Assessment of newborn ~ Emergency medicine.Site

Assessment of newborn

Introduction:

Newborn infants are unique in their physiology and the health problems that they experience.

Neonatal period is characterized by transition to extrauterine life and rapid growth and development.

This is the phase in life with the greatest risk of mortality.

It is also the most critical period for long term physical and neurocognitive development.

Definition:

Neonatal period. From birth to under four weeks ( <28 days) of age. An infant is called a neonate during this phase. Early Neonatal Period - First week of life ( <7 days or <168 hr) Late neonatal period - extends from 7th to <28th day. Postneonatal period - Period of infancy from 28 days to <365 days of life. Weeks of gestation refer to completed weeks of gestation, e.g. 36 weeks gestation, refer to range of gestation from 36 weeks O day to 36 weeks and 6 days.

Perinatal period - Perinatal period extends from 22nd week of gestation (L154 days or weighing L500 g at birth) to less than 7 days of life. Live birth - A product of conception, irrespective of weight or gestational age, that, after separation from the mother, shows any evidence of life such as breathing, heart-beat, pulsation of umbilical cord or definite movement of voluntary muscles. Fetal death - A fetal death is a product of conception that,after separation from the mother, does not show any evidence of life. Still-birth - Fetal death at a gestational age of 22 weeks or more or weighing more than 500 g at birth. Term neonate - A neonate born between 37 and <42 weeks (259-293 days) of gestation. Preterm neonate - A neonate born before 37 weeks (<259 days) of gestation irrespective of the birth weight.

Post-term neonate. A neonate born at a gestation age of 42 weeks or more (294 days or more). Low birthweight (LBW) neonate. A neonate weighing less than 2500 g at birth irrespective of the gestational age. Very low birthweight (VLBW) neonate. A neonate weighing less than 1500 g at birth irrespective of the gestational age. Extremely low birthweight (ELBW) neonate. A neonate weighing less than 1000 g at birth irrespective of the gestational age. Neonatal mortality rate (NMR). Deaths of infants under the first 28 days of life per 1000 live births per year. Perinatal mortality ratio (PNMR). Number of perinatal deaths (stillbirths plus neonatal deaths before 7 days of life) per 1000 live births. It is designated as a ratio since the numerator is not part of the denominator.

Preparing for resuscitation:

Preparation for delivery should include:

i. A radiant heat source ready for use

ii. All resuscitation equipments immediately available and in working order

iii. At least one person skilled in neonatal resuscitation

Evaluation:

Evaluation is based primarily on the following three signs: respiration, heart rate (HR) and color.

APGAR Score:

TABC resuscitation:

T-Temperature: Provide warmth, dry the baby and remove the wet linen.

A-Airway: Position the infant, clear the airway (wipe baby's mouth and nose or suction mouth, nose and in some instances, the trachea in non-vigorous baby born through meconium stained liqor). If necessary, insert an endotracheal (ET) tube to ensure an open airway.

B-Breathing: Tactile stimulation to initiate respirations, positive-pressure breaths using either bag and mask or bag and ET tube when necessary.

C-circulation: Stimulate and maintain the circulation of blood with chest compressions and medications as indicated.