CONCEPTS OF NEONATAL CARE
Reported by: Genevieve Manrique R.N.
INTRODUCTION A newborn should have a thorough evaluation performed within 24 hours of birth to identify any abnormality that would alter the normal newborn course or identify a medical condition that should be addressed (eg, anomalies, birth injuries, jaundice, or cardiopulmonary disorders)
General Appearance of a Normal Newborn: Well-flexed, full range of motion, spontaneous movement Signs of potential distress or deviations from expected findings: Posture limp Asymmetry of movement Persistent tremor, twitching
HISTORY TAKING Review of this pregnancy, labor, and delivery including screening tests and risk factors for sepsis. Review of past pregnancies including a history of congenital anomalies, still births, and/or genetic or syndromic conditions. Review of the mother's and father's medical and genetic history. In particular, maternal illnesses prior to and during pregnancy, A review of maternal medications should be performed
HEART RATE 120-160 NORMAL RESPIRATIONS 30-60 NORMAL TEMPERATURE 97.8-99 NORMAL B/P 80/46 NORMAL HEAD CIRCUMFERENCE 13-14 IN CHEST CIRCUMFERENCE 30-33 CM 12-13 IN LENGTH 18-22 IN WEIGHT 2500-4000 GM 5-9 LBS
VERNIX CASEOSA WHITE CHEESY SUBSTANCE FOUND ON SKIN LANUGO DOWNY FINE HAIR SEEN ON PINNA, FOREHEAD ACROCYNOSIS PINK BODIES WITH BLUE EXTREMITIES ERYTHEMA TOXICUM NORMAL NEWBORN RASH BEEFY RED ON ABDOMEN MILLIA SMALL PIN HEAD SIZE PEARLY BALLS ON NOSE TELANGIECTATIC NEVI STORK BITE. BLANCHES WITH PRESSURE. FOUND NEVUS FLAMMEUS PORT WINE STAINRED/PURPLE, DOES NOT BLANCH
Introduction Thermoregulation in the neonate is a critical physiological function that is strongly influenced by physical immaturity, extent of illness and environmental factors
Monitoring - Peripheral temperature should be recorded hourly Use of Incubator - Any neonate less than 1.5 kg should be nursed within an enclosed incubator Use of Baby Therm - Babytherms provide heat by a combination of conduction (from below via a gel mattress) and radiation
Use of Open Basinette - A well neonate, >1.5 kg, who no longer requires close monitoring or intensive care and who can maintain a stable central temperature in 26-28°C room temperature, can be transferred to an open bassinette or small cot.
Signs of Cold Stress:
central temperature < 36.5°C increase in core-toe gap > 2°C mottled & pale increased capillary refill time, i.e. > 2 seconds increased oxygen requirements metabolic acidosis tachycardia hypoglycaemia apnoeas bradycardia
Intervention to Cold Stress:
Place a neonate of < 1.5kg in an incubator Use a baby-therm Increase the set temperature by 1°C every 15 minutes according to the neonate¶s response Take their temperature every 30 - 60 minutes until warmed to an acceptable temperature
Identify & eliminate any environmental causes, e.g. wet bed, over exposure, handling Promote a flexed position Ensure ventilator gases are adequately warmed to 37°C
Introduction Prematurity is a birth that is at least three weeks before a baby's due date. It is also known as preterm birth (or less than 37 weeks ² full term is about 40 weeks). Prematurity is the leading cause of death among newborn babies. Being born premature is also a serious health risk for a baby. Some babies will require special care and spend weeks or months hospitalized in a neonatal intensive care unit (NICU).
Common Problems of Prematurity Premature babies often have medical problems because their organs and body systems have not developed sufficiently. The lungs, brain, gastrointestinal tract, and immune system are most often affected and pose the greatest risks for causing long-term problems and death
Complication: Gestational age (weeks) Respiratory distress syndrome Moderate bleeding in the brain (Grade 3) Severe bleeding in the brain (Grade 4) Chronic lung disease Inflammation or death of part of the GI tract (necrotizing enterocolitis, or NEC) General infection Survival to 120 days or hospital discharge Survival without any of these complications