Review of CPR for newborns [2005 AHA] By Elizabeth Kelley Buzbee A.A.S., R.R.T.-N.P.S., R.C.P.

question You are called to L & D to assess a newborn for CPR. You are called to L & D to assess a newborn for CPR. List the 4 questions you ask yourself about the baby. List the 4 questions you ask yourself about the baby.

answer 1. Was this a full term gestation? 2. Is the amniotic fluid clear and normal? 3. Is the baby crying or breathing? 4. Is there good Muscle tone?

question Your baby is a 27 weeker who is 1100 grams. Your baby is a 27 weeker who is 1100 grams. She is floppy with a heart rate of 88 bpm and gasping She is floppy with a heart rate of 88 bpm and gasping She has an Sp02 of 75% She has an Sp02 of 75% What do you do? What do you do?

answer Clear the airway, Establish an airway and mask bag at 100% at a rate of bpm Clear the airway, Establish an airway and mask bag at 100% at a rate of bpm Reassess the HR in 30 seconds Reassess the HR in 30 seconds

question After mask bagging for 30 seconds, you see that the baby’s chest rises with the bagging at a PIP 25 cwp and that the HR is now 45. After mask bagging for 30 seconds, you see that the baby’s chest rises with the bagging at a PIP 25 cwp and that the HR is now 45. What do you do at this point? What do you do at this point?

answer Start chest compressions at a rate of 90 bpm with RR 30 1:3 ratio Start chest compressions at a rate of 90 bpm with RR 30 1:3 ratio Reassess in 30 seconds Reassess in 30 seconds Go ahead and intubate with a 3.0 endotracheal tube. Go ahead and intubate with a 3.0 endotracheal tube.

question When the doctor intubates the patient with a 3.0 endotracheal tube he pushes it to the 9 cm depth. When the doctor intubates the patient with a 3.0 endotracheal tube he pushes it to the 9 cm depth. What do you do [someone else is still doing compressions] What do you do [someone else is still doing compressions]

answer Check BBS with stethoscope over the axillary in both left and right. Check BBS with stethoscope over the axillary in both left and right. Check the Sp02 Check the Sp02 If you hear some gross leaking, push the ET-tube down to the 10 cm mark [3.0 ET tube] If you hear some gross leaking, push the ET-tube down to the 10 cm mark [3.0 ET tube] Re-check the BBS & Sp02 and tape the tube Re-check the BBS & Sp02 and tape the tube

question You have been doing chest compressions/ventilation at 1:3 ratio for 30 seconds and when you stop compressions you note that the baby’s HR is now 110. You have been doing chest compressions/ventilation at 1:3 ratio for 30 seconds and when you stop compressions you note that the baby’s HR is now 110. What do you do now? What do you do now?

answer Stop compressions, keep bagging at bpm at 100% Stop compressions, keep bagging at bpm at 100%

question The ET tube is in good position based on assessment of the BBS, but you notice that the Sp02 on 100% bagging at PIP 24 is only 89%. The ET tube is in good position based on assessment of the BBS, but you notice that the Sp02 on 100% bagging at PIP 24 is only 89%. What do you do? What do you do?

answer In the first 30 minutes of life. a Sp02 about 90% is acceptable at this time. In the first 30 minutes of life. a Sp02 about 90% is acceptable at this time. Because the baby most likely has IRDS type I we could add a PEEP valve to the bag and place baby on PEEP 5 cwp. Because the baby most likely has IRDS type I we could add a PEEP valve to the bag and place baby on PEEP 5 cwp.

question You notice that the baby’s belly is getting quite large and tight. You notice that the baby’s belly is getting quite large and tight. What do you do? What do you do?

answer Ask the nurse to place a naso-gastric tube to vent the excessive air from the stomach that is causing a restrictive defect Ask the nurse to place a naso-gastric tube to vent the excessive air from the stomach that is causing a restrictive defect

question If the baby had not had a good pulse after a few minutes of chest compressions, what would you do? If the baby had not had a good pulse after a few minutes of chest compressions, what would you do?

answer If HR is still less than 60 bpm, continue CPR & If HR is still less than 60 bpm, continue CPR & administer epinephrine [1:10,000] by IV.01 to.03 mg/kg administer epinephrine [1:10,000] by IV.01 to.03 mg/kg