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MARLON V.

MURALLON, MD, DPPS, DPSNbM

MATERNAL FACTORS AFFECTING THE NEONATE


1. Hypertension a. pre- eclampsia b. eclampsia 2. Bleeding a. abruptio placenta b. placenta previa

MATERNAL FACTORS AFFECTING THE NEONATE


3. Infection a. Premature rupture of membrane b. Premature labor/ birth c. Chorioamnionitis d. Recent maternal infection/ illness e. Intrapartum/ postpartum maternal fever (> 380 C) f. Rupture of membranes > 18 hours

EVALUATE RESPIRATORY DISTRESS


RESPIRATORY RATE Normal * 30 60 breaths per minute * breathing without difficulty * Auscultation clear breath sounds, equal air entry bilaterally

EVALUATE RESPIRATORY DISTRESS


Respiratory rate < 30 per minute * if labored, may be sign of exhaustion * assess severity of apnea and quality of air entry * Gasping ! Ominous sign of impending cardiorespiratory arrest

EVALUATE RESPIRATORY DISTRESS


Respiratory rate > 60 per minute * Evaluate ventilation & oxygenation * work of breathing * blood gas

EVALUATE RESPIRATORY DISTRESS


DIFFERENTIAL DIAGNOSIS Preterm: RDS Term: TTN Pneumonia DIAGNOSTICS CXR
CBC w Pc

Blood CS
Hgt

EVALUATE RESPIRATORY DISTRESS


Work of breathing or respiratory effort 1. Grunting attempt to increase intrathoracic pressure in response to collapse of alveoli * helps retain small volume of air in alveoli 2. Nasal flaring attempt to decrease airway resistance * sign of air hunger 3. Retractions

EVALUATE RESPIRATORY DISTRESS


3. Retractions a. Intercostal b. Substernal c. Subcostal d. Suprasternal : between ribs : under sternum : below rib cage : above sternum

EVALUATING FOR SHOCK


RESPIRATORY EFFORT * increased work of breathing * tachypnea * apnea * !!! Gasping * Arterial blood gas - Respiratory, Metabolic or mixed acidosis?

EVALUATING FOR SHOCK


PULSES * Strength of pulses a. weak evaluate for shock b. bounding consider PDA, large AV malformation, truncus arteriosus * compare brachial to femoral Brachial stronger than femoral consider coarctation or interrupted aortic arch

EVALUATING FOR SHOCK


PERIPHERAL PERFUSION 1. Capillary Refill Time (CRT) * Normal less than or equal to 3 secs * Compare upper to lower body 2. Cool skin

EVALUATING FOR SHOCK


COLOR 1. Cyanosis 2. Pale white - low hemoglobin 3. Mottled skin

EVALUATING FOR SHOCK


HEART RATE 1. NORMAL * 120 160 Beats per minute (bpm) * may range 80 200 2. Bradycardia * Heart rate < 100 bpm * hypoxemia, hypotension, acidosis depress conduction system * Rule out heart block 3. Tachycardia * sustained heart rate > 180 bpm * may indicate decrease cardiac output, CHF * Rule out arrythmias

NEONATAL INFECTION (SEPSIS)


CLINICAL SIGNS 1. Respiratory distress 2. Temperature instability 3. Feeding intolerance 4. Abnormal : a. skin perfusion b. heart rate c. blood pressure d. neurological status

NEONATAL INFECTION (SEPSIS)


PRE- TRANSPORT LAB EVALUATION Obtain the 4B s 1. Blood count 2. Blood culture 3. Blood sugar 4. Blood gas

: CBC w differential : obtain adequate amount : check early & be vigilant : respiratory distress suspected shock

WHEN TO CALL A DOCTOR


1. High risk pregnancy 2. Meconium stained amniotic fluid 3. Infant in respiratory distress 4. Infant who is not breathing or cyanotic 5. Infant with poor/ fair suck and activity