Neonatal Resuscitation Exam Study Guide

what is our goal heart rate for newborns? - >100 BPM approximately ____% of newborns require some degree of resuscitation - 10% As a CRNA who is our primary responsibility? - the mom! the infant in the first few minutes to hours after birth is called - newborn an infant during the first 28 days of life - neonate includes the neonatal period and extends through 12 months of age - infant physical expansion of the lungs results in the critical _________ in PVR - decrease failure to normalize pulmonary vascular resistance may result in persistence of _________ and _________ - intra cardiac and extra cardiac shunts disruption of fetoplacental circulation may render the newly born at risk of ________ - acute blood loss what is the presumed cause of TTN (transient tachypnea of the newborn) - retained fetal liquid TTN is more common in ________ and ________ - small preterm infants and babies delivered by C-section surfactant is produced by what? - type 2 pneumocytes by what age gestation is surfactant present? - 34-38 weeks gestation what 4 factors prolong transitional circulation? - 1. hypoxemia 2. hypercarbia 3. acidosis 4. hypothermia what 5 situations can prolong transitional circulation? - 1. prematurity 2. congenital heart disease 3. sepsis 4. high altitude 5. prolonged stress which structure connects the umbilical vein (or placenta) to the IVC? - ductus venosus what structure connects the right and left atrium? - foramen ovale what structure connects the pulmonary artery and the descending aorta? - ductus arteriousus trace the fetal circulation from the placenta to the aorta - placenta --> umbilical vein --> ductus venosus --> IVC --> RA ---> foramen ovale --> left atrium ---> Left ventricle --> aorta ---> brain/heart/UE --> SVC --> RA --> RV --> pulmonary artery --> ductus arteriosus --> descending aorta --> LE/hypogastric arteries --> umbilical arteries (2) --> placenta when does the foramen Ovale functionally close? - when LAP > RAP within the first few hours of life When does the Forman Ovale permanently close? - months to years when does the patent ductus arteriosus close functionally and anatomically? - functionally closes in 24-48 hours anatomically in several weeks what causes the ductus arteriosus to close? - increased PaO2 and decreased prostaglandin there is a rapid _______ in PVR in the first 24,48 hours after birth due to: _________, __________, ___________ - decrease due to: expansion of lungs, direct exposure of lungs to O2, reabsorption of water what happens to pulmonary blood flow in utero, birth and after birth? - it is low in utero, rapidly increases at birth and stays the same what happens to PA pressure in utero, birth and after birth? - it is high in utero followed by a rapid but less dramatic decrease at birth and 1st week of life what happens to PVR in utero, birth and after birth? - it is high in utero, rapidly decreases at birth and gradually decreases after birth what factors increase PVR (9) - 1. hypoxia 2. hypercarbia 3. acidosis 4. hypothermia 5. hyperinflation (more peep/pressure) 6. atelectasis (can't oxygenate well or remove CO2) 7. sympathetic stimulation (increased catecholamines) 8. high hematocrit (thicker blood) 9. surgical constriction 6 things that decrease pvr - 1. oxygen 2. hypocarbia 3. alkalosis 4. normal FRC 5. block sympathetic stimulation 6. low hematocrit how would you set up your ventilator for a pulmonary HTN neonate? - lowest pressure possible while still adequately ventilating and maintaining HR >100 what temperature do you want your room for a pulmonary HTN neonate? - uncomfortably hot for everyone but the baby what would be a good vasopressor to give a pulmonary HTN neonate with high PVR? - vasopressin, it will not increase pulmonary htn just SVR in the newborn baby, the ________system is more developed? (parasympathetic or sympathetic nervous system) - parasympathetic targeted preductal SpO2 1 minute after birth - 60-65% targeted preductal SpO2 2 minutes after birth - 65-70% targeted preductal SpO2 3 minutes after birth - 70-75% preductal SpO2 4 minutes after birth - 75-80% pre-ductal SpO2 5 minutes after birth - 80-85% pre-ductal SpO2 10 minutes after birth - 85-95% aggressive pharyngeal suctioning can cause _________ and ________ and delay the onset of spontaneous breathing - laryngeal spasm and vagal bradycardia Is it recommended that all meconium stained babies to routinely receive intrapartum suctioning before delivery of the shoulders? - no what are the 5 categories of the Apgar score? - 1. heart rate 2. respiratory effort 3. color 4. reflex irritability (response to insertion of a nasal catheter) 5. muscle tone