Review Question - QID 109279

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APGAR Scores Introduction Five Minute designed to assess the neonates status and adaptation to the external world QID: 109279 (M2.OB.17.4800)

QID 109279 (Type "109279" in App Search)

A newborn male is evaluated one minute after birth. He was born at 38 weeks gestation to a 28-year-old gravida 3 via vaginal delivery. The patient’s mother received sporadic prenatal care, and the pregnancy was complicated by gestational diabetes. The amniotic fluid was clear. The patient’s pulse is 70/min, and his breathing is irregular with a slow, weak cry. He whimpers in response to a soft pinch on the thigh, and he has moderate muscle tone with some flexion of his extremities. His body is pink and his extremities are blue. The patient is dried with a warm towel and then placed on his back on a flat warmer bed. His mouth and nose are suctioned with a bulb syringe.

Which of the following is the best next step in management?

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Chest compressions and bag-mask ventilation

0/37

Intravenous epinephrine and reassessment of Apgar score at 5 minutes

1/37

Positive pressure ventilation and reassessment of Apgar score at 5 minutes

62%

23/37

Supplemental oxygen via nasal cannula and reassessment of Apgar score at 5 minutes

30%

11/37

Endotracheal intubation and mechanical ventilation

2/37

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This patient presents at one minute of life with a pulse of < 100/min, irregular breathing, moderate muscle tone with flexion, acrocyanosis, and whimpering in response to irritable stimuli, which give him an Apgar score of 5. The best next step in management is positive-pressure ventilation and reassessment of his Apgar score at 5 minutes.

All neonates should be evaluated using the Apgar scoring system at 1 and 5 minutes of life. The Apgar scoring system can be remembered with the acronym APGAR, which stands for Appearance, Pulse, Grimace, Activity, and Respiratory effort. Each sign is given a value of 0, 1, or 2 and added together to compute the overall Apgar score. Positive pressure bag-mask ventilation should be initiated in patients with a weak respiratory effort or pulse of < 100/min.

Incorrect Answers:
Answer 1: Chest compressions would not be appropriate for this patient because his pulse is > 60/min. Chest compressions should be initiated in patients with a pulse persistently < 60/min after 30 seconds of adequate ventilation.

Answer 2: Intravenous epinephrine should be administered to patients with a < 60/min that fail to respond to both a 30-second trial of adequate ventilation and chest compressions.

Answer 4: Supplemental oxygen via nasal cannula is not used in neonatal resuscitation. Respiratory support should be provided with positive pressure bag-mask ventilation.

Answer 5: Endotracheal intubation and mechanical ventilation should be pursued if positive pressure bag-mask ventilation is ineffective or prolonged.

Bullet Summary:
Apgar scores should be assessed for all newborns at 1 and 5 minutes of life, and newborns with weak respiratory effort or pulse < 100/min should be resuscitated with positive pressure bag-mask ventilation.

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