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Neonatal care nc
- 1. Neonatal Care for paramedics Nancy Caroline ch. 42
- 13. Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP.
- 27. Meconium Aspiration Routine tracheal suction is no longer recommended for a depressed newborn.
- 28. Meconium Aspiration What we used to do:
- 34. Premature and Low Birth Weight Infants • Premature: Delivered before 37 weeks of gestation – Increased mortality – Associated morbidities © American Academy of Orthopaedic Surgeons.
- 35. Seizures in the Newborn • Suggest the presence of neurologic disorder • Usually related to an underlying abnormality • Prolonged seizures may cause brain injury.
- 36. Seizures in the Newborn • Types of seizures: – Subtle seizure – Tonic seizure – Spasm – Myoclonic
- 37. Seizures in the Newborn • Assessment and management – Evaluate prenatal and birth history. – Perform a careful physical exam. – Obtain vital signs and oxygen saturation. – Provide additional oxygen, assisted ventilation, blood pressure evaluation, and IV access.
- 38. Hypoglycemia • Blood glucose level of less than 45 mg/dL – Imbalance between glucose supply and use • May result in: – Seizures – Brain damage
- 39. Hypoglycemia • May be at risk due to: – Disorders related to decreased glycogen stores – Increased use of glucose
- 40. Vomiting • Uncommon during the first weeks of life – May be confused with regurgitation – Result of an abnormality • Assessment Findings – Distended stomach, signs of infection, increased intracranial pressure, or drug withdrawal • Management – Focus on ensuring a patent airway – Watch for bradycardia due to vagal stimulation
- 41. Neonatal Jaundice • Considered pathologic when: – Clinically visible in first 24 hours – Serum bilirubin increases more than 5 mg/dL/d. – Bilirubin exceeds 12 mg/dL. – Conjugated bilirubin makes up greater than 20% of total serum bilirubin concentration. – Clinical jaundice persists for more than 1 week in full-term infants or for more than 2 weeks in preterm infants.
- 42. Thermoregulation • Thermoregulation limited in newborns – Average normal temperature of newborn— 37°C (99.5°F) – Range for neonate—36.6°C to 37.2°C (97.9°F to 99°F) © Jones & Bartlett Learning.
- 43. Hypothermia • Drop in body temperature to less than 35°C (95°F) • Newborns are sensitive to environmental conditions, especially after delivery
- 44. Fever • Rectal temperature greater than 38°C (100.4°F) • Newborn may not always present with fever in an illness or infection. • May be caused by overheating or dehydration
- 45. Fever • Management – Ensure a patent airway and adequate ventilation – Administration of an antipyretic agent to a neonate is of questionable benefit
- 46. DO NOT USE COLD PACKS ON NEWBORNS TO TREAT FEVER
- 47. Fever • Assessment and management – Examine for rashes. – Obtain history. – Note increased respiratory rate and work of breathing. Courtesy of Centers for Disease Control and Prevention.
- 48. Common Birth Injuries in the Newborn • Birth trauma injuries include: – Those involving instruments during delivery – Excessive molding of the head – Caput succedaneum – Cephalohematoma – Linear skull fractures
- 49. Common Birth Injuries in the Newborn • Birth trauma injuries include (cont’d): – Brachial plexus injuries – Facial nerve palsy – Diaphragmatic paralysis – Laryngeal nerve injury – Spinal cord injury
- 50. Common Birth Injuries in the Newborn • Clavicle—most frequently fractured bone – Examination will show: • Crepitus • Palpable bony irregularity • Possible lack of arm movement on affected side
- 51. Pathophysiology of Congenital Heart Disease • Congenital heart disease (CHD) – Most common birth defect – Can present with varying degrees of cardiorespiratory compromise
- 52. Pathophysiology of Congenital Heart Disease • Cyanosis – Visual detection is difficult. – Detection methods include: • Measuring oxygen saturation • Pulse oximetry • Monitoring oxygen saturation
- 53. Pathophysiology of Congenital Heart Disease • Noncyanotic disease (pink defects) – Oxygenated blood is shunted from the left side of the heart to the right side. – Called a left-to-right shunt
- 54. Pathophysiology of Congenital Heart Disease • Patent ductus arteriosus: – Ductus arteriosus does not close after birth. – If left untreated, patient could develop heart failure. © Jones & Bartlett Learning.
- 55. Congenital Heart Anomilies Transposition of great vessels
- 56. Septal Defects Atrial and Ventricular