Contents Chapter Topic Page Neonatology Respiratory Cardiology
Contents Chapter Topic Page Neonatology Respiratory Cardiology
Contents Chapter Topic Page Neonatology Respiratory Cardiology
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Neonatal Resuscitation<br />
High Risk Deliveries<br />
A person trained in neonatal resuscitation is usually called to be present for the following<br />
deliveries:<br />
1. Antepartum factors<br />
• Maternal diabetes<br />
• Pregnancy induced hypertension<br />
• Chronic hypertension<br />
• Anaemia or Rhesus isoimmunisation<br />
• Previous fetal or neonatal death<br />
• Bleeding in second or third trimester<br />
• Maternal infection<br />
• Maternal cardiac, renal, pulmonary,<br />
thyroid or neurological disease<br />
• Oligo/polyhydramnios<br />
• Prolonged rupture of membranes<br />
• Premature rupture of membranes<br />
2. Foetal factors<br />
• Emergency Caesarean section<br />
• Breech or other abnormal presentation<br />
• Premature labour<br />
• Precipitous labour<br />
• PROM > 18 hrs. before delivery<br />
• Prolonged labour (>24 hours)<br />
• Prolonged second stage of labour (>2<br />
hours)<br />
• Fetal bradycardia<br />
Apgar Score<br />
Apgar score<br />
Colour<br />
(Appearance)<br />
0 1 2<br />
Blue or<br />
Pale<br />
Pink centrally.<br />
Blue<br />
extremities<br />
Completely<br />
Pink<br />
Heart Rate Absent < 100/min > 100/min<br />
Response to nasal No Grimace Cough or<br />
stimuli (Grimace)<br />
sneeze<br />
Tone (Activity) Limp Some flexion Active<br />
movement<br />
Breathing<br />
Absent Slow,<br />
Vigorous<br />
(Respiration)<br />
irregular Cry cry<br />
• Post-term gestation<br />
• Multiple pregnancy<br />
• Size-dates discrepancy<br />
• Drug therapy<br />
• Maternal substance abuse<br />
• Fetal Malformation<br />
• Diminished fetal activity<br />
• No prenatal care<br />
• Maternal age < 16 or > 35 years<br />
• Non-reassuring FHR patterns<br />
• Use of general anaesthesia<br />
• Uterine tetany<br />
• Narcotics to mum within 4 hours of<br />
delivery<br />
• Meconium-stained liquor<br />
• Prolapsed cord<br />
• Abruptio placentae<br />
• Placenta praevia<br />
While the Apgar score at birth may not be useful for decision-making at the<br />
beginning of resuscitation, it is helpful for assessing the infant’s condition and<br />
identifying the infant with a problem. Subsequent Apgar scores help in the<br />
assessment of the effectiveness of the resuscitative effort.
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