Introduction
Dr. Miada Mahmoud Rady
EMS/481
Neonatal emergencies lecture 1
Introduction
 Newborn : babies within the first few hours after birth.
 Neonates : within the first month after birth.
 Paramedic is usually called to take care of newborn in two
cases :
1. For transport in case hospital delivery.
2. In case of unscheduled either ( home or in the field
delivery ).
Introduction
 Unscheduled delivery means two patient , at least , the mother
and the baby.
 Most of new born will need minimal stimulation .
 The need for further intervention is affected by several factors.
Neonatal resuscitation
 Factors that may indicate the need for further intervention
include :
1. Antepartum Factors.
2. Intrapartum Factors.
Factors that may indicate the need
for resuscitation :
Antepartum Factors
Intrapartum Factors
1. Multiple gestations
2. Inadequate prenatal care
3. Mother’s age (<16 or
>35)
4. History
of
prenatal
morbidity or mortality.
5. Post term gestation.
6. Drugs or medications.
1. Premature labour
2. Meconium stained amniotic
fluid
3. Ruptured membranes more
than 24 hours prior to
delivery
4. Narcotics within 4 hour of
delivery
5. Abnormal presentations.
Transition From Fetal To Neonatal
Circulation
 Dramatic changes occurs as the newborn prepares for
extra uterine life :
1. Fluid in the fetal lungs is forced out through chest
compression during delivery.
2. Newborn usually takes first breath within seconds of
delivery independent of cutting cord.
Transition from Fetal to Neonatal
Circulation
3. Stimulant of the First Breath include :
a. Mild acidosis.
b. Initiation of stretch reflexes in the lungs.
c. Hypoxia.
d. Hypothermia .
Transition from Fetal to
Neonatal Circulation
4. Changes that occur with the first breath:

At birth , the lung expand as become filled with air and alveolar
fluid gradually leaves the lungs .

At the same time , lung arterioles open allowing considerable
amount of blood to enter the lung.

As result , the blood that was passing through the ductus arteriosus
enter the lung where it pick up oxygen and then this blood is
carried to supply the newborn tissue , so the ductus starts to close.

Circulation to the lungs increases left atrium flow, increased
pressure causes the foremen ovale to close and blood
circulates normally.

During the first breath , pulmonary vascular resistance
drops .
Transition from Fetal to
Neonatal Circulation
4. Delay in drop pulmonary pressure leads to:
a. Delayed transition.
b. Hypoxia.
c. Brain injury.
d. Death.
Assessment
of
the newborn
Assessment general guidelines
1. Assess the newborn immediately after birth.
2. Ideally, one paramedic attends the mother while the other
attends the newborn.
3. Newborns will be slippery and require both hands.
4. Use the following parameters to assess newborn : heart rate ,
respiratory rate , skin color and APGAR score.
General parameters
1. Normal heart rate 150–180/min :
 Slowing to 130–140 thereafter.
 A pulse less than 100 indicates distress.
2. Normal respiratory rate 40–60/min.
Normal appearance

Head : shows molding which is the irregular shape of a baby's
head from the birth process. Normal shape usually returns by the
end of the first week.

Vernix : This is a white, greasy, cheese-like substance on the skin
of many babies at birth. It protects the baby's skin during
pregnancy.

Lanugo : This is soft, downy hair on a baby's body , It's more
prominent in premature babies , gradually disappear.
Normal appearance
 Color : A baby's skin coloring can vary greatly .
1. When first born, the skin is a dark red to purple color. As the
baby begins to breathe air, the color changes to red.
2. This redness normally begins to fade in the first day.
3. A baby's hands and feet may stay bluish in color for several
days , due to underdeveloped blood circulation.
4. Blue coloring of other parts of the body, however, isn't
normal.
Normal appearance
 Milia : are tiny, white, bumps on a newborn's nose, cheeks,
chin and forehead, milia form from oil glands and disappear on
their own.
APGAR test
 Definition :
1. A quick test performed on a baby at 1 and 5 minutes after
birth :
 The 1-minute score : determines how well the baby
tolerated the birthing process.
 The 5-minute score : determines how well the baby is
doing outside the mother's womb.
How the test is done?.............
 You will examine the baby's:
1. Breathing effort
2. Heart rate
3. Muscle tone
4. Reflexes
Each
category
scored with 0, 1, or
2, depending on the
observed condition
5. Skin color
is
Why the test is done??
 This test is done to determine whether a newborn needs help
breathing or is having heart trouble.
 Normal Results
1. The APGAR rating is based on a total score of 1 to 10.
2.
The higher the score, the better the baby is doing after
birth.
3. A score of 7, 8, or 9 is normal and is a sign that the
newborn is in good health.
APGAR
score
A for appearance
1. Appearance (Skin color):
• If the skin color is pale blue, the infant scores 0 for color.
• If the body is pink and the extremities are blue, the infant
scores 1 for color.
• If the entire body is pink, the infant scores 2 for color.
P for pulse
2. Pulse (Heart rate) :
 is evaluated by stethoscope ,this is the most important
assessment:
 If there is No Heartbeat, the infant scores 0 for heart rate.
 If heart rate is Less Than 100 Beats per minute, the infant
scores 1 for heart rate.
 If heart rate is Greater Than 100 Beats per minute, the
infant scores 2 for heart rate.
G for grimace
3. Grimace response ( reflex irritability ):
•
It is a term describing response to stimulation such as a mild
pinch :
– If there is no reaction, the infant scores 0 for reflex irritability.
– If there is grimacing, the infant scores 1 for reflex irritability.
– If there is grimacing and a cough, sneeze, or vigorous cry, the
infant scores 2 for reflex irritability.
A for activity
3. Activity ( Muscle tone):
– If muscles are loose and floppy, the infant scores 0 for
muscle tone.
– If there is some muscle tone, the infant scores 1.
– If there is active motion, the infant scores 2 for muscle
tone.
R for respiration
1. Respiration ( Breathing )effort:
– If the infant is not breathing, the respiratory score is 0.
– If the respirations are slow or irregular, the infant scores 1
for respiratory effort.
– If the infant cries well, the respiratory score is 2
Neonatal
resuscitation
Neonatal resuscitation
1. Initial steps of neonatal resuscitation include:
I.
Airway (position and clear)
II. Breathing (stimulate to breathe)
III. Circulation (assess heart rate and oxygenation)
2. Additional resuscitation steps :
•
They are used based on need and include →
Additional Resuscitation Steps
1. Supplemental Oxygen.
2. Positive Pressure Ventilation.
3. Intubation.
4. Chest Compressions.
5.
Medications.
Initial steps of stabilizing a
newborn
I.
Warming the newborn to prevent hypothermia.
II. Positioning the newborn
III. Clearing the airway if necessary
IV. Drying and stimulating breathing
Warming the newborn to prevent
hypothermia
1. Place on prewarmed towels or blankets and dry.
2. Replace wet towels with dry, prewarmed ones.
3. When resuscitation is complete, place the newborn on the
mother’s chest or abdomen, another heat source, or under a
radiant warmer.
Four mechanisms of heat loss in
newborn and corresponding
interventions
 Evaporation : Dry infant immediately.
 Conduction : Place on mothers body skin to skin.
 Convection : Cover with a blanket, wear a cap.
 Radiation : Keep away from cold windows and cold objects.
Mechanisms of heat loss
So why warming the
newborn is so
important???
Effect of Cold Stress
1. Increased oxygen need.
2. Decreased surfactant production.
3. Respiratory distress.
4. Hypoglycemia.
5. Metabolic acidosis.
6. Jaundice.
7. Vasoconstriction can cause a return to fetal circulation
patterns.
Warming the newborn to
prevent hypothermia
 Neutral thermal environment which helps prevent heat loss
and help the infant to maintain stable body temperature.
 Thermoneutral zone should be 32° to 35° C.
 Elevated temperature causes increased need for oxygen
and glucose and vasodilation leads to increased insensible
fluid loss.
 So
Closely
monitor
overheating of infant.
warming
equipment
to
prevent
Any question????