Gravida indicates the number of times a woman is or has been pregnant, regardless of the pregnancy outcomes
Para indicates the number of pregnancies reaching viable gestational age
Steroids before birth can help the unborn infant’s lungs to develop more quickly
Umbilical cord contains:
Wharton’s jelly
One vein
Two arteries
The primary action in neonatal resuscitation
Providing effective ventilation because the primary cause of persistent oxygen desaturation and/or bradycardia at delivery is Inadequate ventilation
Two ways assess an infant’s heart rate at delivery:
Auscultation of the heart
Placement of EKG leads
Tactile Stimulation
Types of tactile stimulation given to an infant to stimulate breathing
Drying the infant
Rubbing the infant’s back
Tapping the soles of the infant’s feet
Warming the infant
If tactile stimulation has been given and the patient is not responding they are most likely in secondary apnea and need PPV
Intrapartum Factors which can become a risk for the infant
Emergency C-section
Forceps or vacuum-assisted deliveries
Breech or other abnormal presentation
Premature Labor
Precipitous labor
Chorioamnionitis
PROM > 18 hours before delivery
Macrosomia
Prolonged labor > 24 hours
Category 2 or 3 fetal heart rate patterns
Use of general anesthesia
Uterine tachysystole with fetal heart rate changes
Narcotics administered to the mother 4 hours prior to delivery
Meconium-stained amniotic fluid
Prolapsed cord
Abruptio placentae
Placenta previa
Significant intrapartum bleeding
Magnesium Sulfate
Prevents preeclampsia
Prevents seizures
Slow or stop preterm labor
To prevent injuries to a preterm infant’s brain
Preeclampsia
A condition in pregnancy characterizes by high blood pressure, fluid retention and proteinuria
How preeclampsia affects the unborn infant
Preeclampsia can impair kidney and liver function
Cause blood clotting issues
Pulmonary edema
Seizures
Affects the blood flow to the placenta and can lead to smaller or prematurely born infants
Premature Rupture of Membranes (PROM)
The amniotic sac surrounding the infant ruptures before 37 weeks of pregnancy
Complications to the infant
Increase risk of infection
Increase risk of a premature birth
Underdeveloped lungs
Meconium Aspiration Syndrome
Meconium is the first stool of the newborn
Aspiration occurs when:
An infant breathes in a mixture of meconium and amniotic fluid into the lungs before or around the time of birth
The fetus is stressed during labor
Placental Abruption
Occurs when the placenta partially or completely separates from the inner wall of the uterus before delivery
Effects on a newborn infant:
Decrease in oxygen to the infant
Decrease heart rate
Decreased tone
Decreased color
Chorioamnionitis
An inflammation of the fetal membranes due to a bacterial infection
Oligohydramnios
When too little amniotic fluid surrounds the infant
APGAR score
A quick overall assessment of a newborn’s well-being
Measures the infant’s color, heart rate, reflexes, muscle tone and respiratory effort
At 1 minute and 5 minutes. For prolonged resuscitation 10 minutes
Each parameter is scored between 0-2
0 indicates no effort
2 indicates a vigorous effort
The APGAR timer is activated when the infant’s body is delivered. The doctor or L&D nurse will shout out “time” and the APGAR clock will start
3 questions that are asked to determine if an infant requires resuscitation
Was the infant born at term?
Is the infant breathing or crying
Is there good muscle tone
Targeted Pre-ductal SpO2 After Birth
A guideline used in conjunction with the APGAR timer. Saturation levels are assessed at timed intervals. Oxygen can be adjusted based on the time and saturations levels
1 minute= 60%-65%
2 minutes= 65%-70%
3 minutes= 70%-75%
4 minutes= 75%-80%
5 minutes=80%-85%
10 minutes=85%-95%
The sequence used to turn on the pulse oximeter at the delivery
Place the oximeter probe Pre-ductal using either the hand or wrist
Plug the probe into the oximeter outlet
Turn on the pulse oximeter
Acrocyanosis
Refers to the cyanosis found in the extremities, particularly the palms of the hand and soles of the feet
Normal for pre-term and newborn infants as long as no cyanosis is present in the central part of the body
Setting the Neopuff
Attach the Neopuff circuit to the gas outlet located on the front of the Neopuff
Attach one end of the oxygen tubing to the nipple adapter located on the front of the Neopuff, the other end of the oxygen tubing to a blended gas source
Turn the blended gas source flow to 10 lpm
Turn the Maximum Pressure Relief knob completely to the right
Turn the Inspiratory Pressure Control knob completely to the right
Occlude both ends of the Neo-Tee
The pressure on the manometer should display a pressure of 70 cmH20
Turn the Maximum Pressure Relief knob to the left until the manometer displays 40 cm H20
Place the cover over the knob
Turn the Inspiratory Pressure Control knob to the left until the manometer displays 20 cm H2O
Turn the PEEP valve located on the Neo-Tee until the manometer displays a PEEP of 5 cm H20
Oxygen is set at 21%
For infants greater than 35 weeks the Inspiratory Pressure Control Knob will be set at 25 cmH2O
Warmth
It is important to keep preterm and term infant’s warm following delivery because:
Infants, especially pre-term infants are vulnerable to cold stress
The larger surface-area-to-body-mass ratio
Thin permeable skin
Small amount of subcutaneous fat
Limited metabolic response to cold
Items will be utilized to minimize heat loss at the delivery
Increase the temperature of the delivery room. 25C-26C (77F-79F)
Max the warmer heat output to 100%
Place pre-warmed blankets on the warmer
Place a portable warming pad under the layers of towels located on the warmer
Place a polyethylene plastic wrap on the warmer. When the infant is placed on the warmer wrap the infant’s entire body in the plastic wrap
Place a hat on the infant’s head
If possible, keep the sides up on the radiant warmer
When transferring to the NICU, use a pre warmed transport incubator
Chest compressions
Indications
Heart rate below 60 bpm, despite at least 30 seconds of effective positive pressure ventilation
Techniques for compressions
Thumb technique
2-finger technique
Coordinating compressions and ventilations for an infant
3 compressions plus 1 ventilation
120 “events” per 60 seconds
90 compressions plus 30 breaths
If the heart is improves to over 60 bpm
PPV via the Neopuff continue at 40-60 breaths per minute
Intubations
Clinical indications for endotracheal intubation for an infant at delivery
If there is meconium and the infant has depressed respirations, muscle tone, or rate
Positive pressure ventilation via Neopuff/mask is not resulting in adequate clinical improvement
If the need for positive pressure ventilation lasts beyond a few minutes
Chest compressions are necessary
Extreme prematurity
Surfactant administration
Suspected diaphragmatic hernia
Endotracheal tubes used in the NICU
Sizes and the corresponding gestational age and weight for each size
2.5 ETT - - less than 28 weeks - - less than 1000 grams
3.0 ETT - - less than 28-34 weeks - - less than 1000-2000 grams
3.5 ETT - - 34-38 weeks - - 2000-3000 grams
3.5-4.0 ETT - - less than 38 weeks - - less than 3000 grams
Calculations used for correct ETT placement for an infant
Weight (kg) + 6 = lip line placement
Length (cm) x .18 = infant less than 30 weeks lip line placement
Length (cm) x .19 = infant greater than 30 weeks lip lie placement
Signs that an endotracheal tube is in the esophagus instead of the trachea
Continued bradycardia
Low saturations
CO2 detector fails to show the presence of expired CO2 (yellow)
No audible breath sounds
Air heard in the stomach
Gastric distension
Poor chest moment
Laryngoscope blades sizes available for intubation
00 = extremely preterm infants
0 = preterm infants
1 =term infants
Surfactant
Initial dose of Curosurf is 2.5 ml/kg
Subsequent dose of Curosurf is 1.25 ml/kg
Can give 2 repeat doses for a total of 3 doses with 12 hours between each dose
BCPAP in the Delivery Room
BCPAP initiated immediately after the infant is placed on the warmer
Initial setting is 7 cmH2O
Silverman-Score:
The Silverman-score is used to assess the degree of respiratory distress in infants after the initiation of early BPAP
The information is used to decrease the BCPAP from the initiated 7cmH20 to 5 cmH2O
Scoring will start 6 hours after the infant is placed on early BCPAP
Scoring will continue until the infant’s BCPAP is a 5 cmH20
With early BCPAP, the primary indicator that an infant may require a dose of Curosurf is an FiO2 at or greater than 40%