Neonatology
Tests for High-Risk babies
1. U/S
2. Non-stress test
3. Contraction stress test
4. Biophysical profile (non-stress & contraction
stress test)
5. Amniocentesis
Stages of labour
1. Latent phase 0-4cm dilated Up to 24hrs
2. Active phase 4-7cm dilated 4-8 hrs
3. Deceleration phase 8-10cm dilated 30 mins- 2 hrs
Fetal Monitoring during Labour and Delivery
FHR Monitoring Fetal scalp blood sampling
- Measures HR to trend a fetus’s tolerance to - Used during labour when FHR isn't reassuring
labour - A scalp pH >7.25 is reassuring
FHR <110bpm = bradycardia - Acidotic = intolerance to labour
FHR >160bpm = tachycardia
Early decelerations Fetal head compression, usually
benign
Variable decelerations Umbilical cord compression
Late decelerations Placental insufficiency
Sinusoidal tracing Severe Acidosis, Anemia, or
Hypoxia
,Anticipating Neo Resuscitation
Antepartum Risk Factors Intrapartum Risk Factors
- Maternal diabetes - Emergency c-section
- HTN - Breech
- PROM - Premature labour
- Mult. gestations - Prolonged labour >24hrs
- Maternal age <16 or >35 y/o - Mec stained
Clinical Manifestations 4 pre-birth questions:
- Irregular breathing 1. What is the expected gestational age?
- Bradycardia 2. Is the amniotic fluid clear?
- Tachycardia 3. Are there any additional risk factors?
- Pallor 4. What's our umbilical cord management
- Cyanosis plan?
- Desat
- Hypotension
Umbilical cord clamping
Preterm newborns: Term newborns:
- Decrease mortality - Decr. Chance of developing Iron deficiency
- Higher BP & BV anemia
- Decr. Need for blood transfusion - May improve neurodevelopmental
- Lower incidence/risk of brain hemorrhage outcomes
- Lower risk of NEC - May require phototherapy for
hyperbilirubinemia
Neo Resuscitation
Indications for Pulse Oximetry: Why apply the SpO2 monitor to the right wrist, not
1. When resuscitation anticipated the left?
2. Confirm perception of persistent central - The right wrist gets blood directly from the
cyanosis aortic arch before the ductus arteriosus =
3. When using supplemental O2 a more accurate measure of the oxygen the
4. When PPV is required brain and upper body are receiving
compared to other limbs.
- This helps identify issues like
duct-dependent congenital heart disease.
,APGAR Scores
- Assigned @ 1 minute, 5 minutes, every 5 minutes until an APGAR of 7 is achieved
Criteria 0 1 2
Appearance Blue, pale trunk, lips, Acrocyanosis Completely Pink
face
Pulse Absent <100bpm >100bpm
Grimace None Grimace Cough or sneeze
Activity Limp Some flexion Active motion
Respirations absent/irregular Slow / crying Strong crying
Primary apnea: stimulation results in Secondary apnea: no amount of stimulation will resume
resumption of breathing breathing
PPV
Indications for PPV: Delivering PPV
1. Apnea - Start at 0.21 (can use 0.30 if <35 weeks GA)
2. Gasping - Set the flowmeter to 10LPM
3. HR <100bpm - 40-60br/min
4. SpO2 below target *MR. SOPPA (5 brs b/w every step and 30 sec of effective
PPV)
, Self-inflating bags
Advantages: Disadvantages:
- Does not need a compressed gas source - Hard to determine a good seal
- Fills spontaneously - Reservoir attachment required if
- Pop-off valve needed to deliver FiO2 of 1.0
- Req. PEEP valve
Flow inflating bags
- Easier to access - Needs a compressed gas source
- Can “feel” pts' lung Cl - Req. tight seal
- Can provide free-flow O2 - Does not have a pop-off valve
- Reliable FiO2 - Requires flow between 5-10LPM
T-Piece
- Mechanical devices to deliver manual - Have to preset PIPs and PEEP
breaths at a set flow - Challenging to change pressures during
- Consistent PIPs and PEEPs active resus.
- Reliable FiO2 - Need a gas source
ETT sizes ( peds= 16 + age/4) depth = size x 3
Insertion depth: NTL
- Distance in cm from baby’s nasal septum to the ear tragus + 1 cm
Tests for High-Risk babies
1. U/S
2. Non-stress test
3. Contraction stress test
4. Biophysical profile (non-stress & contraction
stress test)
5. Amniocentesis
Stages of labour
1. Latent phase 0-4cm dilated Up to 24hrs
2. Active phase 4-7cm dilated 4-8 hrs
3. Deceleration phase 8-10cm dilated 30 mins- 2 hrs
Fetal Monitoring during Labour and Delivery
FHR Monitoring Fetal scalp blood sampling
- Measures HR to trend a fetus’s tolerance to - Used during labour when FHR isn't reassuring
labour - A scalp pH >7.25 is reassuring
FHR <110bpm = bradycardia - Acidotic = intolerance to labour
FHR >160bpm = tachycardia
Early decelerations Fetal head compression, usually
benign
Variable decelerations Umbilical cord compression
Late decelerations Placental insufficiency
Sinusoidal tracing Severe Acidosis, Anemia, or
Hypoxia
,Anticipating Neo Resuscitation
Antepartum Risk Factors Intrapartum Risk Factors
- Maternal diabetes - Emergency c-section
- HTN - Breech
- PROM - Premature labour
- Mult. gestations - Prolonged labour >24hrs
- Maternal age <16 or >35 y/o - Mec stained
Clinical Manifestations 4 pre-birth questions:
- Irregular breathing 1. What is the expected gestational age?
- Bradycardia 2. Is the amniotic fluid clear?
- Tachycardia 3. Are there any additional risk factors?
- Pallor 4. What's our umbilical cord management
- Cyanosis plan?
- Desat
- Hypotension
Umbilical cord clamping
Preterm newborns: Term newborns:
- Decrease mortality - Decr. Chance of developing Iron deficiency
- Higher BP & BV anemia
- Decr. Need for blood transfusion - May improve neurodevelopmental
- Lower incidence/risk of brain hemorrhage outcomes
- Lower risk of NEC - May require phototherapy for
hyperbilirubinemia
Neo Resuscitation
Indications for Pulse Oximetry: Why apply the SpO2 monitor to the right wrist, not
1. When resuscitation anticipated the left?
2. Confirm perception of persistent central - The right wrist gets blood directly from the
cyanosis aortic arch before the ductus arteriosus =
3. When using supplemental O2 a more accurate measure of the oxygen the
4. When PPV is required brain and upper body are receiving
compared to other limbs.
- This helps identify issues like
duct-dependent congenital heart disease.
,APGAR Scores
- Assigned @ 1 minute, 5 minutes, every 5 minutes until an APGAR of 7 is achieved
Criteria 0 1 2
Appearance Blue, pale trunk, lips, Acrocyanosis Completely Pink
face
Pulse Absent <100bpm >100bpm
Grimace None Grimace Cough or sneeze
Activity Limp Some flexion Active motion
Respirations absent/irregular Slow / crying Strong crying
Primary apnea: stimulation results in Secondary apnea: no amount of stimulation will resume
resumption of breathing breathing
PPV
Indications for PPV: Delivering PPV
1. Apnea - Start at 0.21 (can use 0.30 if <35 weeks GA)
2. Gasping - Set the flowmeter to 10LPM
3. HR <100bpm - 40-60br/min
4. SpO2 below target *MR. SOPPA (5 brs b/w every step and 30 sec of effective
PPV)
, Self-inflating bags
Advantages: Disadvantages:
- Does not need a compressed gas source - Hard to determine a good seal
- Fills spontaneously - Reservoir attachment required if
- Pop-off valve needed to deliver FiO2 of 1.0
- Req. PEEP valve
Flow inflating bags
- Easier to access - Needs a compressed gas source
- Can “feel” pts' lung Cl - Req. tight seal
- Can provide free-flow O2 - Does not have a pop-off valve
- Reliable FiO2 - Requires flow between 5-10LPM
T-Piece
- Mechanical devices to deliver manual - Have to preset PIPs and PEEP
breaths at a set flow - Challenging to change pressures during
- Consistent PIPs and PEEPs active resus.
- Reliable FiO2 - Need a gas source
ETT sizes ( peds= 16 + age/4) depth = size x 3
Insertion depth: NTL
- Distance in cm from baby’s nasal septum to the ear tragus + 1 cm
