SAQ 455 – Paediatrics – ongoing neonatal resuscitation and persistent hypoxia

Paediatrics – ongoing neonatal resuscitation and persistent hypoxia.

a. Next 20 minutes

• Reassess heart rate, respiratory effort, colour/SpO2 and chest movement; confirm that ventilation is effective.
• Allocate roles, continue neonatal resuscitation leadership, and liaise early with paediatrics/neonatal retrieval.
• Optimise airway position and ventilation; intubate if bag-mask ventilation is ineffective or prolonged ventilation is required.
• Start chest compressions at 3:1 if the heart rate remains below 60/min despite effective ventilation.
• Gain umbilical venous access and give adrenaline 10 microgram/kg IV, repeated every 3-5 minutes if indicated.
• Consider 10 mL/kg isotonic crystalloid or O-negative blood if hypovolaemia or blood loss is suspected.
• Actively manage temperature, glucose, monitoring and documentation, and keep the father informed through a nominated staff member.

b. Persistent hypoxia on FiO2 1.0

• Pneumothorax.
• Endotracheal tube malposition, including right or left main bronchus intubation.
• Meconium or aspiration with airway obstruction.
• Tube blockage or secretions.
• Congenital heart disease with duct-dependent or cyanotic physiology.
• Congenital lung disease or pulmonary hypoplasia.
• Persistent pulmonary hypertension of the newborn.