ASSESSMENT OF THE NORMAL NEWBORN This is the assessment of the newborns immediate transition to extrauterine life.
Neonates Birth to 28 days Circulation changes from fetal to newborn. ductus venosus (closure). foramen ovale (closes). ductus arteriosus (closure) Cardiovascular system Normal hr 120-160 Bp 80-60/45-40, 100/50 Respiratory Respirations irregular, 30-60, obligatory nose breather, 15 second apnea normal. Hepatic system Breakdown of hb to bilirubin, conjugated in liver, excreted in stool (serum high = 13 - 22 mg/dl) Hyperbilirubinemia before 24 hrs (toxic, kernicterus) Pathologic jaundice (Bililights, exchange transfusion) Physiologic jaundice at day 2-3, 50% have hydration, stooling Thermoregulation Risk of hypothermia: -subcutaneous fat. -Thin epidermis. -Large body surface area in relation to body mass more heat loss. To prevent hypothermia: -Skin to skin contact. -Dress warmly, hat on. -No draft. -Keep dry. -Keep off cool surfaces. -Check temp frequently until stabilized Renal System Easy to under or overhydrate Void < 24 hours after birth, 2x/day first week, then > 6x/day GI system Meconium stool - 24-48 hrs. Transitional stool - days 2-3 10% weight loss first week Immune System passive immunity
-placental transfer IgG -breastfeeding IgA Hematologic system Leukocytosis normal Blood volume (placental transfer, cord blood) hct up then down Rh factor - Antigen found on surface of RBC. Rh neg mom, Rh positive dad Antibodies made, destroy fetal Red Blood Cells in subsequent pregnancy. Erthroblastosis Fetalis *Rhogram after delivery Normal Newborns: Initial Care Vitamin K IM Id (every separation, every shift). V/S with temp (warming). Eye prophylaxis - erythromycin 1hr (chlamydia & gonnorrhea). Physical assessment. Gestational age assessment. Umbilical Cord Care Clean & dry. Alcohol wipe once a day. Topical antiseptic only in contaminated areas. Vitamin K First few hours. 0.5-1.0 mg IM. Prevents hemorrhagic disease. Eye Prophylaxis 1% silver nitrate. 1% TTCN ophthalmic ointment. 0.5% erythromycin ointment. Physical Assessment LGA, AGA, SGA Physical characteristics - normal, pre & post term Posture Vernix caseosa -cheesy white -normal -antibacterial properties -protects the newborn skin
Lanugo Sole creases Areola, breast Ears Genitals Nails Vital Statistics: -Weight =6lbs. -Length=48-50 cm -Chest=32-33 cm -Head=33-35 cm Vital Signs -Temp=37.2 C -Pulse=120-160bpm -Respiration=30-60 breaths per minute -BP=80/46 mmHg at birth and rises about 100/50 mmHg Neurological Assessment Sucking (rooting): Stimulation of the cheek causes infant to turn head toward stimulus Swallowing: swallowing caused by stimulation of the palate Extrusion: after stimulation of palate, tongue is pushed out when touched Tonic neck (fencing): Extension of arm and leg to side to which head is forcible turned with flexion of opposite arm (should be absent by 3-4 months) Palmar (plantar): fingers tighten around an object placed in the palm; similar response when the sole of the foot is stroked near the toes Moro (startle): Extension then flexion of arms and legs, fanning then clenching of fingers in response to startling stimulus Pull to sit: The infants head lags until upright Babinski: Dorsiflexion of big toe and fanning of other toes when sole of the foot is stroked from heel to toe (should be absent after 1 year). Neurologic - sensory capabilities Hearing, Vision Taste, Touch - Pain Smell Crying - what to do Smiling - reflex & social CARE OF NEWBORN Care of the Newborn in the Field May need to help them clear mucous and amniotic fluid from the airway. Use a bulb syringe. Use it gently.
If bulb syringe is not available, use any suction device, including a small hypodermic syringe without the needle. Ventilate if Necessary If not breathing following brief stimulation, ventilate. Ideally, bag/mask, 100% oxygen, pressure gauge, flow control valve. May need to use mouth-to-mouth. Cover nose and mouth. Use shallow puffs to ventilate. Position the Baby Keep the baby on its back or side, not on its stomach. Neither extend nor flex the head. Either may obstruct the airway. Newborn babies normally make this adjustment themselves. If depressed, you need to position the head to get a good airway. Check the Heartbeat Normal newborn rate is >100. Palpate umbilical cord or brachial artery. If pulse <100, ventilate the baby, using whatever skills and equipment you have. Dry the Baby Hypothermia is common. Wet newborns rapidly lose heat. Use a warm, dry, soft towel. Any absorbent material: Shirt T-shirt Socks Replace the Wet Towels Then let the mother hold the baby. Her body heat will help keep the baby warm. Cover the head to prevent heat loss. Keep the Baby Warm Keep the airway open. Keep the head covered. Use any available cloth or heat-retaining material. Check temp several times: 97.7-99.3F axillary. Evaluate the Baby Breathing
Color Heart Rate Tactile stimulation (rubbing) with a towel. May effectively stimulate a mildly depressed baby Colour Most newborns have acrocyanosis (body is centrally pink, but hands and feet are blue. Cyanosis requires treatment: -Oxygen -Airway -Ventilation Field Expedient Bottle Breast feeding is better. If mother not available formula warm to body temperature. If formula not available, use sugar water. Avoid cows milk unless there is no alternative and baby formula is not expected soon. APGAR SCORING A irway P ulse G rimace A ppearance R - eflex What Do The APGAR Scores Mean? The five items to be assessed are arranged in priority. From most important which is the heart rate. Least important which is color. The scores given are between zero and two for each condition with a final total of up to ten. At the one minute APGAR, scores between seven and ten indicate the baby will need only routine post delivery care. Scores between four and six may indicate some assistance may be required for breathing. Scores under four may call for prompt lifesaving measures. At the five minute APGAR, a score of seven to ten is normal. If the score falls below seven the baby will continue to be monitored and retested every five minutes up to twenty minutes. Lower than normal scores do not mean there will be any permanent problems for the baby. Heart rate: 0 - No heart rate. 1 - Fewer than 100 bpm, the baby is not very responsive. 2 - More than 100 beats per minute, the baby is obviously vigorous.
Respiration: 0 - Not breathing. 1 - Weak cry; may sound like whimpering or grunting. 2 - Good, strong cry. Muscle tone: 0 Limp. 1 - Some flexing (bending) of arms and legs. 2 - Active motion. Reflex response: 0 - No response to airways being suctioned. 1 - Grimace during suctioning. 2 - Grimace and cough or sneeze during suctioning. Color: 0 - The baby's whole body is completely blue or pale. 1 - Good color in body with blue hands or feet. 2 - Completely pink or good color.
