Chapter 3 Initial Steps of Newborn Care

Question 1

How long should cord clamping be delayed for most vigorous term and preterms?

Answer 1

30-60 seconds
(p.35)

Question 2

What are the three “Rapid Evaluation” questions post birth?

Answer 2

1. Term
2. Tone
3. Tenor or are they breathing or crying
   (p.35)

Question 3

If any of the answers to the three Rapid Evaluation question are “NO” where does care of the newborn continue?

Answer 3

At the radiant warmer
(p.35)

Question 4

Is routine laryngoscopy for meconium stained fluid recommended?

Answer 4

NO (p.35)

Question 5

What are the expected ranges of POX in the minutes after birth? (TABLE)

Answer 5

1 min 60%
2 65
3 70
4 75
5 80
10 85-95%
(p.34)

Question 6

What FiO2 should be used for newborns greater or equal to 35 weeks?

Answer 6

21%

Question 7

What FiO2 should be used for newborns less than to 35 weeks?

Answer 7

21-30% (p. 34)

Question 8

When is the baby’s birth process considered to be complete?

Answer 8

“time of birth is marked as when the last fetal body part emerges from the mother body” (p. 37)

Question 9

What are some benefits of delayed cord clamping in preterms?

3 benefits

Answer 9

1. decreased need for meds to support BP
2. decreased need for blood transfusion
3. possible improved survival
   (p.37)

Question 10

What are some benefits of delayed cord clamping in term babies?

3

Answer 10

1. may improve early hematological measurements
2. benefits with neuro development
3. May increase the need for phototherapy for elevated bilirubin
   (p. 37)

Question 11

When might you want to clamp the cord immediately?

Answer 11

When placental circulation is not intact
1. placental abruption
2. bleeding placental previa
3. bleeding vasa previa
4. cord avulsion
(p. 37)

Question 12

What is the definition of a preterm baby?

Answer 12

less than 37 weeks
(p.39)

Question 13

What are the “Initial Steps of Newborn Care”?

Answer 13

1. Provide Warmth W
2. Dry D
3. Stimulate S
4. Position head and neck A
5. Clear secretion S
   (p.40)

Question 14

At what temperature should the baby be maintained?

Answer 14

36.5-37.5
p.41)

Question 15

How is a preterm of LESS than 32 weeks kept warm?

Answer 15

DO NOT DRY, wrap in plastic
(p.41)

Question 16

When positioning the babies head and airway how should the neck be extended?

Name position
describe extension degree
eye direction

Answer 16

“sniffing position”
NEUTRAL or slightly extended and eyes directed straight upwards
may place a small rolled towel under the shoulders
(p.42)

Question 17

What is the order of suctioning for a newborn with secretions?

Answer 17

Mouth then nose
(p. 43)

Question 18

Why should you avoid vigorous suctioning?

Answer 18

May cause vagal response leading to apnea or bradycardia
(p.44)

Question 19

When setting up suctioning, what vacuum pressure is used?

Answer 19

80-100 mmHg
(p.44)

Question 20

What is the primary intervention for a baby with a heart rate less than 100?

Answer 20

PPV, even if breathing
(p.44)

Question 21

How should the heart rate be assessed?

Answer 21

With a stethoscope held to the left side of the chest
DO NOT use umbilical pulsations
count for 6 sec. and multiply by 10
if unable to count–may use POX or cardiac monitor
(p.45)

Question 22

What does acrocyanosis indicate?

Answer 22

Cyanosis limited to the hand and feet is a common finding in newborns and does NOT indicate poor oxygenation
(p. 45)

Question 23

How might central cyanosis present?

Answer 23

As cyanosis of the lips, tongue,, torso, may be normal for several minutes after birth

Question 24

Where should the POX be placed on a newborn and why?

Answer 24

RIGHT hand or wrist to read preductal blood O2 that better represents the blood flow to the brain and heart
(p.45)

Question 25

How long might it take for a POX to obtain a good reading?

Answer 25

1-2 minutes
(p.45)

Question 26

What is a normal intrauterine POX?

Answer 26

60%
(p.47)

Question 27

Can you free flow O2 via an ambu bag?

Answer 27

NO
(p.49)

Question 28

When using an O2 blender and flow meter, what should the flow rate be set at?

Answer 28

10L/min
(p.50)

Question 29

List the three rapid evaluation questions that determine which newborns should be brought to the radiant warmer for initial steps?

Answer 29

TERM, TONE, TENOR
1. What is the gestational age, the the baby term
2. Does the baby have good tone?
3. Is the baby breathing or crying

p.56

Question 30

List the 5 initial steps of newborn care?

Answer 30

1. Warm
2. Dry
3. Stimulate
4. Position head and neck
5. Suction airway if needed

p.56 WDSAS

Question 31

You count a newborns heartbeat for 6 seconds and count 6 beats. You report the heart rate as,
a. 36 bpm
b. 60 bpm

Answer 31

b. 60 bpm
p.56

Question 32

Oxygen saturation should be 85% to 95% by,
a. 2 min of age
b. 10 min.

Answer 32

b. 10 min.
p26

Question 33

You have provided warmth, dried, stimulated, positioned the head and neck, and cleared secretions. It is now 60 seconds after birth and the baby is still apneic and limp. What your next action?

Answer 33

PPV and call for help if alone

p.56

Question 34

The baby is breathing, the heart rate is greater than 100 beats per minute, the airway is clear, and correctly positioned but respirations are labored you may consider,
a. deep pharyngeal suction
b. CPAP

Answer 34

b. CPAP
p. 56