Emergency Care In The Streets: Chapter 40 Neonatology

Front 1

newborn

Back 1

Infant within the first few hours after birth.

Hint 1

40.6

Front 2

neonate

Back 2

Infant within the first month after birth.

Hint 2

40.6

Front 3

Antepartum (Before Birth) Risk Factors

Back 3

-Multiple gestation
-Pregnant woman's age <16 or >35 years
-Post-term (>42 week's) gestation
-Toxemia, HTN, diabetic
-Polyhydramnios (excessive amount of amniotic fluid)
-Premature rupture of the membrane and fetal malformation
-In adequate prenatal care
-History of perinatal morbidity or mortality
-Use of drugs or medications
-Fetal anemia
Oligohydramnios (decreased volume of amniotic fluid during a pregnancy)

Hint 3

40.6

Front 4

Intrapartum (During Birth) Risk

Back 4

-Premature labor
-Rupture of membranes >24 hours before delivery
-Abnormal Presentation
-Prolapsed cord
-Chorioamnionitis
-Meconium-stained amniotic fluid
-Use of narcotic within 4 hours of delivery
-Prolonged labor or precipitous delivery
-Bleeding
-Placenta previa

Hint 4

40.6

Front 5

In utero (ie, in the pregnant woman's womb) the fetus receives oxygen from the _________.

Back 5

placenta

Hint 5

40.7

Front 6

Describe the fetus lungs

Back 6

Collapse and filled with fluid, and most of the fetal blood flow is diverted away from the lungs.

Hint 6

40.7

Front 7

Fetal transition

Back 7

A rapid series of events which happen at birth enabling the baby to breathe. Lungs expand with air, the pulmonary pressure drops and blood begins to flow to the lungs, picking up oxygen.

Hint 7

40.7

Front 8

Causes of Delayed Transition in Newborns

Back 8

-Main cause being hypoxia
-Meconium or blood aspiration
-Acidosis
-Hypothermia
-Pneumonia
-Hypotension

Hint 8

40.7

Front 9

premature

Back 9

An infant delivered at less than 37 weeks.

Hint 9

40.7

Front 10

term

Back 10

An infant born at 38 to 42 weeks of gestation.

Hint 10

40.7

Front 11

post-term

Back 11

An infant born after 42 weeks of gestation.

Hint 11

40.7

Front 12

Key questions for delivery or post delivery

Back 12

Mother's age, length of pregnancy (in weeks), the presence and frequency of contractions, the presence or absence of fetal movement, whether there have been any complications (diabetes, HTN, Fever), whether membranes have ruptured including time and makeup (clear, meconium stained, or bloody), and medications taken.

Hint 12

40.8

Front 13

Minimum equipment needed for birth

Back 13

Warm dry blankets, bulb syringe, two small clamps or ties, and a pair of clean scissors.

Hint 13

40.8

Front 14

Baby positioning during birth

Back 14

Keep baby below the placenta, at level with mother, with head slightly lower than body.

Hint 14

40.8

Front 15

Normally newborns are ________ at birth.

Back 15

cyanosis

Hint 15

40.9

Front 16

Neonates max suction time is

Back 16

10 seconds

Hint 16

40.9

Front 17

APGAR

Back 17

Develop in 1953 by Dr. Virgina Apgar to help determine the need for and effectiveness of resuscitation.

Hint 17

40.9

Front 18

When should APGAR be determined?

Back 18

Within 1 to 5 minutes after birth. A score of <7 should be reassessed every 5 mins till 20 mins after birth.

Hint 18

40.9

Front 19

Positioning of baby immediately after birth

Back 19

Hold the baby with the head slightly lower than the body to facilitate drainage of secretions.

Hint 19

40.9

Front 20

First A in APGAR

Back 20

Appearance-skin color
2 is completely pink
1 is Body pink, extremities blue
0 is central blue, pale

Hint 20

40.10

Front 21

P in APGAR

Back 21

Pulse rate
2 is >100
1 <100 but not 0
0 is Absent

Hint 21

40.10

Front 22

G in APGAR

Back 22

Grimace-irritability
2 is cries
1 is grimaces
0 is no response

Hint 22

40.10

Front 23

Second A in APGAR

Back 23

Activity-muscle tone
2 is Active motion
1 is some flexion of extremities
0 is Limp

Hint 23

40.10

Front 24

R in APGAR

Back 24

Respiratory-effort
2 is strong cry
1 is slow and irregular
0 is Absent

Hint 24

40.10

Front 25

acrocyanosis

Back 25

Centrally pink, blue hands and feet.

Hint 25

40.10

Front 26

Newborn Resuscitation

Back 26

First 30 seconds warm and assess, if apneic for 20 seconds or longer respiratory pause or has a pulse rate less than 100 bpm begin PPV-positive pressure ventilation via BVM.
After min is pulse is < than 60 bpm, begin CPR.

Hint 26

40.10

Front 27

Blow-by oxygen flow

Back 27

Set of 5 lpm and do not blow directly into newborns eyes.

Hint 27

40.10

Front 28

Reasoning for BVM if pulse is < 100 bpm

Back 28

Hypoxia is the main cause of bradycardia.

Hint 28

40.10

Front 29

Signs that require BVM

Back 29

Periodic breathing, intercostal retractions (sucking in between the ribs), nasal flaring, grunting on expiration.

Hint 29

40.12

Front 30

Normal tidal volume for an infant

Back 30

5 to 8 mL/kg.

Hint 30

40.12

Front 31

Note about first few breaths with neonate

Back 31

With BVM it may require higher pressure and you may need to cover the spring-load pop valve with your fingers because the lungs are collapse.

Hint 31

40.12

Front 32

What is correct timing for ventilations in newborns?

Back 32

40 to 60 breaths/min
Use breath two-three, breath two-three

Hint 32

40.12

Front 33

Newborn intubation blade size

Back 33

No 1 for full term infants, No 0 for premature infants

Hint 33

40.13

Front 34

ET size for new born

Back 34

2.5 to 4.0 mm
Full term 4.0 mm
34 to 38 weeks 3.5mm
28 to 34 weeks 3.0 mm
before 28 weeks 2.5

Hint 34

40.13

Front 35

How to determine NG size in baby

Back 35

Bottom of the earlobe to tip of nose and halfway between xiphoid process and umbilicus.

Hint 35

40.15

Front 36

Average baby weight

Back 36

Full term 6.5 to 9 lbs (3 to 4 kg)
At 28 weeks 2.5 lbs (1 kg)

Hint 36

40.17

Front 37

Epi in newborn

Back 37

After 30 seconds of ventilations and 30 seconds of CPR if bradycardia does not improve move onto epi at 0.1 to 0.3 mg/kg of 1:10,000 IV equal to 0.01 to 0.03 mg/kg. No IV consider 0.3 up to 1mL/kg ET, repeat in 3 to 5 mins, with persistent bradycardia. Usually requires med con.

Hint 37

40.17

Front 38

A fluid bolus in an infant consist of:

Back 38

10mL/kg of NS given over 5 to 10 mins

Hint 38

40.18

Front 39

Signs of hypovolemia include

Back 39

Pallor, delay capillary refill, weak pulse despite a good pulse rate or high quality chest compressions.

Hint 39

40.18

Front 40

Sodium Bicarbonate in newborns:

Back 40

After a duration of ventilations and chest compressions you may suspect acidosis. Medical control may suggest an initial dose of 2 mEg/kg of 4.2% solution (0.5 mg/mL) IV over 5 to 10 minutes. Rapid administration changes pH rapidly increasing the risk of bleeding into the brain.

Hint 40

40.18

Front 41

Narcan in newborns

Back 41

Do not give to newborn of a drug-addicted mother as it has been proven to cause seizures that often lead to death, just bag pt. Only use if it is an acute narcotic exposure with med con at 0.1mg/kg
May be give IV or IM

Hint 41

40.18

Front 42

Dangers of Meconium Aspiration

Back 42

If the newborn inhales the meconium-stained amniotic fluid either in utero or at delivery, their airway may become plugged and hypoxia may ensue. Significant increase in dangers of meconium aspiration after 42 weeks of gestation.

Hint 42

40.19

Front 43

What to do when a baby is born through meconium-stained amniotic fluid?

Back 43

Assess the newborn, if crying and virgours, continue with standard interventions. If depressed intubate at once, do not dry or stimulate the baby. Attach the moconium aspirator to the ET tube and suction while withdrawing the tube from the trachea. Repeat as needed. After suctioning is complete start drying and stimulating. Be prepared for PPV. Without ET sucess, start resuscitation guidelines.

Hint 43

40.19

Front 44

Diaphragmatic hernia

Back 44

An abnormal opening in the diaphragm, commonly left sided. Has an incidence of 1 in 2,500 live births. Increases chance of respiratory distress. Signs are heart sounds shifted to the right, decrease breath sounds on Lt, sunken abdomen as contents are in chest cavity. Pt will need an OG tube to minimize intestinal distention, may not have appropriate size tube in field.

Hint 44

40.19

Front 45

Apnea in newborns

Back 45

At first during primary apnea warm and stimulate baby. If this does not stimulate breathing, move on to secondary apnea and provide PPV.

Hint 45

40.19

Front 46

What is low birth weight? Common cause?

Back 46

< 5.5 lbs
Most common cause is premature (before 37 weeks) birth.

Hint 46

40.20

Front 47

Premature infants are at high risk for resiratory distress because deficiency in ________. Define

Back 47

Surfactant
The substace formed in the lungs that helps keep the small air sac or alveoli from collapsing and sticking together.

Hint 47

40.21

Front 48

Define seizure clinically

Back 48

A paroxysmal alteration in neurologic function, behavior and/or autonomic function.

Hint 48

40.21

Front 49

Dextrose via IV in infants

Back 49

A 10% dextrose solution may be given at 2 mL/kg.

Hint 49

40.24

Front 50

Complications from a delay in clamping the umblical card

Back 50

A delay in clamping the umbilical cord and keeping the infant below the placenta may allow blood to flow into the infant, which can in turn lead to polycythemia.

Hint 50

40.8

Front 51

What is the most common seizure type in newborns?

Back 51

Clonic