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

 

 

 

  • If thick meconium in amniotic fluid, consider oral intubation

 

 

Respirations present ?

 

  • No

 

 

 

    • Position infant supine or on side with neck in neutral position
    • BVM 30 sec at 40-60 breaths/min with 100% Oxygen

 

  • 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 100% Oxygen

 

  • 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.

 

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.

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate