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Basic Infant Stabilization

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If possible it is always better to deliver High Risk mothers and babies at a Regional facility. ... DO NOT use hot water bottles/gloves next to the skin, can ... – PowerPoint PPT presentation

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Title: Basic Infant Stabilization


1
Basic Infant Stabilization
  • Kristen Smith RNC/CM NICU
  • Perinatal Outreach Coordinator

2
Goal
  • Refresh the knowledge of those in outlying
    hospitals that are no longer delivering babies.

3
Why?
  • All hospitals need to prepare for resuscitation,
    stabilization, and transport of infant (sick or
    well).
  • All patients deserve and expect safe, quality
    care.
  • Errors can occur in virtually all areas of care.

4
Get ready!
  • Prepare -- make sure your hospital has the
    equipment you need to deliver a baby and
    resuscitate not only the mother but also the baby
    if needed. (Bag, mask, Ett, etc.)
  • Think How will I provide a warm environment for
    the baby? (Warmer, warm blankets, Isolette,
    thermal mattress.)

5
If possible it is always better to deliver High
Risk mothers and babies at a Regional facility.
  • The best transporter for baby is the mothers
    womb. Be very weary though, you do not want to
    deliver a baby on the side of the road!

6
Delivery!!!
7
Provide Thermal Management1st step in NRP
(Neonatal Resuscitation)
  • Dry thoroughly.
  • Remove wet linen.
  • Provide a warm environment.
  • Take the infants temperature Q15-30 until WNL
    and then Q1 hour.
  • Remember that normal for an infant is 97.6-99.2
    axillary.

8
Heat loss through
  • Conduction putting a baby on a cold surface,
    not pre-warming the warmer.
  • Convection drafty area or people running past
    the area the baby is in.
  • Evaporation not removing the wet linens.
  • Radiation having the warmer next to a cold wall.

9
Always remember!
  • Dry and remove the wet linens within a
  • 20 second time frame.
  • DO NOT use hot water bottles/gloves next to the
    skin, can cause burns.
  • There are thermal mattresses on the market if you
    think this would help in your area.
  • Always use your warmers on Servo mode!

10
Case
11
Evaluating Respirations2nd step in NRP
  • Position shoulder roll to open airway.
  • Suction (mouth and nose) if needed to clear
    airway.
  • Remember that babies are changing from fetal
    to neonatal circulation and breathing so they
    are emptying the fluids out of their lungs.
  • If the baby has a good cry with effective
    respiratory effort, go to checking the HR.

12
Increased work of breathing ?
  • Respiratory Rate gt60.
  • Increased effort shown by retractions, nasal
    flaring and/or grunting.
  • Requiring Oxygen.
  • (color dusky/oximitry low)
  • Apnea is NEVER normal in a newly born infant.
  • A weak cry or gasping sounds are an ominous sign
    of exhaustion and arrest!

13
So what do you do?
14
Assist ventilations for 15-30 seconds.
  • Pressure should be 20-40 initially then decreased
    to 15-20.
  • More importantly look for chest rise!
  • Rate at 40-60 breaths per minute.
  • If you bag a baby for a couple minutes you
    will need to place an OG tube to help get the air
    out of the stomach. Leave the OG open as a vent
    if needed.

15
Reasons for Respiratory Problems
  • Respiratory Distress Syndrome (RDS)
  • Transitory Tachypnea of the Newborn (TTN)
  • Pneumonia/Aspiration Syndrome from Meconium or
    Amniotic Fluid (cause of surfactant deficiency).
  • Obstruction mass, hernia, pneumothorax.

16
Okay --- now your 1st30 seconds after
deliveryhave gone by!
  • Whats next?

17
Evaluate Heart Rate
  • gt100 ?
  • 60-100 bagging (even if baby crying)
  • lt60 ?
  • Chest compressions ratio 3/1 (90/30).
  • Finger position.
  • Re-check HR Q30 seconds.

18
Color
  • Pink ?
  • Blue -- requires stimulation to cry, if no
    improvement then whiff with O2.
  • Pale -- Bag/mask ventilation may be needed
    especially if poor muscle tone.
  • Remember that hands/feet can remain slightly
    cyanotic for awhile in babies but central
    cyanosis should not be evident.

19
Biggest hint!
  • Keep the baby PINK!

20
NRP meds
  • Epinephrine may repeat Q 3-5
  • IV, UVC, Ett rapid administration
  • 0.1-0.3 ml/KG (110,000 concentration)
  • Narcan 0.1 mg/KG IM
  • CAUTION!!!
  • NS 10ml/KG IV, UVC over 5-10
  • (Blood if blood loss evident.)

21
If infant is sickcall the NICU!
  • Start a PIV (24G) to quickly provide glucose to
    normalize blood sugar levels.
  • Blood sugar should be gt50.
  • You can also use this PIV to give other meds like
    a bolus and/or antibiotics.

22
Glucose
  • D 10 at 80 ml/KG/day.
  • Recheck 15-30 after initiation.
  • If lt50 then give 2 ml/KG of D 10 over 15.
  • If still lt50, may repeat.
  • If gt50 then continue monitoring every 30 until 2
    tests gt50 then hourly x2.
  • Goal is a blood sugar level of 50-110.

23
Babies at High Risk forLow Blood Sugars
  • Premature
  • SGA
  • LGA
  • Sick Infants using sugar more quickly.
  • Stress, Infection, Shock, RDS, Cardiac Problems,
    Hypothermia.

24
Apgars
  • Done at 1 minute, 5 minutes and 10 minutes of
    age.
  • Only a tool for assessing infants condition at
    birth.
  • Does not determine if you resuscitate, you do not
    wait to do that.

25
Apgar Scoring Chart
26
Promote Breastfeeding
  • There are advantages to mother and baby!
  • Can assist with prevention of hypoglycemia in
    baby with the early intake of colostrum.
  • Promotes bonding!
  • Helps stimulate moms natural Pitocin to aid in
    the involution of the uterus.
  • Do Not let baby feed if there is Respiratory
    Distress!

27
Continue checking vital signs!
  • Every hour for 1st few hours.
  • If baby is being transported we will want to know
    Temperature, HR and rhythm, Respiratory
    rate/effort, O2 need and Oximitry, Blood Pressure
    and Perfusion/Pulses, Neurological Status, Urine
    Output, Glucose level and if feeding or has a PIV.

28
Beyond the Basics
  • STABLE program
  • Sugar monitoring including umbilical line
    placement
  • Temperature review
  • Airway (including blood gases, chest X-rays,
    needle aspiration and intubation)
  • Breathing
  • Labs (including CBC review, antibiotic TX and
    shock)
  • Emotional support and evaluation.

29
Thank You!
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