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Discussion

Primary/secondary apnea.

Can someone give me clinical examples? (recerting my NRP and can never wrap my brain around this one. maybe i should go to bed!)

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    • Expert

    Recognition and treatment of Primary and Secondary apnea

    1. Primary Apnea: When asphyxiated, the infant responds with a increased respiratory rate. If the episode continues, the infant becomes apnic, followed by a drop in heart rate and a slight increase in blood pressure. The infant will respond to stimulation and 02 therapy with spontaneous respirations.

    2. Secondary apnea: When asphyxia is allowed to continue after primary apnea, the infant responds with a period a gasping respirations, falling heart rate, and falling blood pressure. The infant takes a last breath and then enters the secondary apnea period. The infant will not respond to stimulation and death will occur unless resuscitation begins immediately.

    * Because after delivery of an infant it is impossible to differentiate between primary apnea and secondary apnea, assume the infant is in secondary apnea and begin resuscitation immediately.

    I hope this helps!

    Stephen

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    It's tough to comprehend because 'primary' and 'secondary' don't really mean what we expect them to mean. It would be easier if they referred to 'early-stage apnea' and 'late-stage apnea.'

    Primary: I always think of those little feeder-growers who set off the apnea alarm, but as soon as you walk over and lift the blanket up, they jump wildly and start breathing (then look at you like, "Crud! Forgot that breathing thing again!").

    Secondary: When the hypoxic process continues for a while, it's that point where you can rub them and flick their feet all you want, but they don't start breathing without PPV.

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    • Author

    Thanks Eric, this was what I was looking for.

    Can someone help me out with situations at a delivery? Am I right in thinking that a secondary apnea is more indicative of a in utero event , such as a nuchal cord, and a primary would be more of a 29 weeker that is making effort at delivery, but then becomes apenic without PPV?

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    • Expert

    Right...... primary would be a weak respiratory effort that you can "bring back" with blowby, suctioning and stimulation. (could include obstructive apnea). Secondary apnea could occur with a prolonged delivery, delayed suctioning (I hate it when the OB takes his sweet time showing the kid to mom, blah blah, then saunters over and asks for an Apgar score 3 minutes into the kid's life.) where the baby becomes so hypoxic and neuroogically depressed that PPV and subsequently bringing the Spo2 up are the only thing that will bring the respiratory drive back.

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    • Expert

    On the opposite end of the spectrum, Steve: the CNM is in such a hurry to hand off the kid, she forgets to clamp and cut and just avulses the umbi off.

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    Right...... primary would be a weak respiratory effort that you can "bring back" with blowby, suctioning and stimulation. (could include obstructive apnea). Secondary apnea could occur with a prolonged delivery, delayed suctioning (I hate it when the OB takes his sweet time showing the kid to mom, blah blah, then saunters over and asks for an Apgar score 3 minutes into the kid's life.) where the baby becomes so hypoxic and neuroogically depressed that PPV and subsequently bringing the Spo2 up are the only thing that will bring the respiratory drive back.

    Nothing like being called down for "thick mec" - baby comes out limp with no respiratory effort. Then the OB takes their time clamping of the cord, lets dad cut the cord, then suctions out the baby with the bulb syringe. And then everybody wonders why the baby ends up with mec aspiration... I thought (according to the new NRP guidelines) that the OBs weren't supposed to suction at the perineum if there was mec present...

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    On the opposite end of the spectrum, Steve: the CNM is in such a hurry to hand off the kid, she forgets to clamp and cut and just avulses the umbi off.

    I wish you could have seen the shuddersquirm convulsion I just had in my chair.

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    Nothing like being called down for "thick mec" - baby comes out limp with no respiratory effort. Then the OB takes their time clamping of the cord, lets dad cut the cord, then suctions out the baby with the bulb syringe.

    And let's not forget to take pictures of the whole thing too! Gotta have that Kodak moment!

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    • Expert

    Or "How much does he weigh?" while you're in & out suctioning and intubating.

    Best one:

    "Aunt": "Are you going to circumcise him now?" - (while stim/sx)

    Me: Let's give him a few minutes......:devil:

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    • Author

    :banghead:

    Nothing like being called down for "thick mec" - baby comes out limp with no respiratory effort. Then the OB takes their time clamping of the cord, lets dad cut the cord, then suctions out the baby with the bulb syringe. And then everybody wonders why the baby ends up with mec aspiration... I thought (according to the new NRP guidelines) that the OBs weren't supposed to suction at the perineum if there was mec present...

    That always makes me feel like screaming, "Hurry the **** up!!!!!!" :banghead:

    As far as suctioning at the perineum, we have had this argument time and time again with OB. Their argument is that it is "suggested". :bugeyes:

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    • Expert
    I wish you could have seen the shuddersquirm convulsion I just had in my chair.

    To make things worse, she asked the neo why there was so much blood on the baby's abd! The neo says, "I think you exceeded it's tinsile strength...." :rolleyes:

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    • Expert

    I love the "how much does s/he weigh?" thing. Ummm, the baby's feet have barely cleared the perineum?

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