Neonatal resuscitation and post-resuscitation stabilisation — formative SAQs

SAQ 1 — The first-minute algorithm and escalation (10 marks)

A term infant is born apnoeic and limp after an emergency caesarean for fetal bradycardia. After warmth, drying and stimulation there is still no breathing, and the heart rate is 70 beats per minute. ^{[1] [10]}

Questions

1. State the three first-minute assessment questions and the action each "no" triggers. (3 marks) ^[1]
2. Describe your ventilation technique: rate, starting pressure, and starting oxygen for this term infant. (3 marks) ^[1]
3. The heart rate falls to 44 despite 30 seconds of effective ventilation with visible chest rise. State the next steps, including the compression-to-ventilation ratio and the adrenaline dose. (4 marks) ^{[1] [4]}

Model answer

First-minute triage (3). The three questions are: is the baby term, is there good tone, and is the baby breathing or crying? A "no" to any, or apnoea or gasping, moves the infant onto the resuscitation pathway. This infant is term but limp and apnoeic, so the pathway begins with positive-pressure ventilation. ^[1]

Ventilation (3). Begin positive-pressure ventilation at 40 to 60 breaths per minute using the lowest pressure that gives gentle chest rise (about 20 to 25 cm of water in most term infants), starting in air (21% oxygen) for a term infant. Titrate the inspired oxygen against the pre-ductal saturation nomogram. ^[1]

Escalation (4). Because the heart rate is under 60 despite at least 30 seconds of effective ventilation, add chest compressions coordinated with ventilation in a 3:1 ratio (about 120 events per minute) using the two-thumb encircling technique, and raise the inspired oxygen toward 100%. If the heart rate remains under 60, give adrenaline 0.01 to 0.03 mg per kilogram intravenously (0.1 to 0.3 mL per kilogram of the 1:10,000 concentration) via an umbilical venous catheter, repeated every three to five minutes. Reassess the heart rate every 60 seconds. ^{[1] [4]}