Pediatric Treatment Guidelines
New AAP Guidelines
2004 Edition
Karen Scruggs, MD
Michael T. Johnson, MD
Current Clinical Strategies Publishing
www.ccspublishing.com/ccs
Digital Book and Updates
Purchasers of this book may download the digital book and updates for Palm, Pocket PC, Windows and Macintosh. The digital books can be downloaded at the Current Clinical Strategies Publishing Internet site:
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Copyright \u00a9 2004 by Current Clinical Strategies Publishing. All rights reserved. This book, or any parts thereof, may not be reproduced or stored in a retrieval network without the written permission of the publisher. The reader is advised to consult the drug package insert and other references before using any therapeutic agent. No warranty exists, expressed or implied, for errors and omissions in this text.
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Neonatology
Normal Newborn Care
I. Prenatal pediatric visit
A.The prenatal pediatric visit usually takes place
during the third trimester of the pregnancy. Maternal nutrition, the hazards of alcohol, cigarette smoking and other drugs, and the dangers of passive smoking shouldbediscussed.Maternal illnesses and medications should be reviewed.
Prenatal Pediatric Visit Discussion Issues
Maternal History
General health and nutrition
Past and present obstetric history
Maternal smoking, alcohol, or drug use
Maternal medications
Infectious diseases: Hepatitis, herpes, syphi\u00ad
lis, Chlamydia rubella
Maternal blood type and Rh blood groups
Family History
Newborn Issues
Assessment of basic parenting skills
Feeding plan: Breast feeding vs formula
Car seats
Circumcision of male infant
II. Delivery
A. Neonatal resuscitation
1.All equipment must be set up and checked before
delivery. The infant who fails to breath spontaneously at birth should be placed under a radiant warmer, dried, and positioned to open the airway. The mouth and nares should be suctioned, and gentle stimulation provided.
2.The mouth should be suctioned first to prevent
aspiration. Prolonged or overlyvigorous suctioning may lead to bradycardia and should be avoided unless moderate-to-thick meconium is present in the airway.
3.The infant born with primary apnea is most likely
to respond to the stimulation of drying and gentle tapping of the soles of the feet. The infant who fails to respond rapidly to these measures is experiencing secondary apnea and requires positive pressure bag ventilation with oxygen.
4.Adequate ventilation is assessed by looking
for chest wall excursions and listening for air exchange. The heart rate should be assessed while positive pressure ventilation is being applied. If the heart rate does not increase rapidly after ventilation, chest compressions must be started by an assistant. If the infant fails to respond to these measures, intubation and medications are necessary. Epinephrine can be administered via the endotracheal tube. Apgar scores are used to assess the status of the infant at 1 and 5 min following delivery.
Apgar Scoring System
Sign
0
2
1
Heart
rate
Absent
Slow
(<100
beats/min
)
100
beats/min
or more
Absent
Weak
cry; hypo-
ventila\u00ad
tion
Strong
cry
Limp
Some
flexion
Active
motion
No re-
sponse
Grimace
Cough or
sneeze
Respira\u00ad
tions
Muscle
tone
Reflex
irritability
of 00
Pediatric Treatment
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