Post on 30-Dec-2015
Embed Size (px)
DESCRIPTIONNEWBORN ASSESSMENT. MIHAI CRAIU MD PhD. INITIAL EVALUATION. Physical assessment in neonates serves to describe anatomic NORMALITY. - PowerPoint PPT Presentation
NEWBORN ASSESSMENTMIHAI CRAIU MD PhD
INITIAL EVALUATIONPhysical 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.
First examination immediately at birth
Recurrent evaluations at 5 minutes interval
The evaluation tool is Apgar score
APGAR SCORE 1The 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, Gesticulacin, Actividad, Respiracin) French (Apparence, Pouls, Grimace, Activit et Respiration) although the letters have different meanings.
APGAR SCORE* * Apgar Virginia. A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. Analg. 1953. 32 (4): 260267
APGAR SCORE 2The 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 3A 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 4Apgar 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 5The purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical careIt was not designed to make long-term predictions on a child's health.
APGAR SCORE 6Apgar 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 7The test has also been reformulated with a different mnemonic, How Ready Is This Child - HRITCThe criteria are essentially the same:Heart rate, Respiratory effort, Irritabililty, Tone, Color.
COMPLETE EXAMINATIONIs complete after the 24 h after birthIf any part of an assessment is abnormal at that time, discharge will de delayed > 48 hReevaluation should focus on :EyesCardiovascular systemHepatobiliary system
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 TEAMEnsure 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 EREnsure 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 1Acute severe peripartum hypoxia results in primary apnoea (in-utero)This is compensated byFetal bradycardiaRise in fetal BP Redistribution of blood flow occursIncrease in blood flow in brain & heartDecrease in skin & kidneys
IN THE DELIVERY ROOMTransitional pathophysiologyMore severe and prolonged hypoxia results in secondary apnoea (in-utero)This is difficult to differentiate primary and secondary apnoea.It has practical consequencesSecondary apnoea does not respond to stimulat.Primary apnoea responds to tactile stimulation
IN THE DELIVERY ROOMAnticipationIt is possible to anticipate many babies that may require resuscitation20% of children in poor condition at birth can not be predictedThis is why all attending staff in delivery room should master basic resuscitation procedures.
IN THE DELIVERY ROOMMin 0 General care (Thermal care)Min 0 1 - Airway and breathingMin 2 3 - CirculationMin 3 4 - Consider Fluid Inotrope infusionSodium bicarbonate