Frequently Asked Questions

Q - Question 1?

A - Answer 1.

Q - Question 2?

A - Answer 2.

Q - What makes shoulder dystocia so dangerous?

A - What makes shoulder dystocia dangerous is the baby can start breathing when the head is out, which triggers the physiological changes that cut off the life line from the umbilical cord and transition to breathing from lungs, but they can't adequately breathe while stuck. So they can asphyxiate and need to get out quickly. Exaggerate the hip flexion and put lots of pressure on the fundus. You're working to dislodge the anterior shoulder.

Q - Concerning administration of epinephrine during newborn resuscitation, why does the newborn have a max of 3ml of fluid down the ETT and pediatrics have a max 2ml of fluid?

A - The dose given in kids greater than 24hrs is 10x higher than in neonates. Remember that the concentration used in medical cardiac arrest via ETT is 1:1000. The 2mL max in peds is 2mg while the 3mL max in Newborns is 0.3mg.

Q - What was the rational for giving a min dose of 0.5ml of epinephrine instead of 0.3ml for a 3kg neonate?

A - It is easier to deal with a fixed minimum dose than do calculations in this patient population.  NRP recommended dosing is 0.01-0.03mg/kg. A dose of 0.05mg gets closer to the middle of that range that 0.01mg/kg.

Q - Has there been any dicussion around the use of naloxone in a newborn resuscitation when there is suspected fentanyl use by the mother prior to birth?

A - Naloxone is not recommended for newborns because there is an increased chance of seizures, possibly due to acute withdrawal.  Naloxone has been used in past editions of NRP for infants born to mothers with a history of narcotic administration in which there is diminished respiratory drive. There is insufficient evidence to evaluate either the safety or efficacy of using naloxone to manage respiratory depression in these infants. In addition, there is little known about the pharmacology of naloxone along with concerns regarding possible complications from its use. NRP recommends that these infants be managed with appropriate respiratory support using PPV as would any infant in which there is apnea or inadequate respiratory drive.