It is generally agreed that the most appropriate surrogate decision makers for young children are
their parents
, unless they are acting in such a way that the child may be harmed.
Who is the usual surrogate decision maker for a newborn?
Parents, as surrogate decision makers for their infants, are generally expected by
health care providers
to act in the child's “best interest.” However, when the wishes of the parents are contrary to those of the medical profession, an ethical dilemma occurs.
What are the ethical principles that guide resuscitation of a newborn?
Four Ethical Principles
The ethical principles of autonomy, beneficence, nonmaleficence, and justice
are fundamental principles essential in making decisions regarding neonatal resuscitation. They are presented here as a framework to evaluate the dilemma of resuscitating infants at the limits of viability.
What is true about pneumothorax in newborn?
A pneumothorax occurs
when some of the tiny air sacs (alveoli) in a baby's lung become overinflated and burst
. This causes air to leak into the space between the lung and chest wall (pleural space). The most common cause of pneumothorax is respiratory distress syndrome.
What is the preferred method for assessing heart rate during chest compressions in a newborn?
An electronic cardiac monitor
is the preferred method for assessing heart rate during chest compressions. Chest compressions continue for 60 seconds prior to checking a heart rate.
When are chest compressions indicated in a newborn?
Chest compressions are indicated
whenever the heart rate remains below 60 bpm
despite 30 seconds of effective positive pressure ventilation. Newborn infants whose heart rate drops to below 60 bpm are usually hypoxic and acidotic.
When is surrogate decision making necessary?
A surrogate decision maker, also known as a health care proxy or as agents, is an advocate for incompetent patients.
If a patient is unable to make decisions for themselves about personal care
, some agent must make decisions for them.
What should be done for the newborn post resuscitation?
- Outline the observations and monitoring required by a newborn infant following resuscitation at birth.
- Review the screening and management of blood glucose levels to prevent and/or treat hypoglycaemia.
- Discuss the management of fluids and electrolytes in the infant who has required resuscitation.
What is the ideal depth of chest compressions for a newborn?
Objective: For infant and child resuscitation, current basic life support guidelines recommend a compression depth of
one third to one half of the anteroposterior chest diameter
.
How soon after giving epinephrine should you check baby's heart rate?
The heart rate should be re-checked
after 1 minute of giving
compressions and ventilations. The dose of epinephrine can be re-peated after 3-5 minutes if the initial dose is ineffective or can be repeated immediately if initial dose is given by endo-tracheal tube in the absence of an intravenous access.
How common is pneumothorax in newborn?
Neonatal pneumothorax is a life-threatening condition associated with a high incidence of morbidity and mortality. [1] Its incidence in the Neonatal Intensive Care Unit (NICU) is reported as
1-2% and over 40% in the presence of respiratory distress syndrome
. [2,3] It is more common in ventilated neonates.
How long does it take a pneumothorax to heal in a newborn?
It may take
a few days
for the tear to heal. The chest tube will stay in during this time. The baby may need breathing support (such as supplemental oxygen or a ventilator) until the air leak heals.
Can a baby's lung collapse from crying?
An infant who was born prematurely spent nearly two weeks in intensive care after her lungs collapsed from crying
too
hard, her mother claims. Robyn Theaker was born in March, five weeks early, weighing just over 5 pounds.
What is the CPR ratio for an infant?
Two-person CPR ratio for the child and infant will be
15 compressions to 2 breaths
.
What is the preferred method for pulse check in an infant?
The accepted standard for determining cardiac arrest in infants is the use
of palpation of the brachial pulse
to detect pulselessness.
How soon after administration of epinephrine should you pause compressions and reassess the baby's heart rate?
Epinephrine administration must be accompanied by positive pressure ventilations and high quality chest compressions for
45 seconds to one minute
before reassessing the neonate's heart rate (Kattwinkel et al., 2011; NRP, 2011).
