Newborn Life Support

What comes before anything else in primary survey for neonates?

• Thermal regulation because:

  • No shivering mechanism

  • Low glucose reserves

  • Large surface area to mass ratio so quicker heat loss

Why are we sometimes required to help establish normal breathing after birth?

• Passage through the birth canal is a hypoxic event

  • When baby is in utero, their lungs are full of fluid (Gas and nutrient exchange done via placenta)

  • When born, foetal circulation needs to quickly shut down

  • Cord is made redundant (after a few minutes)

  • Pulmonary circulation needs to open

• This mostly happens spontaneously, but sometimes we need to intervene

What must we do in the first 60 seconds of delivery if the baby is not breathing?

• Keep cord attached

• Dry the baby and keep towel on to make as warm as possible

• Tactile stimulation to stimulate breathing

Describe the physiological differences in the circulatory system between adults and a foetus

• Blood flow from placenta to liver

• From liver to heart via IVC

• Blood skips pulmonary arteries (as lungs full of fluid), goes through hole between R and L side and circulates via aorta back through body, then returns to placenta

What is the main cause of arrest in neonates?

• Respiratory arrest

What are ways in which babies can lose heat quickly and how do we address this?

• Radiation loss (heat lost to colder objects nearby) - get coolers away

• Convection loss (heat carried away by moving air around the baby) - turn off fans and air conditioning, close windows and doors

• Evaporation loss (heat lose when moisture on the skin evaporates) - dry baby very quickly

• Conduction loss (heat transferred from the baby’s body to a colder surface that is touching them) - don’t put baby on cold surface

What do we need to do to prepare when attending a potential birth or BBA?

On way to/just arrive at job:

• Prepare equipment (take maternity kit with you)

• Call for help (2nd DCA + CTM)

• If preterm/high risk pregnancy/active NLS - Call for APPCC

At Job:

• Ensure ambient temperature high

  • Close doors/windows

  • Reduce cold droughts

  • Adequate lighting

• Set up NLS area

  • Firm surface, Off the floor, Preferably in same room as mother

  • Two towels

  • Transwarmer (fabric side up)

  • Prepare hat, foil blanket, resus equipment

  • Set up iPad next to area with newborn life support checklist on JRCALC ready

• Ask consent to view area

What are the two pathways that could occur once baby is born and what actions should we take?

After birth:

• Note time of birth

• Stimulate and dry off for 60 seconds (don’t stimulate if under 32 weeks) - paramedic may listen to HR (if under 60bpm may cut cord and move)

• If breathing

  • Hand to mother wrapped up

• If not breathing

  • Cut cord

  • Bring baby to NLS area

    • If under 32 weeks, put in plastic bag (tactile stimulation for under 32 weeks could peel skin off)

  • Place directly on transwarmer (fabric side, ensure ‘unlocked’)

  • Wrap in the two towels (over transwarmer and baby together)

  • Wrap in foil blanket

  • Put on hat

  • Start NLS using NLS checklist

What is the modified primary survey for neonates?

TABCDEF

• Thermal care

• Airway

• Breathing

• Circulation

• Disability

• Environment

• Family

What is the extrication and conveyance procedure for neonatal life support?

• Pre-alert nearest ED with obstetrics on site

• State gestation and that the baby is newborn

• Make sure ambulance is warm before extracting

• Use pedimate in adapted way - baby wrapped, no car seats, no skin to skin

• Ask ED to call maternity if:

  • Placenta retained

  • Mother unstable

When should and shouldn’t we attempt resuscitation on a baby?

• New born should have a resuscitation attempted

• Condition optimised before conveyance with NLS on route, even in circumstances where resuscitation appears futile and death inevitable

• Unless

  • Baby showing clear signs of death prior to birth, such as maceration (skin breakdown, organs visible and decomposing/softened)

  • Baby is known to be below 22 weeks gestation (see cuddle pockets guide)

• Consult with APPCC desk