Transcript Orientation To the world of newborn

Orientation to the world of
newborn
Topics covered
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The NICU
◦ where to go
◦ what to do
Delivery room set up
 Review of neonatal resuscitation
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Learning Objectives
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Understand
◦ various mode of thermoregulation
◦ importance of communication
◦ steps in resuscitation of newborn
The NICU
 2nd
floor at Lakeside Hospital
 Please be at NICU by 7.30am
 3 minute scrub prior to entering NICU
 Wear gloves for all patient contact
 Wash hands between patients
 Please use the baby’s individual
stethoscope (found at baby’s bedside)
Scrub before entering NICU
Waterless Hand Wash
The NICU
Attend at least 1 delivery with NNP or
residents
 If parents ask questions, please refer them
to medical team
 Mute cell phone & talk softly around
babies
 Please wear scrubs while in the NICU
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The NICU
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People you will see in the NICU
◦ Charge nurse
◦ Bedside nurse (usually have 2-3 babies per
nurse)
◦ Respiratory therapists (usually 2 in NICU)
◦ Neonatal nurse practitioners
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Nancy Wood
Kathy Smith
Shelly Holcomb
Julie Evans
Angie Noya
The NICU
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Assigned patients by the residents
◦ Review history and physical with residents
◦ Pre-round with residents
◦ Review laboratory and radiology results with
residents
◦ Talk to RNs about patient and prior to
examining patient
Isolation Room – Gown & Glove
Isolette
The NICU
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Present patients during rounds (usually
starts around 8.30-9.00am)
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Brief history and current problems
Issues overnight
Vital signs, current weight & change in weight
Brief review of physical examination
The NICU
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Present patients during rounds
◦ Intake (Type of feeds, TPN, amount,
nipple/gavage)
◦ Total intake (mL/kg/day) and output
(mL/kg/hr)
◦ Laboratory, radiology, consult results
◦ List of medications
◦ Assessment and plan for the day
The NICU
Rounds usually end by 11.30am
 Noon conference (for residents)
 Please remind attending and residents on
days you will not be present in the
afternoon
 In the afternoon or prior to leaving for
the day
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◦ Check up on your patient
◦ Review assessment and plan with residents
The Delivery Room
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Need to wear
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Head cover
Mask
Shoe cover
You may be asked to scrub and wear scrub
gown to receive baby
Stand around radiant warmer
 Speak softly
 Be aware of sterile fields!
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Hats, masks, shoe covers before
entering OR
Scrub area in OR
Neonatal Resuscitation
Most newborn transition to extrauterine
life without complications
 ~10% require some intervention
 10-20% from above require aggressive
intervention
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Preparation prior to delivery
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Adequate personnel
◦ Open communication with OB team
◦ Should have minimum of 3 person trained in
NRP for high risk deliveries
◦ Good communication within team
◦ Good coordination of function for each team
member
Preparation prior to delivery
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Obtain information from OB nurses
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Gestational age of baby
Why are we delivering?
Is meconium present (if membranes ruptured)
Any pertinent maternal history?
 Fever
 Pertinent labs
 Complications during pregnancy/labor
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Pass above information to rest of team!
Preparation prior to delivery
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Equipments
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Radiant warmer
Warm blankets (lots of it!)
Stethoscope
Plastic wrap for babies <1000g
Bag-mask ventilation
Oxygen blender
Laryngoscope
Endotracheal tubes
Suction
Preparation prior to delivery
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Radiant warmer
◦ Switch on when enter delivery room
◦ Provides radiant heat
◦ Make sure sides are up to prevent convective
heat loss
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Warm dry blankets
◦ Provides conductive heat
◦ Prevents evaporative heat loss
Radiant warmer in DR
Preparation prior to delivery
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Check equipments
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Put on gloves!
Resuscitation bag, air flow & oxygen
Suction device (bulb and wall suction)
Meconium aspirator (if meconium present)
Laryngoscope and endotracheal tube
Preparation prior to delivery
Ensure have adequate personnel
 Assign roles to team members
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◦ Be specific (who, what, when)
◦ Be aware of what and how team members are
performing
Vocalize findings/difficulties to team
members
 Do not be afraid to CALL FOR HELP
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Initial Resuscitation
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Provide warmth
◦ Turn on radiant warmer
◦ Place baby on warm dry blanket
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Dry and Stimulate
◦ Dry baby with warm dry blanket
◦ Remove wet linen from baby
Initial Resuscitation
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Airway
◦ Clear airway with bulb syringe
 Mouth 1st, nose 2nd
◦ Position baby to open airway
Initial Resuscitation
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Breathing
◦ Primary apnea
 Can be reversed by stimulation
 Rub backs and flick heels
 Do NOT turn baby upside down!
◦ Secondary apnea
 Require bag and mask ventilation
 May require endotracheal intubation
Initial Resuscitation
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Pick the right size of mask
◦ Fit from bridge of nose to chin
◦ Do not cover eyes
Wood FE et al; Arch Dis Child – Fetal and Neonatal Ed 2008;93:F230-4
Flow-inflating bag
Initial resuscitation
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Breathing
◦ Term infant may require peak PIP 20-30
cmH20 initial inflation pressure
◦ Provide 30-60 breaths a minute
Initial resuscitation
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Circulation
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Assess color, tone and heart rate
Palpate brachial and umbilicus for pulse
Tap out heart rate
Chest compression if needed
 2 different techniques
Assessing Heart Rate
Palpation for umbilical pulse and
Auscultation by stethoscope
Palpation for brachial pulse
Chest compression techniques
2 finger technique
2 hand technique –
thumbs side-by-side
over midsternum
Transport Isolette
Apgar Scores
Developed by Virginia Apgar in 1953
 To assess effectiveness of resuscitative
efforts
 Assess heart rate, respiration, color, tone
and grimace
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Apgar Scores (How Ready Is This
Child?)
0 Points
1 Point
2 Points
Heart rate
Absent
<100bpm
>100bpm
Respiration
Apnea
Gasping, irregular
Strong cry
Irritability
Absent
Facial grimace
Sneeze, cough,
pulls away
Tone
Absent
Arms & legs
extended
Active
movements
Color
Blue-gray, pale all
over
Pink body, blue
extremities
Pink all over
Assessment of tone
Normal tone in term newborn
Assessment of color
Acrocyanosis
Cyanotic newborn
Algorithm of resuscitation
Birth
Term?
Amniotic fluid clear?
Breathing?
Good tone?
No
Warm
Position
Clear airway
Dry, stimulate, reposition
Yes
Routine care
- Warm
- Dry
- Clear Airway
- Assess color
Algorithm of resuscitation
Evaluate breathing, HR,
Color & tone
HR <100 or apnea
30s
Positive pressure ventilation
HR <60
30s
Ensure effective inflation
Start chest compression
HR <60
Medications
30s
www.exutero.wordpress.com
Visit this link while in NICU rotation
 For Students: review articles
 Complete test (may work in group)
 For Interns: complete 4 consecutive
(weekly) resident readiness tests
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◦ Email completed tests to Priscilla Busch
 [email protected]
 Completion of assigned test(s) is mandatory.
 Failure to Complete a test will result in failure of
the rotation (for students or interns).
THANK YOU!
QUESTIONS?