Basic Neonatal Care
Presented by
Kristy Oswald RNC
Neonatal Transport Team
Anatomical Considerations: Infant versus Adult
1. Head:
a. Proportionally larger in a newborn than an adult.
b. Approximately one-fourth of the newborns body size.
- Susceptible to greater heat loss when exposed.
2. Chest:
a. Ribs are much softer and pliable.
-Easier to injure chest organs.
3. Body Surface:
a. Larger body to surface area to body mass ratio.
-Susceptible to greater heat loss when exposed.
4. Smaller airways:
a. Tongue: Large relative to the mouth.
-Easier to obstruct airway with secretions.
b. Obligate nose breathers
-Must keep nose clear of secretions.
5. Immature Immunological Systems:
a. Greater risk of infection.
6. Circulation
a. Smaller blood volumes.
Initial Care of the Newborn
1. Position, dry and suction the newborn: done in first 30 seconds
a. Position on back with head positioned in neutral position.
b. Dry baby thoroughly and remove wet linens.
c. Bulb suction the mouth and nose as needed.
2. Stimulate the Newborn: done in first 30 seconds
a. Begin by drying the newborn.
b. Flick the soles of the feet.
c. Gently rub the back.
3. Keep warm.
a. Hat on babe or cover with the blanket.
b. Dry blanket or towel on babe at all times.
c. Place infant skin to skin with mom if her condition is stable.
Assessment of the Newborn
1.
Assess Skin Color
-Is it blue or white?
-Is it pink with blue hands and feet?
-Is it pink?
2. Assess Heart Rate
-Is it zero?
-Is it < 100?
-Is it > 100?
3. Assess the Respirations
-Are they absent?
-Are they slow and irregular or gasping?
-Do you have a strong cry?
4. Assess the Grimace?
-Is there no response?
-Is there only a facial grimace?
-Is the baby actively crying?
5. Assess Activity
-Is the baby limp or flaccid?
-Is there slight flexion of the extremities?
-Is the baby well flexed with active motion?
This is your APGAR score and is a quick assessment of the infant’s well-being.
APGAR scoring is done at 1 and 5 minutes and then as needed.
Sign
0 Points
1 Point
2 Points
A
Activity (Muscle
Tone)
Absent
Arms and Legs
Flexed
Active Movement
P
Pulse (heart rate)
Absent
<100
>100
G
Grimace (Reflex
Irritability)
No Response
Grimace
Sneeze, cough, pulls
away, crying
A
Appearance (Skin
Color)
Blue-gray, pale
all over
Pink, except for
extremities
Pink over entire body
R
Respiration
Absent
Slow, irregular
Good, crying
Anticipation and Recognition of the Neonate in Distress
1. Recognition and treatment of Primary and Secondary apnea
a. Primary Apnea: When asphyxiated, the infant responds with an increased
respiratory rate. If the episode continues, the infant becomes apnic, followed by a
drop in heart rate and a slight increase in blood pressure. The infant will respond to
stimulation and O2 therapy with spontaneous respirations.
b. Secondary Apnea: When asphyxia is allowed to continue after primary apnea, the
infant responds with a period of gasping respirations, falling heart rate, and falling
blood pressure. The infant takes a last breath and then enters the secondary apnea
period. The infant will not respond to stimulation and death will occur unless
resuscitation begins immediately.
-Assume the infant is in secondary apnea because you can not differentiate between the
two and begin resuscitation.
Bag and Mask Ventilation in the Newborn
1. Indications for bag and mask ventilation
a. Apnea
b. Heart rate less than 100 beats/minute
2. Rate: 40-60 breaths/minute
3. Pressure to Use:
a. Initial breath after delivery: 30-40 cm H2O
b. Normal delivery: 15-20 cm H2O
c. Diseased Lungs: 20-40 cm H2O
Chest Compressions
1. Indications:
a. Heart rate is zero
b. If after 30 seconds of PPV the heart rate is below 60 beats/minute
2. Technique
a. One fingers breadth below nipple line, using 2 fingers
b. One fingers breadth below nipple line, using the two thumb method with hands
encircling the chest.
c. ½ to ¾ inch compression depth.
d. Accompanied with ventilations:
-NRP guidelines: 120 events/minute, 90 compressions + 30 breaths. (One and
two and three and breath)
If adequate ventilations and chest compressions do not work, advanced life support (ALS) is
required. Continue with ventilations and chest compressions until care can be transferred to an
ALS provider or the newborn demonstrates adequate ventilations and perfusion.
-Remember that effective ventilations include a good seal and normal inhalation/exhalation
times. Ventilation too fast and forcefully will compromise the heart and circulatory system.
Meconium Stained Fluid (MSF)
-Greenish substance that represents the newborn’s first bowel movement.
-Amniotic fluid that is greenish or brownish-yellow indicates the presence of meconium.
-MSF may signal fetal distress during labor.
-Be prepared for a possible resuscitation
Prolapsed Cord
-Condition where the umbilical cord presents through the birth canal before delivery of
the head.
-Serious emergency.
-If not recognized early, the end result is death of the newborn.
-Be prepared for a full resuscitation of the newborn.
Premature Delivery
-Any delivery at 36 weeks gestation or less.
-Hypothermia is a big risk. Keep the baby warm.
-Be prepared for a full resuscitation of the newborn.
-Always request ALS assistance when delivering a preterm.
Normal Vital Signs
1.
2.
3.
4.
Temperature: 97.7-99.4, axillary
Heart Rate: 120-160 beats/minute
Respiratory Rate: 40-60 breaths/minute
Blood Pressure: Term Infant: Systolic 55-69, Diastolic 33-45, Mean 41-54.
Preterm Infant: Systolic 37-57, Diastolic 18-38, Mean 24-36.
-Width of the cuff should cover two-thirds of the upper arm.
-BP will be increased when the cuff is too small.
5. Oximeter: <29 weeks: 84-89%
29-32 weeks: 86-92%
32-34 weeks: 90-94%
34-37 weeks: 92-96%
>37 weeks: 94-97%