Neonatology Notes PDF

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Summary

Neonatology notes for lecture
Topics included -
a. Routine Delivery Room Care
b. Resuscitation of Depressed Infant
c. Normal physical exam and maturity testing
Etc......

Description

NEONATOLOGY Notes ROUTINE DELIVERY ROOM CARE 1. Position: Place infant head downward immediately, to clear mouth, pharynx & nose of secretions 2. Suction: Gently suction nose and pharynx with bulb syringe or soft catheter, while stimulating to cry a. Non-high risk infant: head down b. High risk (e.g. CS delivery): crib level 3. Assess APGAR score Sign 0 Blue, pale extremities & A trunk Absent P No response G A Limp R

Absent

1 Blue extremities Pink trunk Below 100 Grimace Some flexion of extremities Slow, irregular

2 Completely pink Above 100 Cry, cough, sneeze Active motor Good strong cry

Score: 7-10 at 1 min = vigorous infant 4-6 = mild-moderate asphyxia → 100% O2 by face mask 0-3 = severe asphyxia → intubation One-minute score: gives index of necessity for resuscitation Five-minute score: more valuable in predicting mortality, success of resuscitation and neurologic deficit at 1 year of age

Resuscitation of the depressed infant Score 4-6 - Vigorous stimulation and suctioning of secretions - Assisted ventilation for the depressed baby may produce spontaneous respiration - If still unresponsive, tracheal intubation and positive pressure Score 0-3 -Vigorous stimulation and suctioning of secretions -Immediate intubation and O2 inhalation -Correction of acidosis 4. Maintain body heat a. Body surface of NB thrice that of adult b. Rate of heat loss 4x that of adult occurring by: i. Convection to cooler air ii. Conduction to cooler materials

iii. Radiation from infant iv. Evaporation from moist skin c. Initial rectal temperature (NV: 36.6 – 37.2C), then q4 until stable. Following readings taken per axilla q8 5. Normal physical exam and maturity testing Skin: vernix caseosa, lanugo, jaundice (> 24 hours), harlequin color, mottling (thermoregulatory instability), Mongolian spots, milia, erythema toxicum (harmless small erythematous papules) Head/ Neck: HC, fontanels (bulge, bulging or depressed) Caput succedaneum – edema w/ or w/o ecchymoses, ill-defined borders, disappearing in a few days Cephalhematoma – subperiosteal bleed limited by periosteal attachments, NOT crossing suture lines, absorbed slower than a caput Craniotabes – soft areas of bone, which give a “pingpong” ball sensation when depressed Epstein pearls – whitish shiny cysts on palate & gums Chest: Normal RR: 30-80/min, diaphragmatic Periodic breathing (apnea < 10 sec) – normal in pre-term Normal CR: 120-160 ; auscultate for murmurs Brachial = femoral pulse intensity; BP (term): 50-70/25-50 Abdomen/ Back: Globular but not distended; diastasis recti (separation of recti muscles common in newborns) Liver edge palpable 2-3 cm subcostal margin; Back without dimpling or tuft of hair Hip dislocation Barlow ‘s test -dislocate unstable hip; flex and adduct hip Ortolani’s test – dislocate unstable hip; abduct → “clunk”

Neurologic Reflex Moro Stepping Placing birth Sucking and rooting Palmar; Plantar grasp Adductor spread of knee jerk Tonic neck Neck righting Landau Parachute reaction

Appears Birth Birth 6 wks Birth

Disappears 8 months 6 weeks

Birth Birth

4 months, awake 7 months, awake 6 months; 10 months 7 months

2 months 4-6 months 3 months 9 months

6 months 24 months 24 months Persists

6. Measurements: weight, length, HC, CC and AC Low birth weight (LBW) infants Very low birth weight infants (VLBW) Extremely low birth weight infants (ELBW)

Weight BW < 2275 grams BW < 1500 grams BW < 1000 grams

Small for gestational age (SGA) – BW < 10th percentile for gestation or below 2 standard deviations from mean Large for gestational age (LGA) – BW > 90th percentile 7. Antiseptic skin and cord care Cord: 2 arteries, 1 vein (AVA) 8. Apply 1 cm strip Erythromycin ointment to both eyes to prevent Ophthalmia neonatorum 9. Inject 1 mg Vit K/IM to prevent hypoprothrombinemia...