Post Resuscitation Care Flashcard 1

C. Rationale: Studies have shown that morbidity and mortality are reduced in patients with hypoxic-ischemic encephalopathy (HIE) who undergo therapeutic hypothermia. This must be done immediately as there is a therapeutic window for the success of therapeutic hypothermia.

D. Rationale: Anaerobic metabolism produced by poor ventilation and asphyxia can cause increased secretion of insulin (hyperinsulinemia), leading to hypoglycemia. Increased insulin secretion is the body’s way of preserving itself because it needs to utilize glucose in times of significant stress. Since glucose is a major fuel for the brain, persistent hypoglycemia can cause brain injury after resuscitation if it is not corrected.

A. Rationale: Newborns needing frequent attention are typically those who have difficulty in the transition phase. These patients require frequent monitoring, and the NICU can provide them with these services. Post-resuscitation care includes providing persistent, continuous positive airway pressure or mechanical ventilation, or continuous cardiac monitoring.

C. Rationale: Warming techniques to produce a slow but gradual increase in the newborn’s body temperature are recommended to prevent apnea and arrhythmias. It is recommended to increase the temperature by 0.5°C per hour.

A. Rationale: The pulmonary vascular tone of newborns that have undergone neonatal resuscitation will be extremely sensitive to sudden changes in oxygen saturation or hypothermia. Maintaining high or low concentrations of arterial oxygen may cause complications later. Therefore, one must avoid unnecessary suctioning or immediate bathing of the newly born in this case. The measurement of arterial blood gases is necessary for the attending physician to make an informed decision on which supplemental oxygen concentration level to provide.

B. Rationale: Infants born at > 36 weeks gestational age with worsening hypoxemic-ischemic encephalopathy may undergo therapeutic hypothermia in institutions that are experienced in this procedure.

D. Rationale: Giving positive pressure ventilation risks the development of a pneumothorax. A small pneumothorax will resolve spontaneously. Hence, in this case, continuous monitoring is warranted. If the patient deteriorates, thoracentesis can be performed. Mechanical ventilation will potentially worsen the pneumothorax, and antibiotics are not indicated because there is no sign of infection.

B. Rationale: The ventilator should be set to provide a PEEP of 5 cm H₂O, which keeps the lungs inflated between breaths.

D. Rationale: The neuroprotective intervention of therapeutic hypothermia is recommended for term and near term neonates with hypoxemic ischemic encephalopathy (HIE). Infants born at > 36 weeks gestation with worsening of HIE may undergo therapeutic hypothermia at institutions experienced in this procedure.

D. Rationale: The pulmonary vascular tone of the newly born patient that has recently undergone neonatal resuscitation is very labile to arterial oxygen changes and hypothermia at this time. Therefore, healthcare providers must avoid any unnecessary suctioning because it can cause oxygen desaturation. Too much oxygen can also contribute to harming the patient. Thus, keeping a constant oxygen titration with continuous pulse oximetry monitoring to make sure that oxygen is between 94% to 99% is recommended. Target SpO₂ may be lower for preterm infants and clinicians should follow their units clinical guidelines.