Makindo Medical Notes

Related Subjects: |Introduction to Obstetrics and Gynaecology |Female Reproductive Anatomy and Physiology |Basic Concepts of Pregnancy |Health Issues In Pregnancy |Risk assessment In Pregnancy |Anaemia In Pregnancy |Hypertension In Pregnancy |Diabetes In Pregnancy |Epilepsy In Pregnancy |Hyperemesis In Pregnancy |Obesity In Pregnancy |Prescribing in Pregnancy |Multiple Pregnancy |Preterm Labout |Management of Labour and Complications |Assessment of the newborn

Immediate Management and Assessment of the Newborn

• After birth, immediate management and assessment of the newborn are essential to ensure their transition from intrauterine to extrauterine life. The first few minutes are critical for determining the need for resuscitation or other interventions.
• The main steps in immediate newborn care include assessing the need for resuscitation, performing the APGAR score, providing warmth, and initiating feeding if the newborn is stable.

Initial Assessment and Drying

• Immediately after birth:
  • Dry the newborn thoroughly to prevent heat loss through evaporation. The newborn's skin is wet, and rapid heat loss can lead to hypothermia.
  • Remove any wet towels or blankets and replace them with dry, warm linens.
  • Position the newborn in a neutral position to maintain an open airway (sniffing position).

APGAR Score

• The APGAR score is performed at 1 minute and 5 minutes after birth to assess the newborn’s adaptation to extrauterine life. The score assesses five criteria:
  • Appearance (Skin Color):
    • 0: Blue/pale all over
    • 1: Blue extremities, pink body (acrocyanosis)
    • 2: Completely pink
  • Pulse (Heart Rate):
    • 0: Absent
    • 1: Below 100 bpm
    • 2: Above 100 bpm
  • Grimace (Reflex Irritability):
    • 0: No response to stimulation
    • 1: Grimace/weak cry
    • 2: Vigorous cry
  • Activity (Muscle Tone):
    • 0: Limp
    • 1: Some flexion
    • 2: Active motion
  • Respiration (Breathing Effort):
    • 0: Absent
    • 1: Weak, irregular, or gasping
    • 2: Strong cry
• Each criterion is scored from 0 to 2, with a total possible score of 10. Scores:
  • 7–10: Normal; no intervention usually required.
  • 4–6: Moderate depression; may require some resuscitation (e.g., ventilation).
  • 0–3: Severe depression; immediate resuscitation needed.

Newborn Resuscitation

• If the newborn shows signs of respiratory distress or poor APGAR scores (less than 7), initiate resuscitation steps based on the Neonatal Resuscitation Program (NRP) guidelines.
• Initial steps:
  • Position the newborn’s head to open the airway (neutral position).
  • Clear the airway if necessary (suctioning the mouth and nose).
  • Provide stimulation (e.g., gently rub the newborn’s back or flick the soles of the feet).
  • If the newborn does not start breathing or the heart rate is <100 bpm, start positive pressure ventilation (PPV) with a bag-mask device.
• If the heart rate remains <60 bpm despite effective ventilation for 30 seconds, begin chest compressions (3 compressions to 1 ventilation) at a rate of 90 compressions and 30 ventilations per minute.
• Consider administering epinephrine (0.01–0.03 mg/kg) via umbilical venous catheter or endotracheal tube if there is no response after 60 seconds of chest compressions and ventilation.

Thermoregulation

• Maintaining the newborn’s body temperature is crucial to prevent hypothermia, which can lead to metabolic complications.
  • Dry the newborn immediately after birth and use warm towels.
  • Use a radiant warmer or skin-to-skin contact with the mother to maintain warmth.
  • Avoid exposure to drafts or cold surfaces
  • Ensure a warm delivery room environment (approximately 23–25°C).

Cord Clamping and Examination

• Delayed cord clamping (30–60 seconds after birth) is recommended to allow for increased placental transfusion and improve neonatal iron stores.
• Early clamping may be necessary in cases of severe fetal distress requiring immediate resuscitation.
• Examine the umbilical cord to ensure it contains the normal three vessels (two arteries, one vein).

Identification and Medications

• Identification:
  • Place identification bands on the newborn’s wrist and ankle immediately after birth to prevent misidentification.
• Routine medications:
  • Vitamin K (1 mg intramuscularly): Administer to prevent hemorrhagic disease of the newborn.
  • Eye prophylaxis (erythromycin ointment): Given to prevent neonatal conjunctivitis, especially from maternal gonorrhea or chlamydia.

Feeding Initiation

• If the newborn is stable, initiate breastfeeding within the first hour after birth (skin-to-skin contact helps promote bonding and breastfeeding).
• Early feeding helps stabilize the newborn’s blood sugar and promotes gastrointestinal adaptation.

8. Physical Examination of the Newborn

• A thorough physical examination should be performed within the first 24 hours to detect any congenital anomalies or other health issues.
  • Check the head for molding or cephalohematoma, and assess the fontanelles.
  • Inspect the eyes, nose, and mouth for structural abnormalities (e.g., cleft palate).
  • Examine the chest for symmetry of movement, breath sounds, and heart sounds (note any murmurs).
  • Palpate the abdomen for masses or organomegaly.
  • Inspect the genitalia for normal development.
  • Perform the Ortolani and Barlow maneuvers to check for hip dysplasia.

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