Newborn Management
- Preparation:
o Towels, warmer, and respiratory equipment
o Gs and Ps
o Gestational Age, and prenatal care
- Delivery
o Stimulation
o Overcome primary apnea
 Rub back, towels, tapping feet
o Oxygenation
 60-65%
 Tx: by suctioning of mouth and then nose
 If they do not get better: PPV
 Intubate?
 Secondary Apnea
o HR
 Goal HR > 100
 If less than 100, give PPV
- Minute 1 – Minute 5
o APGAR 1: 7-10 is good
o <7 APGAR needs something
o O2 – 80-85%
 If not good enough, give FiO2
 Possibly PPV or intubation
o HR> 100 is good
 If 60-100, give PPV
 If < 60, give CPR and EPI
- Minute 5-10
o Oxygenation: 90-95%
 If not there, give FiO2 and PPV
o HR>100 is good
 Same intervention as prior
- APGAR (2, 1, 0)
o Appearance
 Pink Baby
 Acrocyanosis
 Blue
o Pulse
 >100
 <100
 Absent
o Grimace
 Little stimulation
 Lot of stimulation
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 Absent
o Activity
 Resist extension
 Flex but not resist
 None
o Respiration
 Strong and regular
 Irregular respiration
 None
TTN
o Self limiting
o Seen in C-Sections
o Pt: Term baby, grunting
o Dx: CXR, hyperextended lungs
o Tx; PPV
RDS
o Developmental
o Insufficient Surfactant
o PT; Premie, respiratory distress
o Dx: Hypoextended lungs, collapse
o Tx: Intubation and surfactant
Hypoglycemia
o LGA, SGA, DM moms, IUGR
o Pt: asymptomatic, gittery, tremor seizure, lethargy
o Dx: Look for infectious cause
o Tx: Asx: Feed; Sx: 2mg D50; persist: Drip D5 or D10
Well Baby Visit
o 1. Measure Baby
 Wt
 Length
 Head circumference
o 2. Cord
 2 art, 1 vein, clamp
o 3. Shots and Drops
 Vit K
 Hep B or IVIG
 Erythromycin eye drop
o 4. Baby
 Fontanelles
 Red Reflex
 Cleft Lip
 Bones / Clavicle for Crepitus
 Murmurs
 Lung Sounds
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Cord, bowel problem
Genitalia
Imperforate anus (VACETERL)
Skin – Jaundice
Ortolani Barlow