neonatal heart rate
Apgar testing is done
at 1 and 5 minutes after delivery or every 5 minutes for 20 min (for low scores)
G= grimace to suctioning
A= activity ( is baby flexing) muscle tone
R= RR crying - weak or strong- not at all
Blue= 0, Blue extremities/pink torso= 1, Pink= 2
What you do first if baby is unresponsive/blue
always bag first with 100%fi02, 40-60 breaths/min
bag baby for 15-30 seconds- ck HR and if below 60 and continues to stay below 60bpm- begin chest compressions
infant chest compressions
done if HR is below 60bpm and baby's color has not improved (after bagging for 15-30 seconds)
place thumbs on chest between nipples, be careful of xyphoid process - - 3 to 1 if needed give epi down et tube
Ballard (Silverman) gestational age assessment
Scarf sign -done before 42 hours of life- flexing baby etc to discover the gestational age.
lifting the elbow across the body-- assessment is according to how far the elbow will go across the body
45-56% (3 times hemoglobin)
Infants are all screened for
metabolic diseases such as congenital hypothyroidism which is associated with mental retardation
WBC's in infants
-as high as 25 in the immediate newborn period
-high or low WBC and low platelet count are associated with infection in the neonate
What is checked immediately to look for hypoglycemia?
General appearance- what to look for-
edema-peripheral edema, JVD and liver enlargement are signs of cardoivascular problems
Rate and Pattern- very sensitive indicator of respiratory distress. Should be counted for a full minute
Nasal flaring and grunting- this means severe distress.
How does infant create auto PEEP?
in an attempt to preserve FRC
common finding in right heart failure
Caused by reflex vasodialation in the fingers caused by Chronic Hypoxemia. Can also appear in liver and GI disturbances
should occur within 10-15 seconds - decreased time associated with decreased cardiac output or high vasopressors
Auscultation- decreased lung sounds
indicate volume loss- RDS or pneumonia
Infants are very resonant
PFT's for infants- what is best way to track lung compliance?
Pressure/volume loop - best way to determine if more surfactant or less is needed for infant.
change in pressure, change in volume
0-3 = POOR- Resucitate
4-6= FAIR - Stimulate
7-10= GOOD - Celebrate