Baby Reynolds

last authored: April 2011, David LaPierre
last reviewed: May 2011, Dr Ian Johnston




Baby Reynolds is a girl born at 34 weeks gestation after a spontaneous rupture of membranes, with meconium present. The mother waited 24 hours before attending the hospital, at which point she was found to have a fever. Contractions had started three hours beforehand. The fetal heart rate was atypical, but not abnormal.

As the cervix was found to be fully dilated, the team elected to continue with labour, instead of Caesarean section.



The baby was born one hour later. She initially had poor tone, no respirations, and was cyanotic across her body.

What equipment do you want/need to have on hand?

Important equipment includes:


radiant warmer (turned on) and warm towels

gloves, clock, stethescope, pulse oximeter, tape

equipment for:

  • suction (mechanical suction, catheters, meconium aspirator)
  • positive pressure ventilation equipment, with oxygen supply and blender
  • intubation equipment: laryngoscope with 0 and 1 blade, 2.5, 3.0, 3.5 ETT, stylet
  • alternative airways

medications (discussed in another case)



What are your immediate first steps? Demonstrate this with the model.

Place the baby on a radiant warmer and towels without stimulating her.

Visualize the oropharynx using a laryngoscope, and if necessary clear the oropharynx with a large bore suction catheter.

Intubate the trachea with an ETT, attach a meconium aspirator, and suction through the ETT.

Dry and stimulate with a warm towel. If neccesary, stimulate further by flicking the feet or rubbing the back.

Reposition her head.


Demonstate what you next evaluate.

Assess for:


  • respiratory function
  • heart rate: palpate the umbilicus at the base, or listen with a stethoscope. Count 6 seconds and multiply by 10.
  • colour: look for central cyanosis


Baby Reynolds remains cyanotic and apneic and her HR is 90.

What do you do next? What are your options?

Because her HR is below 100, begin postive pressure ventilation. This can be done using:

  • self-inflating bag
  • flow-inflating bag
  • T-piece resuscitator

You have a self-inflating bag available, and you begin providing breaths using room air as the intial gas.


Demonstrate this. How do you assess for response?

Assess for:

  • adequate chest movement
  • bilateral breath sounds
  • improving colour and muscle tone
  • a rise in heart rate


Unfortunately, the heart rate continues to drop, even as you provide effective ventilation. The heart rate is soon assessed at 54.

How do you now respond?

As the heart rate is now below 60, you should begin chest compressions, at a rate of 3 compressions:1 breath.

It is ideal if two team members participate to provide effective CPR.


Consider orogastric tube placement, intubation, and placement of an umbilical line may be started to provide fluids and epinephrine.


You listen to the lungs, and hear decreased breath sounds.

What do you do about this?


If there is inadequate air entry, follow Mr. Sopa to help establish good ventilation:
M- mask adjustment
R- reposition airway
S- suction mouth and nose
O- open mouth
P- pressure increase
A- airway alternative (consider Laryngeal mask airway)


Unfortunately, during the resuscitation, the baby did not respond, and the heart rate continued to decrease. After 10 minutes, the team realized that further resuscitation was not to be successful and stopped CPR.


The mother, understandably, is very distressed, and asks you to go tell the baby's father, who is in the waiting room.


How do you break this bad news to the father?

One method of giving bad news is through the acronym SPIKES:

  • Setting
    get the setting right
  • Perception
    find out what the patient already knows
  • Invitation
    find out what they want to know
  • Knowledge
    give the information
  • Empathise and Explore
    respond to the patient's reactions
  • Strategy and Summary

Role play this with the tutor.


A post-mortem analysis is done, and E. coli was found in the infant's blood. Death was listed as neonatal sepsis, likely from an ascending route.



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