Nov 2007 ACoRN © Admission of a Baby

Nov 2007 ACoRN © Case Mom is 32 yr old G2 P1, 34 wks by datesMom is 32 yr old G2 P1, 34 wks by dates Admitted to hospital with abdominal pain and Hgb of 88g/LAdmitted to hospital with abdominal pain and Hgb of 88g/L Onset of labour is spontaneous - she delivers a baby boy vaginally 2 hours laterOnset of labour is spontaneous - she delivers a baby boy vaginally 2 hours later Apgar 6 and 7Apgar 6 and 7 The baby quickly develops marked work of breathing with severe indrawing - oxygen is required to maintain his colour.The baby quickly develops marked work of breathing with severe indrawing - oxygen is required to maintain his colour. He is transferred to the nursery with oxygen to the face.He is transferred to the nursery with oxygen to the face.

Nov 2007 ACoRN ©

Nov 2007 ACoRN © “Wet-in-bag” resuscitation Gestational Age < 28 w

Nov 2007 ACoRN © How would you usually administer oxygen during resuscitation and transfer?How would you usually administer oxygen during resuscitation and transfer? Oxygen administration

Nov 2007 ACoRN © Case (cont’d) In the nursery, you quickly weigh the baby before positioning him on a radiant warmer.In the nursery, you quickly weigh the baby before positioning him on a radiant warmer. Birth weight is 1900 gms.Birth weight is 1900 gms. How would you keep the baby warm and comfortable on the scale?How would you keep the baby warm and comfortable on the scale? How would you keep the baby pink while weighing?How would you keep the baby pink while weighing?

Nov 2007 ACoRN © Case (cont’d) You transfer the baby to a radiant warmer.You transfer the baby to a radiant warmer. To what do you set the temperature and mode?To what do you set the temperature and mode? Where and how do you secure the skin probe?Where and how do you secure the skin probe? What are causes of over- heating and under-heating the baby?What are causes of over- heating and under-heating the baby?

Nov 2007 ACoRN ©

Nov 2007 ACoRN © Case (cont’d) OR.. You transfer the baby into a warmed humidified incubator with ambient O 2OR.. You transfer the baby into a warmed humidified incubator with ambient O 2 What temperature and mode would you set the incubator to?What temperature and mode would you set the incubator to? What role does humidity play?What role does humidity play? What are causes of over- and under-heating a baby in an incubator?What are causes of over- and under-heating a baby in an incubator? How would you position the baby?How would you position the baby?

Nov 2007 ACoRN © Case (cont’d) While positioning the baby, you reassess breathing, heart rate and colour as per NRP guidelines.While positioning the baby, you reassess breathing, heart rate and colour as per NRP guidelines. Because he is breathing, HR > 100 and colour is pink with administration of oxygen, you do an ACoRN Primary Survey.Because he is breathing, HR > 100 and colour is pink with administration of oxygen, you do an ACoRN Primary Survey.

Nov 2007 ACoRN © Case (cont’d) The Primary Survey shows:The Primary Survey shows: –laboured respirations, moderate indrawing, RR 45/min, decreased breath sounds, grunting with stimulation –O 2 sats 94%: receiving 55% O 2 in a head box –HR 140/min, BP 40/24 mean 30, capillary refill >3 sec –colour pale pink –tone appears somewhat floppy

Nov 2007 ACoRN © How would you usually administer oxygen during stabilization?How would you usually administer oxygen during stabilization? Oxygen hoodOxygen hood Into incubatorInto incubator Nasal prongsNasal prongs Oxygen administration

Nov 2007 ACoRN © How do you best control the inspired oxygen concentration?How do you best control the inspired oxygen concentration? How would you track the amount of oxygen being administered?How would you track the amount of oxygen being administered? Oxygen administration

Nov 2007 ACoRN © Oxygen analyzer How do you calibrate the analyzer?How do you calibrate the analyzer? How often do you calibrate the analyzer?How often do you calibrate the analyzer?

Nov 2007 ACoRN © Cardiorespiratory monitoring Where do you apply the leads?Where do you apply the leads? How do you secure the leads?How do you secure the leads? What should you set the alarm settings to?What should you set the alarm settings to?

Nov 2007 ACoRN © BP measurement What does the BP reflect?What does the BP reflect? What values are you looking for?What values are you looking for? How do you select the appropriate size cuff?How do you select the appropriate size cuff? Where do you apply the cuff?Where do you apply the cuff? What are causes of incorrect results?What are causes of incorrect results?

Nov 2007 ACoRN © Pulse oximeter monitoring Where do you apply the probe?Where do you apply the probe? How do you secure the probe?How do you secure the probe? What are causes of incorrect results?What are causes of incorrect results? What should you set the pulse oximeter alarm settings to?What should you set the pulse oximeter alarm settings to?

Nov 2007 ACoRN © Blood glucose sampling How would you obtain a blood sample from this baby for glucose screening?How would you obtain a blood sample from this baby for glucose screening? –by lab specimen? –by bedside testing device?

Nov 2007 ACoRN © Blood glucose sampling (cont’d) How would you prep the skin for sampling?How would you prep the skin for sampling? How would you grasp the limb during sampling?How would you grasp the limb during sampling? What size of lancet would you use?What size of lancet would you use? How would you protect the lanced site?How would you protect the lanced site? What are the potential complications caused by capillary sampling?What are the potential complications caused by capillary sampling?

Nov 2007 ACoRN © Questions??