New Born

 

History:

 

  • Due date and gestational age
  • Multiple gestation (twins, etc.)
  • Meconium
  • Delivery difficulties
  • Congenital disease
  • Medications (maternal)
  • Maternal risk factors
    • Substance abuse
    • Smoking

 

Significant Findings:

 

  • Respiratory distress
  • Peripheral cyanosis/mottling (normal)
  • Central cyanosis (abnormal)
  • Altered level of responsiveness
  • Bradycardia

 

Differential:

 

  • Airway failure
    • Secretions
    • Respiratory drive
  • Infection
  • Maternal medication effect
  • Hypovolemia
  • Hypoglycemia
  • Congenital heart disease
  • Hypothermia

 

 Treatment:

 

  • Suction mouth and then nose
  • Keep baby at level of the vagina until cord is cut
  • Clamp and cut cord
  • Record infant APGAR
  • Dry the infant, keep infant warm
  • use tactile stimulation to rouse the infant

 

 

Respirations present ?

 

  • No

 

    • Position infant supine or on side with neck in neutral position
    • BVM 30 sec at 40-60 breaths/min with room air

 

  • Yes

 

Heart Rate < 100 with persistent cyanosis ?

 

  • Yes

 

    • Position infant supine or on side with neck in neutral position
    • BVM 30 sec at 40-60 breaths/min with room air

 

  • No

 

    • Continue to monitor
    • Reassess 5 min APGAR
    • Continue Oxygen

 

Heart Rate < 60 ?

 

  • Yes

 

    • Begin CPR for 2 min or until spontaneous heart rate > 80

 

 

Improvement?

 

  • Yes

 

    • Continue Oxygen
    • Continue to monitor
    • Reassess 5 min APGAR
    • Initiate IV

 

  • No

 

    • Intubate and ventilate 1 min; continue CPR

 

    • Initiate IV/ IO

 

 

 

 

Heart rate 60-100 ?

 

  • Yes

 

    • Continue Oxygen
    • Continue to monitor
    • Reassess 5 min APGAR
    • Initiate IV
    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Neonate = birth to 1 day.
  • Maternal sedation or narcotics will sedate the infant.
  • CPR 100-120 compressions per minute and at a depth of no less than 1/3 of anterior/posterior diameter of chest with interruptions less than 5 seconds.
  • If HR is persistently < 60 to consider hypovolemia and pneumothorax as possible easily reversible causes of unsuccessful resuscitations.

 

Apgar Score

 

  • A score is given for each sign at one minute and five minutes after the birth.
  • If there are problems with the baby an additional score is given at 10 minutes.
  • A score of 7-10 is considered normal
  • 4-7 might require some resuscitative measures
  • baby with APGARS of 2 and below requires immediate resuscitation.