Baby Reynolds

last authored: April 2011, David LaPierre
last reviewed: May 2011, Dr Ian Johnston

 

 

 

 

Introduction

Baby Reynolds is a girl born at 39 weeks gestation after an uneventful pregnancy. Her mother's membranes ruptured 2 hours before birth, and meconium was present. As the fetal heart monitor was reassurring, labour continued and she was born vaginally.

 

She initially had poor tone, no respirations, and was cyanotic across her body.

What equipment do you want/need to have on hand?

Important equipment includes:

radiant warmer (turned on) and warm towels

gloves, clock, stethescope, tape

equipment for:

  • suction (mechanical suction, catheters, meconium aspirator)
  • positive pressure ventilation equipment, with oxygen supply
  • intubation equipment: laryngoscope with 0 and 1 blade, 2.5, 3.0, 3.5 ETT, stylet

medications (discussed in another case)

 

 

What are your immediate first steps? Demonstrate this with the model.

Place the baby on a radiant warmer and towels without stimulating her.

Visualize the oropharynx using a laryngoscope, and if necessary clear the oropharynx with a large bore suction catheter

Intubate the trachea with an ETT, attach a meconium aspirator, and suction through the ETT.

Dry and stimulate with a warm towel. If neccesary, stimulate further by flicking the feet or rubbing the back.

Reposition her head.

 

Demonstate what you next evaluate.

Assess for:

 

  • respiratory function
  • heart rate: palpate the umbilicus at the base, or listen with a stethoscope. Count 6 seconds and multiply by 10.
  • colour: look for central cyanosis

 

Baby Reynolds is beginning to breath on her own, but her HR is 90 and she is still cyanotic.

What do you do next? What are your options?

Because her HR is below 100, begin postive pressure ventilation. This can be done using:

  • self-inflating bag
  • flow-inflating bag
  • T-piece resuscitator

You have a self-inflating bag available, and you begin providing breaths using room air as the intial gas.

 

Demonstrate this. How do you assess for response?

Assess for:

  • adequate chest movement
  • bilateral breath sounds
  • improving colour and muscle tone
  • a rapid rise in heart rate

Wrap-up

Baby Reynolds's heart rate improves to 130 after 20 seconds of ventilation, and she soon begins to breath on her own. Ventilation is decreased and then discontinued, and supplemental oxygen is provided until her colour improves.

 

As she has quickly improved, and remains stable, she is brought back to mom, who is reassured that her baby is doing very well. They are enouraged to provide skin-to-skin contact and to begin early breast feeding, with education given.

 

Her nurse checks in frequently, but as she is feeding well, there is no need to go to the nursery.