Chapter 43
Neonatal Care
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43-1
Objectives
43-2
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
[Insert figure 43-20]
43-8
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
– 100-180 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
Sign
Appearance
Grimace
1
Body pink
Extremities
blue
Absent
Below
100/min
No response Grimace
Activity
Limp
Respirations
Absent
Pulse
0
Blue or pale
2
Completely
pink
Above
100/min
Cough,
sneeze, cry
Some flexion Active motion
of extremities
Slow,
Good, crying
irregular
43-14
Questions?
43-15