As the neonatal nurse on duty, you have been called to the delivery suite to attend a delivery. The delivery is for a G2, now P2 mother 40 weeks’ gestation, who is in active labor. The membrane rupture was six hours ago and was clear without smell. Mother had no fever—antenatal labs: O+, hepatitis B negative, syphilis negative. Hgb 12 Hct 36. The mother has been taking FeFol and no other medication. The labor had been progressing without difficulty, but it seemed the mother was unable to deliver the baby. The head is visible from the vaginal canal. The decision is made to use a vacuum extraction to deliver the baby.
The baby is delivered after three pulls of the vacuum. The baby is born limp, breathing 20 times per minute, with a heart rate of 90 beats per minute, grimaces only when you touch him, and is blue.
Multiple Choice Questions
What is the one-minute Apgar for this baby?
A - 4
B - 3
C - 5
What are your next steps for this baby?
A - Stimulate and suction if you see mucus, and begin PPV.
B - Suction, stimulate, and place skin to skin.
C - Recheck Apgar vital signs and place skin-to-skin.
You work on this baby, and within 8 minutes, the baby is crying, pink, and flexed, requiring no oxygen. The vital sig4ns are stable, and glucose is 55 mg/dL (3.05 mmol/L). The team asks you what to do with this baby now.
You say the baby needs to be observed in the neonatal unit because you are concerned about the possible consequences.
A - The baby will develop respiratory distress syndrome.
B - Signs of HIE that can develop at 24 to 72 hours.
C - Resuscitation may cause feeding intolerance in the baby.
Evidence Corner
TOPIC: Post-Resuscitation Care for Neonates Receiving Positive Pressure Ventilation at Birth.
Akinloye, O’Connell, Allen, & El-Naggar (2014).
Author conclusion: The authors looked at post-resuscitation care for infants over 35 weeks of gestation who received positive pressure ventilation (PPV) at birth. They examined neonates who were > 35 weeks’ gestation who had been admitted post-PPV to the neonatal unit between 1994 and 2013. They further divided the information into those neonates who received PPV for less than 1 minute (short PPV) and those who received PPV for greater than 1 minute (long PPV). They found that out of 8 464 neonates, 42.6% were in the short PPV group and stayed in the neonatal unit for > 1 day. Those who received PPV for > 1 minute (long PPV) had more morbidities and required more intensive care intervention. The authors concluded that post-resuscitative care in the neonatal unit is beneficial for all neonates from the short PPV to the long PPV group.
Citation: Olusegun Akinloye, Colleen O’Connell, Alexander C. Allen, Walid El-Naggar; Post-Resuscitation Care for Neonates Receiving Positive Pressure Ventilation at Birth. PediatricsOctober 2014; 134 (4): e1057–e1062. 10.1542/peds.2014-0554
Kudos to the anchor
Knowledge updated
thank you
Thank you, it keeps us updated
Interesting!