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NEWBORN ASSESSMENT

NEWBORN ASSESSMENT. MIHAI CRAIU MD PhD. INITIAL EVALUATION. Physical assessment in neonates serves to describe anatomic NORMALITY.

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NEWBORN ASSESSMENT

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  1. NEWBORN ASSESSMENT MIHAI CRAIU MD PhD

  2. 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.

  3. Neonatal examination • First examination immediately at birth • Recurrent evaluations at 5 minutes interval • The evaluation tool is Apgar score

  4. 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.

  5. APGAR SCORE* * Apgar Virginia. A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. Analg. 1953.32 (4): 260–267

  6. APGAR SCORE

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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").

  12. 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.

  13. 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

  14. FIRST SECOND

  15. 10 SECONDS

  16. 100 SECONDS

  17. 1000 SECONDS

  18. IN THE DELIVERY ROOM • Delivery room resuscitation should be available in all maternities, regardless of level and staff size and knowledge.

  19. 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.

  20. IN THE DELIVERY ROOM Transitional 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

  21. IN THE DELIVERY ROOM Transitional 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

  22. 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.

  23. 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

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