Case studies in Neonatal CPR

via AHI 2005 Guidelines

By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCPKingwood 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 bpmHer RR is 75 bpm with retractionsHer 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 40-60 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