Infant Gasps 8 Minutes After Birth

Abstract

Please read the following vignette and watch the video clip (Fig 1). Figure 1. A 32 2/7-weeks’-gestation male is born by emergent cesarean delivery secondary to suspected abruption. The infant is lifeless, without respirations or detectable heart rate, after birth. The Neonatal Resuscitation Program (NRP) is initiated and followed according to the algorithm. The infant is successfully intubated at 60 seconds after birth; chest compressions are initiated after establishing effective ventilation; an umbilical venous catheter is placed and 0.01 mg/kg of epinephrine is administered via the umbilical venous catheter; 10 mL/kg of normal saline is then infused over 5 minutes. The infant remains lifeless without a heartbeat. A second dose of UV epinephrine is administered 3 minutes after the first dose. The infant gasps for the first time 8 minutes after birth (depicted in video); the heart rate returns, but remains less than 60 beats per minute. The correct intervention at this time is which of the following? 1. Administer sodium bicarbonate 2 mEq/kg intravenously. 2. Continue positive pressure ventilation. 3. Extubate the infant. 4. Discontinue chest compressions. 5. Provide continuous positive airway pressure via the endotracheal tube. Correct Response B. Continue positive …