What Are Neonatal Resuscitation Errors?
“What are neonatal resuscitation errors?” is a common question we get all the time.
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Video Transcript
Timestamps
0:00 Intro
0:49 Birth Injury: What Are Neonatal Resuscitation Errors?
1:07 What Are Apgar Scores?
2:05 What Doctor’s Look At
People frequently ask me, what are problems that can relate to a baby being resuscitated after birth?
Resuscitation means that medical actions are performed to the baby to help them breathe and to try to get their heart rate back to normal. There are some babies, who when they’re born, for a variety of reasons, have low Apgar scores and have to be resuscitated in order to survive.
0:49 Birth Injury: What Are Neonatal Resuscitation Errors?
I’m not going to get into all the reasons that’s necessary. But what I am going to talk about today is what can happen after the baby is born and needs resuscitation, but is not resuscitated adequately.
1:07 What Are Apgar Scores?
First of all, let’s talk about the Apgar scores, because the Apgar scores were developed probably fifty or sixty years ago by Virginia Apgar, a lady doctor at Columbia University Medical School, which is actually where I went to medical school.
I was never fortunate enough to meet Dr. Apgar because she was dead before I was there, but apparently she was a very, very important person in the medical school. As we know, has the Apgar score named after her.
When a baby is born, anywhere in the United States and many places around the world, they are assigned an Apgar score. That is when the baby is examined, and what the doctor or the nurse does is look at five different things about the baby.
2:05 What Doctor’s Look At
First of all, they look at the heartbeat, and if the heartbeat is above a certain number or below a certain number, they score it a certain way. Second, they look for respiratory effort, and some babies will have a great respiratory effort. They will cry and you know they’re breathing very, very well. Some will not. Third, you look for reflex irritability where the baby, if you simply pinch the baby a little bit on the toe, the baby will move and show you good reflex irritability. Some babies don’t move at all. The other is the skin color, and the skin color is usually a difficult one to assess on a baby because many times babies are quite cyanotic or quite blue all over their body, and sometimes they’re not. You get a different score when the skin is better.
Now that’s four out of five of the Apgar scores components. But that frequently gives you plenty of information about how the baby has been born through the birth canal, and how the baby has survived that birth.
When a doctor looks at that Apgar score and sees a low Apgar score, then they know that this baby needs help. Sometimes all you need to do is stimulate the baby and they come around just fine. Sometimes you need to suction the baby and take secretions out of the baby’s mouth and nose, and then they do fine. But sometimes, you need to actually breathe for the baby.
The way this is done, first of all is that you can put a little mask over the baby’s mouth and nose and pump the mask so that a breath goes into the baby. That sometimes will bring the baby around. If that doesn’t work, then you may need to do endotracheal intubation.
Endotracheal means inside the trachea. Of course, in order to do that, you have to go through the mouth, you have to visualize the trachea, and then put a small plastic tube in the trachea, connect it to that same bag and mask, and give a breath for the baby.
Sometimes when this happens to a baby, the baby really needs that endotracheal intubation quickly. Sometimes people are not there in the delivery room to be able to do it efficiently. If they can’t, then you have a problem.
One case that I dealt with some years ago was a baby who needed an endotracheal intubation, and the tube was placed, but the tube went down the esophagus, which is right next to the trachea. When that’s done, no air is getting into the lungs when you try to breathe for that baby.
Well, that baby went to the newborn intensive care unit with that tube in the esophagus. Because of that, the baby ended up getting serious brain damage.
There are ways to detect whether that tube is in the trachea or in the esophagus. But at that particular hospital on that particular day, the nurses and the doctors didn’t do that, and the baby ended up with serious brain damage.
Once the baby is resuscitated with the endotracheal tube, the tube has to be tied into the baby’s face. Sometimes the nurses do it correctly, sometimes they don’t. Therefore if they don’t the tube will slip out. If the tube slips out, the baby needs to be intubated again. Sometimes that’s not done in a timely way.
There are many ways that mistakes can be made with regard to resuscitation of the baby, and these are just a few. Another way is sometimes baby’s need to have cardiac massage, and that needs to be done in a specific way. Sometimes that is not.
Once again, there are observers in most every birth, and what they’re supposed to do is write down everything that happens or doesn’t happen. We have to go through those records and determine whether these things happened as they were supposed to.
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