The Neonatal Emergency

KEY POINTS

Key Terms

Birth Canal - Where the baby passes through for birth; Vagina and cervix.

Pre-term - Any birth before 37 weeks. Able to survive at 23 weeks or 500g. (Depending on lung maturity).

Neonatal CPR - (HR less than 60.) 90 Compressions: 30 Breaths.

Acrocyanosis - Often seen in healthy newborns and refers to the peripheral cyanosis of the hands and feet and/or around the mouth.

Nuchal Cord – Umbilical cord wrapped around the infants neck.

Hypotonia - Commonly known as floppy baby syndrome, is a state of low muscle tone. Not a specific medical disorder, but a potential manifestation of many different disorders.

Apnea - Cessation of breathing for more than 20 seconds.

Primary Apnea - When asphyxiated, the infant responds with an increased respiratory rate. If the episode continues, the infant becomes apneic, followed by a drop in heart rate and a slight increase in blood pressure. The infant will respond to stimulation and 02 therapy with spontaneous respirations.

Secondary apnea - When asphyxia is allowed to continue after primary apnea, the infant responds with a period a gasping respirations, falling heart rate, and falling blood pressure. The infant takes a last breath and then enters the secondary apnea period. The infant will not respond to stimulation and death will occur unless resuscitation begins immediately.

Three Stages of Labor

DILATION OF CERVIX DELIVERY OF INFANT DELIVERY OF PLACENTA

Pertinent Questions

How many weeks gestation (1st

trimester 1-13 weeks;1 to 3 months, 2nd

trimester 14-26 weeks;4 to 6 months, and 3rd trimester 27-30 weeks;7 to 9 months).

What is the due date? How many pregnancies? If previous

pregnancy vaginal or cesarean delivery?

Has the patient had prenatal care? Who is the OB-GYN? Certain Hospital?

Medical HX, any complications with this or previous pregnancies?

Expecting multiple births? Medications, drugs, or alcohol? Contractions how often/how long do

they last? When did they begin? Any spotting, or bleeding? Fluid leaking? Color of the fluid? Feeling of bearing down or needing to

have a bowel movement?

Previous Cesarean Delivery

It is extremely important to know if the patient has had a previous cesarean delivery/if she has an arranged VBAC (Vaginal Birth After

Cesarean) with her physician. **A patient that has had multiple cesarean deliveries and is in active

labor indicates a need for immediate transport to the nearest appropriate facility. **

Previous Cesarean Delivery

VBAC – Vaginal birth after cesarean. (The most concerning risk of VBAC is uterine rupture)

Women with previous cesarean’s are at increased risk for uterine rupture. This is when the uterus has a potential to tear open along the scar line from a prior

cesarean or other major uterine surgery. If the uterus ruptures, an emergency cesarean is needed to prevent life-

threatening complications; including hemorrhage and infection for the mother and brain damage for the baby.

In some cases, the uterus might need to be removed (hysterectomy) to stop the bleeding. While the risk for uterine rupture increases per cesarean delivery, the

initial percent is 1/100.

APGAR SCOREScore at 1 and 5 minutes. 1 to 2 points for A, P, G, A, R. With the score ranges from 1-10.

Thermal Regulation (Skin to Skin)

Classification of hypothermia is based on core temperature

NORMAL – 36.5 to 37.3˚C (97.7 –99.2˚F)

Cold Stress 36.0 to 36.4˚C (96.8 – 97.6 ˚F)

Cause for concern

Moderate hypothermia 32 –35.9˚C (89.6-96.6˚F)

Danger, warm infant

Severe hypothermia – below 32˚C (89.6 ˚F)

Outlook grave, skilled care urgently needed

Prior to delivery infants do not maintain body temp independently Body temperature is one of the primary vital signs for neonates. In terms of ABC’s

A- Airway B- Breathing C- Circulation D- Degrees

Meconium Aspiration

Meconium is the baby's first feces, which is sticky, thick, and dark green and is typically passed in the womb during early pregnancy and again in the first few days after birth.

MAS can affect the baby's breathing in a number of ways, including chemical irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the inactivation of surfactant by the meconium (surfactant is a natural substance that helps the lungs expand properly).

The severity of MAS depends on the amount of meconium the baby inhales as well as underlying conditions, such as infections within the uterus or post maturity (when a baby is overdue, or more than 40 weeks gestational age). Generally, the more meconium a baby inhales, the more serious the condition.

Meconium Aspiration Cont.

Risk Factors a long or difficult delivery

advanced gestational age (or postmaturity)

a mother who smokes cigarettes heavily or who has diabetes, high blood pressure (hypertension), or chronic respiratory or cardiovascular disease

umbilical cord complications

poor intrauterine growth (poor growth of the baby while in the uterus)

Signs and Symptoms of increased work of breathing (Infant)

Nasal flaring

Grunting respirations

Wheezing, stridor, or other abnormal airway sounds

Accessory (intercostal) muscle use

Retractions or movements of the child's flexible ribcage

CLEMC Protocol’s

For detailed OB emergencies refer to the CLEMC protocol book. Abrubtio Placenta DIC (Disseminated Intravascular Coagulopathy) Placenta Previa PROM (Premature Rupture Membranes) Prolapsed Cord Emergency Delivery Nuchal Cord Dystocia (Shoulder Dystocia)