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Pediatric Treatment Guidelines
New AAP Guidelines
2004 EditionKaren Scruggs, MDMichael T. Johnson, MD
Current Clinical Strategies Publishing www.ccspublishing.com/ccs
Digital Book and Updates
Purchasers of this book may download the digital bookand updates for Palm, Pocket PC, Windows and Macintosh.The digital books can be downloaded at the CurrentClinical Strategies Publishing Internet site:www.ccspublishing.com/ccs/pedtreat.htmCopyright © 2004 by CurrentClinical Strategies Publishing.All rights reserved. This book, or any parts thereof,may not be reproduced or stored in a retrieval networkwithout the written permission of the publisher. Thereader is advised to consult the drug package insertand other references before using any therapeuticagent. No warranty exists, expressed or implied, for errors and omissions in this text.Current Clinical Strategies Publishing27071 Cabot RoadLaguna Hills, California 92653Phone: 800-331-8227Fax: 800-965-9420info@ccspublishing.comInternet: www.ccspublishing.com/ccsPrinted in USA ISBN 1-929622-26-0
Neonatology
Normal Newborn Care
I. Prenatal pediatric visitA.
The prenatal pediatric visit usually takes placeduring the third trimester of the pregnancy. Maternalnutrition, the hazards of alcohol, cigarette smokingand other drugs, and the dangers of passive smokingshould be discussed. Maternal illnesses and medicationsshould be reviewed.
Prenatal Pediatric Visit Discussion IssuesMaternal History
General health and nutritionPast and present obstetric historyMaternal smoking, alcohol, or drug useMaternal medicationsInfectious diseases: Hepatitis, herpes, syphilis, Chlamydia rubellaMaternal blood type and Rh blood groups
Family HistoryNewborn Issues
Assessment of basic parenting skillsFeeding plan: Breast feeding vs formulaCar seatsCircumcision of male infant
II.
DeliveryA. Neonatal resuscitation1.
All equipment must be set up and checked beforedelivery.The infant who fails to breath spontaneouslyat birth should be placed under a radiant warmer,dried, and positioned toopen the airway. Themouth and naresshould be suctioned, and gentlestimulation provided.
2.
The mouth should be suctioned first to preventaspiration. Prolonged or overly vigorous suctioningmay lead to bradycardia and should be avoidedunless moderate-to-thick meconium is presentin the airway.
3.
The infant born with primary apnea is most likelyto respond to the stimulation of drying and gentletapping of the soles of the feet. The infant whofails to respond rapidly to these measures isexperiencing secondary apnea and requirespositive pressure bag ventilation with oxygen.
4.
Adequate ventilation is assessed by lookingfor chest wall excursions and listening for air exchange. The heart rate should be assessedwhile positive pressure ventilation is being applied.If the heart rate does not increase rapidly after ventilation, chest compressions must be startedby an assistant. If the infant fails to respondto these measures, intubation and medicationsare necessary. Epinephrine can be administeredvia the endotracheal tube. Apgar scores areused to assess the status of the infant at 1 and5 min following delivery.
Apgar Scoring SystemSign 0 21
HeartrateAbsent Slow(<100beats/min)100beats/minor moreAbsent Weakcry; hypo-ventilationStrongcryLimp SomeflexionActivemotionNo re-sponseGrimace Cough or sneezeRespirationsMuscletoneReflexirritability
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