumes for a variable period of time,
terminating with the "last gasp" and is followed by secondary apnea.
• During secondary apnea, the only way to restore respiratory function is with
positive pressure ventilation and high concentrations of oxygen.
• Thus a linear relationship exists between the duration of asphyxia and the recovery
of respiratory function after resuscitation.
• The longer the artificial ventilation is delayed after the last gasp, the longer it will
take to resuscitate the infant.
• Clinically, primary and secondary apnea are difficulty to distinguish.
• the first breath of an infant has been measured in the delivery room as between
-30 and -140 cm H20.
• The above pressures are needed to overcome the substantial fluid and elastic forces
present in the airway at the time of delivery.
• As surfactant is deposited, however, subsequent breaths rapidly decrease to -4 to
-10 cm H20.
• If surfactant is decreased, as in the case of RDS, the baby must continue to exert
the original very high effort to continue to inflate the lung.
• With limited energy reserves this effort soon deteriorates, and respiratory failure
ensues.