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Neonate Assessment Part 2 - Coggle Diagram
Neonate Assessment Part 2
Assessment: Cardio-Respiratory
Tachypnoea (> 60 breaths per minute)
Apnoea (absence >20 seconds)
Grunting on expiration
Work of breathing
Retractions of intercostal, subcostal, supraclavicular muscles and sternum
Nasal flaring, head bobbing
Cyanosis
Auscultation - equal/unequal air entry, added sounds (?stridor)
Decreased activity
Hypoglycemia -
Hypoglycaemia - (< 2.6 mmol/l)
Preterm, IUGR infants, lack of calorie intake, hypothermia, sepsis, infants of diabetic mothers, infants with inborn errors of metabolism - galactosaemia, hypoxia/asphyxia, hyperinsulinism
Signs & Symptoms
Symptoms (NB may be asymptomatic)
lethargy, limpness, pallor
tremors / jitteriness / convulsions
apnoeas/cyanosis/tachypnoea
Abnormal cry - weak, high-pitched
Common Causes of Respiorty Distress
sepsis/pneumonia
Meconium aspiration syndrome
Transient tachypnoea of a newborn
PPHN
Signs of Respiratory Distress
Respiratory Distress Syndrome (surfactant deficiency)
Transient Tachypnoea of the Newborn
Meconium Aspiration Syndrome
Congenital Pneumonia
Pneumothorax
Chronic Lung Disease (ex-preterm infants)
Congenital anomalies such as congenital diaphragmatic hernia
Hypoglycaemia, Hypothermia
Congenital Heart Disease
Neurological causes e.g. Seizures or Congenital hypotonia
Cardiac Assessment:
Heart rate (100-160 beats/minute)
Tachycardia > 180
Bradycardia < 100
But THINK about the BABY and the TREND!
Murmurs
Blood Pressure
Gestational Age and Post-natal age
Systolic 50 - 72 mmHg
Diastolic 25-45 mmHg
Mean 30-35 mmHg
Pulses
Perfusion /pallor/mottled
Neonatal Stridor:
Commonly caused by laryngomalacia
Vocal cord palsy
Assessment of feeding tolerance
Gastric aspirates/residuals
Aspirate color e.g. bilious aspirates?
Abdominal distension
Bowels open?
Immature gut/dysmotility
“CPAP” belly?
Necrotising enterocolitis
Septic ileus
Assessment of feeding tolenernaces
Type 1 - very constipated
Type 2 - slightly constipated
Type 3 - normal
Type 4 - normal
Type 5 - lacking fibre
Type 6 - inflammation
Type 7 - inflammation
BRISTOL STOOL CHART
Bilious vomiting - Bilious vomiting occurs when there is a gastrointestinal obstruction. Bile is dark green rather than yellow..
Assessment - infection
Lethargy
Pallor, mottling or jaundice
Poor feeding
Apnoeas/desaturations/bradycardias/tachypnoea
Tachycardia/ Prolonged CRT
Hypo or hyperthermia
Hypo or hyper-glycaemia
Increased gastric aspirates
Localized signs such as redness, swelling, warmth or pain
Parents may report “quiet” behaviours
Biochemical markers e.g. C-Reactive Proteins
Signs & symptoms
Assessment - Pain - this can be tricky as neonates cant tell you where the pain is
Response to handling
Tools lack validity and reliability
Degree of subjectivity
Physiological
signs to look for
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Holistic Care of the Neonate & Family
Developmental Care
Family Centered Care
Family Integrated Care is a model used within neonatal care
The Bliss baby charter - Parents are informed, guided and supported so that they understand their baby’s care processes and become confident in caring for them. Parents should have access to information about clinical conditions, tests and treatment, infant development
Impact of admission on thr family
Disruption of Parent-Infant Dyad
Short and long-term impact
May have never really “met” their baby
Maternal stress and anxiety
Bonding
Depression
Grief
Loss of control
Loss of normal
Maybe I was too scared to get involved initially
Newborn Individualized Developmental Care and Assessment Program [NIDCAP]
Cue-based care vs clustering cares
Cluster care to promote long periods of sleep
Individualized care protocols
Observe closely for disorganization behaviors
Fluctuations in heart rate or oxygen saturation
Hiccoughs, sneezing, yawning
Jittery and frantic body movements
Inability to modulate state, limited self-consoling behaviors or unable to be consoled
NIDCAP Aims
Family intergarted care
Multi-centre, multi-national, cluster RCT
< 33 weeks on no or low-level respiratory support
Parents present for at least 6 hours a day
Parents attended educational sessions
Improved weight gain
Decreased parental stress and anxiety
Increased exclusive breastfeeding at discharge
Improved weight gain
Decreased parental stress and anxiety
Increased exclusive breastfeeding at discharge
Summaary of planning care in NICU
A. B..C
And then consider….
The Golden hour
Individualised, cue-based approach to on-going care
Integration and involvement of parents
Multi-disciplinary team