NEW BORN CARE
All levels
1. Begin vigorously drying baby.
2. Using clamps or hemostats, clamp the cord, 6-10 inches from baby, 2 - 3 inches apart, then cut between clamps.
3. Immediately after birth if poor tone, slow/absent breathing, and not crying
a. Warm baby, suction airway with bulb suction, continue to dry and stimulate.
4. Take baby’s pulse at the cord if pulsating. Ascultation more accurate. Heart rate is key to evaluation and decision making.
a. If >100 bpm, observe and continue drying, warming and stimulating. Place on mother’s abdomen and encourage mother to nurse the baby.
b. Consider blow by oxygen. If oxygenation necessary PPV or CPAP more effective. Position infant properly for effective ventilation. Proper airway and respiration can correct low heart rate. “Fix breathing, everything else should follow”. The big challenge for a newborn is converting to lung breathing from fetal oxygenation.
5. 30 seconds after birth
a. if HR < 100, gasping, or apnea begin BVM at 40-60/min
6. 60 seconds after birth
a. if HR <100 but > 60, continue BVM
b. if HR < 60 begin CPR, continue BVM
7. 90 seconds after birth
a. if HR <100 but > 60 continue BVM
b. if HR < 60 continue CPR and BVM
8. Do not let the neonate become hypothermic.
9. Once baby is vigorous and crying with good tone and HR >100 bpm
a. Warp in warm blanket if mother is unstable.
b. Oxygenate if baby still has central cyanosis, not necessarily for acrocyanosis
c. Place on mother’s abdomen and allow to breast feed if condition permits
d. Continue evaluation of baby and mother
e. Transport to hospital with OB or NICU capability based on patient condition
AEMT
If newborn is in distress:
1. Establish IV/IO access
2. Glucose check
PARAMEDIC
1. If despite all measures (CPR and ventilations) infant remains in poor condition and heart rate stays below 60 administer EPINEPHRINE (1:10,000 or 0.1 mg./ml). Give 0.01 mg./kg. (0.1 ml./kg.) IV/IO every 3-5 minutes if heart rate remains below 60.
2. Administer 20 ml./kg. IV/IO bolus.
APGAR SCORE
Sign 0 1 2 1
min 5
min
Skin Color Blue, pale Body pink, extremities blue Completely pink
Heart Rate Absent < 100 >100
Irritability No Resp Grimaces Cries
Muscle Tone Limp Some flexion of extremities Active motion
Resp. Effort Absent Slow & irregular Strong cry
TOTAL SCORE
Pre-Term and Premature newborn considerations
3. Hypothermia is a real risk and every effort should be made to keep the infant warm during the evaluation, treatment, and resuscitation phases. Be aggressive in warming. If plastic sheet or “space blanket” available place on newborn prior to blanket.
4. Don’t delay treatment to obtain an APGAR Score if necessary.
5. Pulse oximeter levels will always start low and improve over the first few minutes.
6. The pattern should be: Dry/Warm/Stimulate-Ventilate-Evaluate-Resuscitate.
7. IV/IO access may be challenging. Should be only attempted if Resuscitation called for.
8. Obtain BGL and treat hypoglycemia if present.
9. Pulse oximetry values between 85 and 95 preferable by ten minutes.
10. 90% of infants require little more than drying and warming. 10 % require ventilatory assistance, and 1% require resuscitation.
All levels
1. Begin vigorously drying baby.
2. Using clamps or hemostats, clamp the cord, 6-10 inches from baby, 2 - 3 inches apart, then cut between clamps.
3. Immediately after birth if poor tone, slow/absent breathing, and not crying
a. Warm baby, suction airway with bulb suction, continue to dry and stimulate.
4. Take baby’s pulse at the cord if pulsating. Ascultation more accurate. Heart rate is key to evaluation and decision making.
a. If >100 bpm, observe and continue drying, warming and stimulating. Place on mother’s abdomen and encourage mother to nurse the baby.
b. Consider blow by oxygen. If oxygenation necessary PPV or CPAP more effective. Position infant properly for effective ventilation. Proper airway and respiration can correct low heart rate. “Fix breathing, everything else should follow”. The big challenge for a newborn is converting to lung breathing from fetal oxygenation.
5. 30 seconds after birth
a. if HR < 100, gasping, or apnea begin BVM at 40-60/min
6. 60 seconds after birth
a. if HR <100 but > 60, continue BVM
b. if HR < 60 begin CPR, continue BVM
7. 90 seconds after birth
a. if HR <100 but > 60 continue BVM
b. if HR < 60 continue CPR and BVM
8. Do not let the neonate become hypothermic.
9. Once baby is vigorous and crying with good tone and HR >100 bpm
a. Warp in warm blanket if mother is unstable.
b. Oxygenate if baby still has central cyanosis, not necessarily for acrocyanosis
c. Place on mother’s abdomen and allow to breast feed if condition permits
d. Continue evaluation of baby and mother
e. Transport to hospital with OB or NICU capability based on patient condition
AEMT
If newborn is in distress:
1. Establish IV/IO access
2. Glucose check
PARAMEDIC
1. If despite all measures (CPR and ventilations) infant remains in poor condition and heart rate stays below 60 administer EPINEPHRINE (1:10,000 or 0.1 mg./ml). Give 0.01 mg./kg. (0.1 ml./kg.) IV/IO every 3-5 minutes if heart rate remains below 60.
2. Administer 20 ml./kg. IV/IO bolus.
APGAR SCORE
Sign 0 1 2 1
min 5
min
Skin Color Blue, pale Body pink, extremities blue Completely pink
Heart Rate Absent < 100 >100
Irritability No Resp Grimaces Cries
Muscle Tone Limp Some flexion of extremities Active motion
Resp. Effort Absent Slow & irregular Strong cry
TOTAL SCORE
Pre-Term and Premature newborn considerations
3. Hypothermia is a real risk and every effort should be made to keep the infant warm during the evaluation, treatment, and resuscitation phases. Be aggressive in warming. If plastic sheet or “space blanket” available place on newborn prior to blanket.
4. Don’t delay treatment to obtain an APGAR Score if necessary.
5. Pulse oximeter levels will always start low and improve over the first few minutes.
6. The pattern should be: Dry/Warm/Stimulate-Ventilate-Evaluate-Resuscitate.
7. IV/IO access may be challenging. Should be only attempted if Resuscitation called for.
8. Obtain BGL and treat hypoglycemia if present.
9. Pulse oximetry values between 85 and 95 preferable by ten minutes.
10. 90% of infants require little more than drying and warming. 10 % require ventilatory assistance, and 1% require resuscitation.