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Newborn Management (Delivery: time 0 min (1 min ⏲: Stimulate!
key!
…
Newborn Management
Delivery: time 0 min
Preparation
- towels
- warmer
- Respiratory equipment
Also… anticipate problems
- eg 24yo G2P2 w/ prenatal care ∆ from 16yo w/ no prenatal care delivering @ 22wk w/ SGA child
- prepare: know…
- gestational age
1 min ⏲: Stimulate!
- key!
- trying to overcome primary apnea
- rub the back, use towels, or tap the feet 👣
- baby will take first deep breath
- start considering oxygenation and circulation
O2
- 1st min, ok if pulse ox not even on, expect baby (SpO2: 60-65%)
- improve w/ suctioning
- suction mouth, then nose (avoiding meconium aspiration)
- then… PPV (+ press vent.) = bag the 👶
- always asking "do they need intubation?"
- is 2º apnea present
- after initial period of spon breathing there may be apnic periods
- oropharyngeal suctioning may be enough
- if baby is not doing well, → endotracheal suctioning
HR ❤️: goal = > 100
- if < 100 in min 1 ⏲
- PPV
- prob an O2 problem, get O2 ↑ w/ vent before worrying about HR ❤️
1 - 5 min: Respirations (most imp) and Circulation
Calc 1st APGAR score
- is baby improving in first few min?
- goal : 7-10 = std
- < 7 = do something
O2
- await good O2 levels pulse ox
- FiO2%
- consider, "do i need PPV?"
HR❤️ : goal = > 100
- 60-100 is likely respiratory issue
- < 60 w/ good chest mvt (+ supp O2)
- cardiac ❤️ problem = CPR
- 3 compression: 1 ventilation
- & access umbilical vein : + Epi
5 - 10 min: improving APGAR (O2 cards less imp)
Calc 2nd APGAR score
- goal: 7-10
- or at least improvement
O2
- SpO2 90-99%
- use FiO2 & PPV
HR❤️
- goal = > 100
- resp issue: 60-100
- code: < 60
> 10 min: move to std care
- no improvement → continued APGAR until 7-10 w/ good O2 & HR❤️
What is Std of Care?
happy fat baby 👶
- measure baby
- weight, length (height), head circ
- Cord
- 2 aa, 1 v, clip/clamp it close to baby & remove excess
- Shots + Drops
- Vit K
- prevents hemorrhagic disease in newborn
- gut incapable of making vit K
- consider HBV
- ± IVIG based on mom's status
- Drops
- ppx Erythromycin,
silver nitrate
- Tx is disease specific : optho peds
PEx
- Scalp
- eye 👁
- mouth 👄
- Crepitus in bones
- Cards❤️
- Lung
- bowel sounds in lung
- other abn
- Cord 🔌
- ± bowel problem = gastroschistis/omphalocele
- Genitals 🍆
- gender the baby
- ± any defects (hypo/epispadias)
- remember
circumscision✂️
- Anus 🍩
- imperforate?
- VACTREL (failure to pass meconium)
- Jaundice
- Ortolani & Barlow
-
TTN
Path: Self limiting
- baby 👶didnt get squeezed thru birth canal
- baby not prop stimulated
Pt: near term 👶
Dx: CXR = hyperextended & wet
Tx: PPV
can persist until 48 hr
RDS
aka real problem! Developmental
Path: insuff surfactant
Pt: severe preemie
Dx: CXR = hypoextended & atelectasis
Tx: Intubation ± surfactant
Hypoglycemia :candy:
assd w/ worse outcomes for baby in development
Path: LGA, SGA, DM mom, IUGR
Pt: Asx, or full blown (jitter, tremor, seizure)
Dx: routine Glu screen
- look for causes of infx r/o (sepsis :biohazard_sign:)
- we just fix it
Tx:
- Sx: then feed
- cant feed? IV bolus glucose (2ml/kg D50)
- persistent? drip IV D5 or D10
-
- review: things to do as soon as baby comes out
- delivery → healthy baby in "well" nursery
- get 👶 oxygenated, make sure ❤️ pumping blood thru body
- O2 and Circulation are 1º focus in first minutes⏲ of life
- Then: diseases, troubleshooting
- finally: normal exam, how to lead to other lectures (diseases)