Chapter 38 Newborn Care

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  The Newborn  Initial Assessment of the Newborn  Focused Assessment of the Neonate  Newborn Resuscitation

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 The Newborn  From birth to one month; called a neonate  Must adjust to life outside the womb

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Initial Assessment of the Newborn  The Apgar score is a standard tool for measuring the health of a newborn  Measures heart rate, respiration, muscle tone, response to stimuli, and color  Assessed one minute and five minutes after birth

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Initial Assessment of the Newborn  A: Appearance –Score 2 Completely pink –Score 1 Cyanotic extremities –Score 0 Central cyanosis

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Initial Assessment of the Newborn  P: Pulse –Score 2 Greater than 100 bpm –Score 1 Less than 100 bpm –Score 0 No pulse

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Initial Assessment of the Newborn  G: Grimace –Score 2 Cough or sneeze –Score 1 Grimace –Score 0 Unresponsive

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Initial Assessment of the Newborn  A: Activity –Score 2 Active –Score 1 Flexion –Score 0 No motion

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Initial Assessment of the Newborn  R: Respiration –Score 2 Good respiration, strong cry –Score 1 Slow or irregular respiration, weak cry –Score 0 Apneic

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Initial Assessment of the Newborn  Management –First priority is to maintain the airway –The newborn produces a large amount of mucus in the first 30 minutes to one hour after birth –If after suctioning respiratory effort is still poor, administer blow-by oxygen –If still no improvement, assist with BVM

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Initial Assessment of the Newborn  Management –Signs of respiratory distress See-saw respirations Chest retractions Audible grunting Intercostal retractions Sternal retractions

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Initial Assessment of the Newborn  Management –Healthy newborns will show the desire to breastfeed –Newborn is prone to hypothermia and must be kept warm

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Focused Assessment of the Neonate  General appearance –Healthy newborn Fetal position Red and flushed skin when crying Head may appear misshapen after vaginal delivery Look for bulging or depressed fontanels Eyes may lack focus Assess umbilical cord; should be bluish-white

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Focused Assessment of the Neonate  Birth trauma –If not moving the arms symmetrically, the newborn may have fractured a clavicle

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Focused Assessment of the Neonate  Birth defects –The mother will want to know if the baby is OK –The EMT may need to help the mother deal with her emotions if the baby is not “perfect”

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Stop and Review  Describe how to obtain an Apgar score.  Describe the meaning of the Apgar score.  What are the treatment priorities for the newborn?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Newborn Resuscitation  Not all newborns breathe spontaneously after birth; some may need assistance  Lay the newborn on his back and vigorously dry him in circular motions  Open the airway with modified jaw thrust  Keep head in neutral position  Suction nostrils and mouth  Provide CPR if necessary

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Newborn Resuscitation  Meconium aspiration –The newborn’s first feces –Can cause difficulty breathing if aspirated

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Stop and Review  Demonstrate the resuscitation of a newborn in cardiac or respiratory arrest.