Case studies in Neonatal CPR via AHI 2005 Guidelines By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP Kingwood College Respiratory Care Department Kingwood College Kingwood, Texas

Question: Case # 1 Your baby is 20 week gestation by dates and by exam. His weight is 350 grams He is born with APGAR's of 3. Is he a candidate for CPR?

answer No, he is too small to be considered viable

Question: Case study # 2 Your patient is 24 week’s gestation by dates. She is flaccid and breathing is irregular & she doesn’t respond to tactile stimulation while you dry her off. Is CRP indicated?

answer Yes, she is premature Her breathing is irregular & she has poor muscle tone

Question What else do you need to know about this infant?

answer Is the amniotic fluid cloudy or clear? Is the HR above 100 bpm? Is the baby centrally cyanotic?

Question The baby’s HR is 120 bpm and her lips are cyanotic. What do you do now?

answer Dry her off Bulb suction her if she needs it Place her in the sniff position. Blow 02 and Reassess her for better skin color & regular RR.

question You are blowing 02 to her face at 5 lpm. Her HR is 125 bpm Her RR is 75 bpm with retractions Her lips are pink after a minute on 02 blow-by What do you want to do now?

answer Place her under a hood Get a pulse-oximeter on her to titrate the Fi02 Reassess her because we are concerned about her being flaccid.

Question: Case study # 3 Your patient is a 27-week gestation, infant who is about 1500 grams What else do you need to know about this infant?

answer Is the baby crying? Does the baby have good muscle tone? Is the amniotic fluid clear?

Question When you assess this infant for these items you note that the baby’s HR is 55 bpm, the respiratory rate is 15 bpm and the baby is flaccid. What do you do at this point?

answer Dry her off, establish an airway and mask bag at bpm Reassess in 30 seconds

Question After 30 seconds, the HR is at 54 bpm, the patient is centrally cyanotic even with bagging with Fi02 100% at a rate of 50 bpm. What do you want to do?

answer Observe the chest for good chest movement Listen to the BBS for good bagging Intubate now & Start compressions at a HR of 90 bpm

question You are bagging at 30 bpm, the chest is rising & The nurse is doing chest compressions at 90 bpm What is the ratio of compressions to RR?

answer 1:3

question After 30 seconds of chest compression, and bagging, you recommend what?

answer Reassess HR and RR, Sp02 and skin color

question How far do we compress the chest during CPR?

Answer: 1/3 to ½ the depth of the chest wall

question The HR is 45 bpm The Sp02 is 76% on Fi02 100% There is a 3.0 endotracheal tube down to # 10 and you hear BBS with bagging. There are no spontaneous breathing efforts & the skin is mottled What do you suggest we do at this time?

answer Continue to do compressions and bagging with 02 Reassess in 30 seconds If no response, give IV epinephrine Continue compressions, bagging and reassess in 30 seconds Check glucose levels and if low give glucose Give volume expanders if hypotensive Perform CPR for 10 minutes before stopping

Question: Case study # 4 Your patient is a 35 week by gestation by dates. His mom has gestational diabetes. He has a APGAR of 6 at 1 minute & 7 at 5 minutes His RR is 65 bpm with minimal retractions, no flaring His HR is 135 bpm He is placed under a croup tent at 40% and his Sp02 rises from 88% to 91% After 10 minutes, you note that his Sp02 has dropped to 85% and that his skin is mottled and he is breathing irregularly What has happened?

answer He is cold-stressed, which has increased his 02 consumption and lowered his glucose levels.

question What do you want to do?

answer Increase his Fi02 Reassess Sp02 and his respiratory rate Mask bag if his RR is still irregular Get his temperature & place him under a heated hood to raise his body temperature Get a serum glucose and replace the glucose he’s used up