The initial respiratory response to hypoxia in the fetus is increased depth and rapidly of breathing movements

Mask inflation is much less effective than tracheal tube inflation when resuscitating new born babies

Sternal and intercostal recession is only seen during the Angola gasping

Stroke volume decrease as the heart rate slows from the normal 140-160 min to approximately 60 mins

Removal of all secretions is important to ensure an unobstructed airway

You should be able to remove large quantities of fetal lung fluid during the suctioning of the newborn airway

If the heart rate has remained undetectable despite 10 mins of effective resuscitation the prognosis is likely to be poor and discontinuing resuscitation should be considered

If drugs are needed in a new born resuscitation the outlook is usually good If drugs are needed in a new born resuscitation the outlook is usually good

Hypothermia can cause apnoea

The length of time it takes a baby to to recover during resuscitation reflects the degree and duration of hypoxia causing the insult

Emergency umbilical venous catheterastaion is a sterile procedure

Blood aspirated from the umbilical venous catheter provides no useful information should be discarded

Poor technique allowing leak around the face mask is a common cause for absences of chest movement

The very pre term baby must be dried before they are wrapped in polythene ( or placed in a plastic bag )and placed under a radiant heat source

In newborn resuscitation immediate peripheral intravenous access is important

Bradycardia during newborn resuscitation should be treated with atropine

Delayed cord clamping is equally as applicable if not more important when dealing with preterm babies than in a baby born at term

Large volumes of 0.9% sodium chloride given intravenously can exacerbate any metabolic acidosis

Large volumes of 0.9% sodium chloride given intravenously can exacerbate any metabolic acidosis

When ongoing and adequate ventilation a response to chest compression is most likely to be seen within 20-30 seconds

Newborn babies with no detectable cardiac output will be acidotic

Using two person airway control is a good way of reducing facemask leak and improving lung inflation ( aeration ) and ventilation

Listening for breath sounds in an intubated baby during ventilation is a good way of ensuring that there is air entry

The small size of babies in relation to there resuscitators means rib fractures are frequently seen after chest compressions

The increased heart size of a newborn baby in relation to the chest size makes chest compressions less effective

If a baby is born through meconium stained liquor , it is necessary to remove all the meconium from the airways before inflating the lungs

If drugs are used in resuscitation it is essential to flush after each drug to ensure the drug reaches the baby’s circulation and to avoid drug incompatibles

Writing clear factual and contemporary records of the resuscitation is just as important if the baby survives as if he/she had died

About 5% of babies born at term need intubation at birth

Fetal distress and birth asphyxia are useful terms to to record in notes

The large surface area to weight ratio of a newborn baby allows it to retain heat efficiently The large surface area to weight ratio of a newborn baby allows it to retain heat efficiently

Palpating the umbilical stump for pulsation is an accurate way of accessing the heart rate

Blood pressure in the the hypoxic fetus is maintained by peripheral vasoconstriction and increased stroke volume

Lactic acid build up impairs cardiac function

Maintaining natural position of the head is no longer important once an oropharyngeal airway is inserted as the lather opens the airway more effectively

Inflation breaths of 2-3 s of pressure of 30cm water are safer than and just as effective as shorter breaths of 0.5 s at pressure of 40cm water

Aponeic baby’s who in response to resuscitation gasp for several minutes before establishing normal regular breathing are likely to have been in terminal apnoea

The blow of valve in a self inflating resuscitation bag means that you cannot deliver more than the specified pressure

During the vaginal delivery about 35mls of lung fluid may be expelled from the oropharynx and large airways

All drugs used in newborn resuscitation can be given by any of the umbilical venous , intra-osseous or intr-tracheal routesAll drugs used in newborn resuscitation can be given by any of the umbilical venous , intra-osseous or intr-tracheal routes

In newborn resuscitation intravenous volume expansion is frequently needed

The laryngeal mask airway (LMA) can be used as an alternative in all babies when intubation is considered necessary for ongoing mangment

Hypoxaemia eventually causes the respiratory centre in the brainstem to cease functioning Hypoxaemia eventually causes the respiratory centre in the brainstem to cease functioning

It is advisable to start resuscitation of a preterm baby born before 30 weeks gestation with a lower inflation pressure than that used in a term baby

A baby who is blue, aponeic and who has a good heart rate at two minutes of age should be resuscitated with oxygen rather than air

After a successful resuscitation care should be taken to avoid both hyperoxaemia and hypocarbia

Anticipatory attendance at high risk instrumental or operative deliveries does not predict the need for newborn resuscitation in all cases

Chest compressions are useful before the lungs are inflated

Before inflating the lungs it is essential to clear the the upper airways in all babies who are born through meconium stained liquor

Irrespective of the size/maturity of the baby the chest in compressed over the lower third of the sternum

Readily visible chest movement in preterm babies during postive pressures ventilation may be a sign of over distension

Parents should be allowed to watch resuscitation

If the heart rate has remained undetectable for > 20 minutes despite resuscitation and exclusion of reversible causes, consider stopping resuscitation

Intraosseous needle placement is relatively straightforward and is the preferred means of securing rapid central access in a newborn resuscitation

When performing delayed cord clamping, at least 60 s is recommended but longer than this may be beneficial

Parents should not be present for the resuscitation of their baby because it will be too traumatic for them to witness

Writing clear, factual and contemporary records of the resuscitation is just as important if the baby survives as if they had died.

There is good evidence to support use of CPAP to stabilise both preterm and term babies

If resuscitation is required and at least 60 s of DCC is not practical, then cord milking (intact or cut cord) is an option in all babies

In the baby born before 28 weeks gestation you should start with inflation pressures of 25 cm water and adjust this according to the chest movement and heart rate response

The laryngeal mask should only be used when managing difficult airways

It is advisable to start resuscitation of a preterm baby born before 32 weeks gestation with a lower inflation pressure than that used in a term baby

.A term baby who is blue, apnoeic and who has a good heart rate at two minutes of age should be resuscitated with oxygen rather than air.

Adrenaline is used at a dose of 20 micrograms kg-1 (0.2 mL kg-1 of 1:10 000 adrenaline) when given via the intravenous or intraosseous route.

Anticipatory attendance at high risk, instrumental or operative deliveries can accurately predict the need for newborn resuscitation in all cases.