Not quite — that's higher than the recommended dose. Correct answer: 10 micrograms/kg IV/UVC (= 0.1 mL/kg of 1:10,000 adrenaline). This is a very commonly mixed-up number in exams — easy to confuse with adult or other paediatric dosing, so worth drilling in.

2. If you had to give adrenaline via the ET tube instead (before UVC access is ready) — what dose, and is it a reliable route?

Correct on the number — ET adrenaline is 100 micrograms/kg (10x the IV dose). And the second half matters too: it's not a reliable route — absorption via the lungs is unpredictable, so it's only ever a stop-gap while IV/UVC access is being obtained, and you'd still push for UVC access urgently even after giving it.

3. Volume replacement (e.g., 0.9% saline or blood) — dose and rate?

Correct dose — 10 mL/kg. And the rate: given over 5–10 minutes typically, faster if there's ongoing severe blood loss/actively exsanguinating (e.g., our abruption case).

4. ET tube size for a term baby (~3.5kg)?

Close but not quite — for a term baby (~3.5kg), the standard ET tube size is 3.5 mm internal diameter. 4mm would be oversized for a term neonate.

Quick reference for size by weight/gestation:

<1kg (extreme preterm, ~23–24 wks): 2.5 mm
1–2kg: 3.0 mm
2–3.5kg (up to term): 3.5 mm
3.5kg (large term baby): 3.5–4.0 mm

5. Pre-ductal SpO2 target at 5 minutes of life?

Close, but the standard reference is a bit higher — the commonly quoted target range at 5 minutes is 80–85%. Full ladder for recall:

2 min: 65%
5 min: 80–85%
10 min: 85–95%

These are guide targets to titrate oxygen against, not hard cutoffs.

6. Chest compression ratio and rate in NLS (compressions:breaths, and events per minute)?

Right — 3:1. And the full detail: that works out to 90 compressions : 30 breaths per minute (120 events total per minute). Worth stating both parts in the exam — examiners often want the "why" behind the ratio (it reflects that respiratory causes dominate in neonates, unlike adult arrest).

7. Where do you give chest compressions, and what technique is preferred in neonates?

Mostly right, small correction on landmark: compressions are given on the lower third of the sternum, just below an imaginary line joining the nipples (not above it) — thumbs sit just below the nipple line, over the lower sternum, avoiding the xiphoid.

Technique — correct: two-thumb encircling technique is preferred (hands encircle the chest, thumbs on sternum) as it generates better pressure and coronary perfusion than two-finger technique, which is the fallback if the encircling technique isn't possible (e.g., single rescuer, or very large baby).

Depth?

Correct — approximately 1/3 of the antero-posterior diameter of the chest.

8. Suction catheter size and negative pressure setting for a non-vigorous meconium baby with visible obstruction (direct vision suctioning)?

That's not quite the right parameter — you've given a pressure figure but the wrong unit context, and missed the catheter size part. Let me give you both:

Suction catheter size: typically a wide-bore catheter (12–14 Fr) for meconium — needs to be wide enough to clear thick particulate matter, unlike the smaller catheters used for routine secretions.
Negative suction pressure: generally set to no more than around -100 to -150 mmHg (not cmH2O, and not as high as -200). Excessive suction pressure risks mucosal trauma and vagal-induced bradycardia.

Easy mix-up point: cmH2O is the unit for ventilation pressures (PIP/PEEP), mmHg is the unit for suction pressure — different scales, don't cross them in the exam.

9. Starting PIP and PEEP settings on the T-piece (Neopuff) for a term baby?

Close, and within a reasonable range — the commonly quoted starting point is PIP ~30 cmH2O and PEEP 5 cmH2O for a term baby (higher initial PIP than preterm, since term lungs need more pressure to first inflate/recruit). Your PEEP of 6 is fine (5–6 is the typical range), but PIP is usually a bit higher for term — 25 would be closer to a preterm starting pressure.

Quick contrast to lock in:

Term: PIP ~30 cmH2O, PEEP 5 cmH2O
Preterm: PIP ~20–25 cmH2O, PEEP 5 cmH2O

Always adjusted immediately based on chest movement response, regardless of gestation.

10. Last one — starting FiO2 for babies <32 weeks vs ≥32 weeks/term?

Correct concept, but the two are swapped — let's fix that:

<32 weeks (preterm): start at 21–30% (lower, air-based, titrate up)
≥32 weeks / term: start at 21% (air), titrate up if needed based on sats/HR response

So actually both start low (21%) — the key nuance is: term babies start on air (21%) by default, while preterm babies have permission to start slightly higher, 21–30%, because they're more likely to need it, but you're not starting anyone high. The universal principle across gestations: start low, titrate up guided by sats target and response — never start high "just in case."

That's the rapid-fire round done. Overall pattern from today: your algorithm logic and sequencing are genuinely strong across all three scenario branches — you never skipped a step in the wrong order and your escalation decisions were sound throughout. The misses clustered in exact numbers (adrenaline dose, PIP/PEEP by gestation, sats targets, ET tube sizing) — which is completely normal and just needs repetition, not re-learning concepts.

Want a condensed one-page cheat-sheet (numbers only — doses, sizes, pressures, targets) as a document you can drill from before the actual exam?

UK NLS Quick Reference — Numbers to Drill

Practice reference only — always defer to the current Resuscitation Council UK NLS manual/algorithm for your course and exam.

Initial Assessment

Assess: tone, breathing, heart rate
Start the clock at delivery
Call for help early if baby not vigorous

Inflation Breaths

5 inflation breaths, ~3 seconds each
Via face mask + T-piece (Neopuff), watch for chest movement
No chest movement → reposition airway, consider 2-person technique, check seal, look for obstruction, repeat before increasing pressure

Oxygen — Starting FiO2

Gestation	Starting FiO2
Term / ≥32 weeks	21% (air)
<32 weeks (preterm)	21–30%

Titrate up gradually, guided by pre-ductal SpO2 and HR response — never start high "just in case"

Pre-ductal SpO2 Targets (right hand/wrist)

Time	Target SpO2
2 min	65%
5 min	80–85%
10 min	85–95%

Ventilation Pressures (T-piece)

Gestation	PIP	PEEP
Term	~30 cmH2O	5 cmH2O
Preterm	~20–25 cmH2O	5 cmH2O

Adjust immediately based on chest movement response

Chest Compressions

Indication: HR <60 bpm despite adequate ventilation (chest moving)
Ratio 3:1 (compressions:breaths) = 90 compressions : 30 breaths/min
Technique: two-thumb encircling (preferred) or two-finger (fallback)
Location: lower third of sternum, just below the nipple line
Depth: ~1/3 of AP chest diameter
Stop compressions once HR >100 bpm
Increase FiO2 once compressions start, titrated to sats

Drugs (via UVC — preferred route)

Drug	Dose	Route/Notes
Adrenaline (IV/UVC)	10 micrograms/kg (0.1 mL/kg of 1:10,000)	Repeat every 3–5 min if no response
Adrenaline (ET)	100 micrograms/kg	Unreliable absorption — stop-gap only while UVC obtained
Volume (saline or blood)	10 mL/kg	Over 5–10 min; faster if active severe blood loss
Dextrose	—	Post-resuscitation only, not during acute CPR cycle

Suction (meconium / visible obstruction only — not routine)

Catheter: wide-bore, 12–14 Fr
Negative pressure: ~100–150 mmHg (not cmH2O — that's for ventilation)
Only suction if obstruction is visible; never delay first inflation breaths for routine suctioning

ET Tube Size by Weight

Weight	ETT size (internal diameter)
<1 kg (~23–24 wks)	2.5 mm
1–2 kg	3.0 mm
2–3.5 kg (up to term)	3.5 mm
>3.5 kg	3.5–4.0 mm

Preterm (<28 weeks) Delivery Room Bundle

Room temp ≥23–25°C
Polythene wrap — baby in undried, neck down, head dried + hat on
Exothermic mattress if available
T-piece resuscitator, not self-inflating bag
Smaller equipment pre-checked (masks, ETT, laryngoscope)
Surfactant availability confirmed with team
Consider CPAP first-line if breathing spontaneously but laboured — don't jump to intubation
Consider LISA/MIST for surfactant delivery while on CPAP

Post-Resuscitation Checklist (once HR >100 and stabilising)

Titrate O2 down (avoid hyperoxia)
Check blood glucose
Recheck temperature
Bloods: FBC/Hb, clotting, blood gas/lactate, group & save/crossmatch if blood loss
Consider therapeutic hypothermia pathway if significant HIE risk
Document timings, drugs, doses, response
Team debrief
Update parents

MILES TO READ B4 I SLEEP

Thursday, 10 September 2026

OLSQ