Evaluation of the Neonate & Infant

Question 1

What is the definition of neonate, infant, and preemie?

Answer 1

Neonate = first 28 days of life
Infant = 29 days to 12 months
Preemie = birth prior to 37 weeks (less than or equal to 259 days)

Question 2

What immediate care is needed in the delivery room and what clinical status questions?

Answer 2

• drying the baby
• clearing the baby’s airway
• warming the baby
• Is neonate > 35 weeks gestation?
• does he/she have good muscle tone?
• is he/she crying/breathing?
• > if yes- the baby should be given to the mother for skin to skin contact, bonding and early breast feeding
• > if no, further evaluation and intervention should be provided

Question 3

When is the APGAR score taken and what does it screen for?

Answer 3

• taken at 1 and 5 minutes
• classifies the newborn’s neurological recovery after birth and immediate adaption to extrauterine life
• total score ranges from 0-10
• 90% in 7-10 range

APGAR = Activity Pulse Grimace Appearance Respiration

Question 4

APGAR score action needed

Answer 4

At ONE minute:

• scores of <4 require immediate resuscitation (clear airway and give oxygen)
• scores of 5-6: some nervous system depression
• scores of 7-10: normal

At FIVE minutes:
<= 6 high risk for CNS/organ system dysfunction
-intervention as indicated
>=7 proceed to a more thorough examination

may continue every 5 minutes until the score is >= 7

Question 5

What time fame is considered the transitional period?

Answer 5

first 4-6 hours of life

Question 6

What are the clinical status assessments of the transitional period?

Answer 6

Every 30-60 minutes

• Heart rate: 120-160/minute (85-90bpm)
• Respirations: 40-60/minute
• Temperature: 36.5-37.5C (97.7-99.5F)
• Color: central cyanosis may indicate respiratory or cardiac disease
• Tone: hypotonia secondary to:
• > medications given to mom during labor
• > underlying syndrome (Down’s Syndrome)
• > sepsis
• > neurological impairment (hypoglycemia)

Question 7

What is gestational age used for and what scoring system can you use?

Answer 7

• helps to predict medical problems and morbidity
• date of LMP is the best estimation if menses were regular
• fetal ultrasound
• BALLARD SCORING SYSTEM
• estimates gestation age to within 2 weeks even in extremely premature newborns
• assessment of neuromuscular and physical maturity

Question 8

Gestational age classification

Answer 8

• preterm < 34 weeks
• late-preterm 34-36 w
• term 37-42 w
• postterm > 42 weeks

Question 9

Birth weight classification

Answer 9

• extremely low < 1000 g
• very low < 1500 g
• low < 2500 g
• normal >= 2500 g

Question 10

What are the maternal history components?

Answer 10

• socioeconomic status
• Family history
• > DM, HTN, thyroid disease, sickle cell anemia, etc

Maternal history

• medications used during pregnancy
• unusual dietary habits
• tobacco, EtOH, or drug use
• occupational exposure
• obstetric history (past and present)

Labor and delivery course

• duration of rupture of membranes
• duration of labor
• mode of delivery
• mom’s condition at delivery
• newborn’s condition at delivery
• risk of sepsis