Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 43 Neonatal Care

43-2 Objectives

Caring for the Newborn 43-3

Beginnings Changes from fetal to neonatal circulation –Fetal airways and alveoli are filled with fluid –Newborn’s respiratory system must suddenly begin and maintain oxygenation –Newborn’s blood pressure increases as umbilical vessels constrict –Newborns are very sensitive to hypoxia 43-4

Important Questions Term gestation? Clear of meconium? Breathing or crying? Good muscle tone? Color pink? 43-5

Meconium Thick and sticky in consistency Varies in color Indication of possible fetal distress If inhaled, may cause severe inflammation of the lungs and pneumonia 43-6

Newborn Care 43-7

Newborn Care 43-8 [Insert figure 43-20]

Newborn Care Normal breathing rate –Between 30 and 60 breaths per minute If breathing is adequate, assess the heart rate. If no improvement after 5-10 seconds, help baby the breathe 43-9

Newborn Care Feel for a brachial pulse Normal heart rate – beats per minute If heart rate is more than 100 beats per minute, assess skin color 43-10

Newborn Care If the heart rate is less than 100 beats per minute: –Immediately breathe for the baby –Reassess in 30 seconds If no improvement and the heart rate is less than 60 beats per minute, begin chest compressions If the heart rate is more than 60 beats per minute but breathing is inadequate: –Breathe for the baby –Reassess in 30 seconds 43-11

Newborn Care Central cyanosis –Bluish tint of the face, chest, or inside of the mouth Acrocyanosis –Bluish tint of the hands and feet 43-12

Newborn Care If baby has: –Adequate breathing –A heart rate of more than 100 beats per minute –But central cyanosis is present: Give blow-by oxygen 43-13

Apgar Score Sign012 AppearanceBlue or paleBody pink Extremities blue Completely pink PulseAbsentBelow 100/min Above 100/min GrimaceNo responseGrimaceCough, sneeze, cry ActivityLimpSome flexion of extremities Active motion RespirationsAbsentSlow, irregular Good, crying

Questions? 43-15