newborn assessment
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NEWBORN ASSESSMENT. MIHAI CRAIU MD PhD. INITIAL EVALUATION. Physical assessment in neonates serves to describe anatomic NORMALITY. - PowerPoint PPT PresentationTRANSCRIPT
NEWBORN ASSESSMENT
MIHAI CRAIU MD PhD
INITIAL EVALUATION
• Physical assessment in neonates serves to describe anatomic NORMALITY.
• The improved techniques for fetal diagnosis help in predicting major malformations, but the neonatal examination carries a primary purpose of identifying more subtle anomalies.
Neonatal examination
• First examination immediately at birth
• Recurrent evaluations at 5 minutes interval
• The evaluation tool is Apgar score
APGAR SCORE 1
• The mnemonic was introduced in 1963 by the pediatrician Dr. Joseph Butterfield.
• Same acronym is used in German (Atmung, Puls, Grundtonus, Aussehen, Reflexe),
• Spanish (Apariencia, Pulso, Gesticulación, Actividad, Respiración)
• French (Apparence, Pouls, Grimace, Activité et Respiration) although the letters have different meanings.
APGAR SCORE*Score of 0 Score of 1 Score of 2 Component of
acronym
Skin color blue all over blue at extremitiesbody pink(acrocyanosis)
no cyanosis body
and extremities pink
Appearance
Pulse rate absent <100 >100Pulse
Reflex irritability
no response to stimulation
grimace/feeble cry when stimulated
sneeze/cough/pulls away when stimulated
Grimace
Muscle tone none some flexion active movement Activity
Breathing absent weak or irregular strong Respiration
* Apgar Virginia. A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. Analg. 1953. 32 (4): 260–267
APGAR SCORE
APGAR SCORE 2
• The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low.
• Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal.
APGAR SCORE 3
• A low score on the one-minute test may show that the neonate requires medical attention, but is not necessarily an indication that there will be long-term problems, particularly if there is an improvement by the stage of the five-minute test.
APGAR SCORE 4
• Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term neurological damage.
• There is also a small but significant increase of the risk of cerebral palsy.
APGAR SCORE 5
• The purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care
• It was not designed to make long-term predictions on a child's health.
APGAR SCORE 6
• Apgar score is no longer used to decide if a neonate requires resuscitation.
• That decision is based on emergency assessment of airway, breathing, and circulation ("ABC").
APGAR SCORE 7
• The test has also been reformulated with a different mnemonic, How Ready Is This Child - HRITC
• The criteria are essentially the same:– Heart rate, – Respiratory effort, – Irritabililty, – Tone, – Color.
COMPLETE EXAMINATION
• Is complete after the 24 h after birth• If any part of an assessment is
abnormal at that time, discharge will de delayed > 48 h
• Reevaluation should focus on :– Eyes– Cardiovascular system– Hepatobiliary system
FIRST SECOND
10 SECONDS
100 SECONDS
1000 SECONDS
IN THE DELIVERY ROOM
• Delivery room resuscitation should be available in all maternities, regardless of level and staff size and knowledge.
RESPONSABILITIES OF THE NEONATAL MEDICAL TEAM
• Ensure that all medical and nursing staff are familial with neonatal resuscitation.
• Ensure that a roster of trained staff immediately available for resuscitation is posted in a visible space of the ER
• Ensure that delivery room staff are able to mobilize timely qualified people for any anticipated problem.
• Ensure that the resuscitation equipment is available and working.
IN THE DELIVERY ROOMTransitional pathophysiology 1• Acute severe peripartum hypoxia
results in primary apnoea (in-utero)• This is compensated by
– Fetal bradycardia– Rise in fetal BP
• Redistribution of blood flow occurs– Increase in blood flow in brain & heart– Decrease in skin & kidneys
IN THE DELIVERY ROOMTransitional pathophysiology• More severe and prolonged hypoxia
results in secondary apnoea (in-utero)• This is difficult to differentiate primary and
secondary apnoea.• It has practical consequences
– Secondary apnoea does not respond to stimulat.
– Primary apnoea responds to tactile stimulation
IN THE DELIVERY ROOM
• Anticipation• It is possible to anticipate many
babies that may require resuscitation• 20% of children in poor condition at
birth can not be predicted• This is why all attending staff in
delivery room should master basic resuscitation procedures.
IN THE DELIVERY ROOM
• Min 0 – General care (Thermal care)
• Min 0 – 1 - Airway and breathing• Min 2 – 3 - Circulation• Min 3 – 4 - Consider
– Fluid – Inotrope infusion– Sodium bicarbonate