The newborn Neonatal resuscitation

❖ Neonatal Resuscitation Program (NRP)❖ Must be able to initiate resuscitation and

assist throughout process❖ First 6 to 12 hours after birth are a critical

transition period for the newborn❖ Must be alert to early signs of distress:

Bluish color of the skin and mucous membranes (cyanosis),Brief stop in breathing (apnea), Decreased urine output. Nasal flaring. Rapid breathing.,Shallow breathing.Shortness of breath and grunting sounds while breathing.

❖ Must be ready to intervene quickly to prevent complications and poor outcomes

Assessment ❖ Heart and respiratory rates at least every 30

minutes during the first two hours of transition.❖ Monitor the axillary temperature every 30

minutes until it stabilizes in the expected range between 97.7°F and 99.5°F

❖ Be alert for signs of hypoglycemia.❖ A full physical assessment including gestational

age assessment is completed within the first few hours of life.

Birth ❖ If the newborn cries vigorously: Palpate the

base of the umbilical cord and count the pulse for six seconds and multiply x 10

❖ Pulse above 100 bpm and a vigorous cry are reassuring signs

❖ Give constant attention to the airway.❖ Newborns often have abundant secretions.❖ A bulb syringe is used to suction the mouth

first and then the nose.❖ Keep the bulb syringe with the newborn, and

teach the parents how and when to suction the baby.

Complications ❖ If the newborn doesn't cry immediately: Transport him or

her to a preheated radiant warmer for prompt resuscitation❖ Dry him or her quickly to prevent heat loss❖ Bag and mask connected to 100% oxygen are used to

provide respiratory support❖ Most newborns do not require resuscitation, and the ones

who do generally respond well to a short period of positive pressure ventilation with a bag and mask.

❖ However, a very small number of infants require chest compressions, intubation, and medications

❖ Give constant attention to the airway❖ Position newborn on side; bulb syringe is used to suction

mouth first, then nose

Thermoregulation ❖ Critical to protecting the newborn from chilling❖ Cold stress increases amount of oxygen and glucose

needed❖ Can quickly deplete body’s glucose and develop

hypoglycemia( < 40 mg/ dl ) ❖ Easily develop respiratory distress and metabolic

acidosis if exposed to prolonged chilling ( PH < 7.20 ) ❖ Dry the newborn while on the mother’s abdomen❖ Swaddle him snugly, and apply a cap to prevent heat

loss❖ Kangaroo care

Hypoglycemia ❖ Ideal glucose range 40-60 mg/dL❖ Perform a heel stick Glucose level of less than 50 mg/dL

requires confirmation (see hospital protocol)Immediately initiate treatment ( 20-30 mg/dl start a line, 30-40 mg/dl give sugar bottle)

❖ If the mother is breast-feeding, encourage early and frequent feedings.

❖ If the newborn is to be bottle-fed, initiate early feedings.

INFECTION CONTROL OF THE NEONATE ❖ UMBILICAL CORD STUMP: Use strict aseptic technique

when caring for the cord❖ Triple dye, bacitracin ointment, or povidone-iodine used

initially to paint the cord to help prevent the development of infection.

❖ PREVENT OPHTHALMIA NEONATORUM: a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia.

❖ 0.5% erythromycin