The Newborn Baby

Question 1

Define “newborn”.

Answer 1

First 24hrs of life.

Question 2

When should resuscitation be withheld for newborns?

Answer 2

<23 weeks gestation, regardless of signs of life.

Question 3

At what age is an infant deemed preterm?

Answer 3

<37 weeks

Question 4

What are the care objectives for a newborn?

Answer 4

1. Establish and maintain effective respiration
2. Prevent hypothermia
3. Tx to appropriate facility

Question 5

What is the most important indicator of effective ventilation in newborns?

Answer 5

Heart rate - should be used to guide the need/effectiveness of resus.

Question 6

How can hypothermia be prevented in newborns?

Answer 6

Dry the head and body, place little beanie on head
Place skin to skin with mother
Cover with warm blankets/towels
If resus required, place bubble wrap over newborns body and small towel/beanie on head.

Question 7

If newborn at term and experienced no complications with birth, Tx to ___________. If not at term or complicated birth, consult with PIPER.

Answer 7

appropriate maternity service.

Question 8

What is the normal weight of a full term newborn?

Answer 8

3.5kg

Question 9

What is the normal blood volume of a full term newborn?

Answer 9

80ml/kg

Question 10

What is the normal heart rate of a full term newborn?

Answer 10

110-170

Question 11

What is the normal RR of a full term newborn?

Answer 11

25-60

Question 12

What is the normal temp of a full term newborn?

Answer 12

36.5 - 37.5

Question 13

What is the normal BGL of a full term newborn?

Answer 13

2.6 - 3.2 mmol

Question 14

What is the overall appearance of a healthy, full term newborn?

Answer 14

Dusky/peripherally cyanosed for first few mins.
Blueish/purple hands and feet are normal for first 24hrs
Good muscle tone, flexing arms and legs
Spontaneous and regular breathing

Question 15

What are the expected SPO2 findings of a newborn at 1, 3 , 5 and 7-10mins?

Answer 15

1min - 60 to 70%
3mins - 70 to 90%
5 mins - 80 to 90%
7-10mins - >90%

Question 16

Where should the newborn SPO2 probe be placed?

Answer 16

Pts right wrist, pre-ductally.

Question 17

When should a newborn be treated as per the Newborn Resus guideline?

Answer 17

If does not rapidly develop effective respirations and good muscle tone after drying and stimulating; deteriorates at any stage or is unable to maintain HR >100bpm.

Question 18

How do newborns lose heat?

Answer 18

Via the large surface area of their head and by evaporation from their wet bodies.

Question 19

If the infant is <32 weeks or <1500g, how is hypothermia managed?

Answer 19

Place newborn in an upside down ziplock, zipping under feet, with a hole in the top cut out for the head. Apply the beanie.

Question 20

Is routine suction required for newborns?

Answer 20

No, even if born in meconium stained fluid, newborns are likely to clear their own airway effectively.

Question 21

Can suctioning be detrimental to newborns?

Answer 21

If not indicated, suctioning can delay onset of respirations and cause bradycardia. Only indicated if airway obstructed.

Question 22

When should the cord be cut?

Answer 22

After it stops pulsating (1-2mins) in the vigorous newborn unless requested otherwise.
If resus required and cord compromises access, cut immediately.

Question 23

If newborn is breathing adequately and has good muscle tone, what is the management?

Answer 23

1. Continue to dry
2. Maintain warmth
3. Monitor HR, breathing, tone, colour
4. Cut cord after 1-2mins when it stops pulsating
5. APGAR

Question 24

If >36 weeks, uncomplicated delivery and stable vital signs, where should the newborn be transported?

Answer 24

Appropriate maternity service (eg. pre-booked)

Question 25

If 32-36 weeks and stable vitals, where should the newborn be transported?

Answer 25

Level 2 hospital with a paediatrician/midwife in consultation with PIPER

Question 26

If <32 weeks, or vitals unstable, where should the newborn be transported?

Answer 26

To a tertiary centre in consultation with PIPER