a) In the immediate care of the newborn, it's crucial to assess and maintain adequate airway clearance as well as prevent heat loss by keeping the baby warm and dry. The Apgar score and a brief physical assessment are performed right away in order to find or rule out abnormalities.
b) It is important to prevent hypothermia in newborns because it can cause cold stress, which is excessive heat loss. The cold-stressed newborn tries to regulate its core body temperature by increasing heat production through certain compensatory mechanisms. This includes initiating brown fat metabolism, which causes an increased need for oxygen, leading to hypoxemia and metabolic acidosis. It also increases the metabolic rate, which can lead to hypoglycemia.
c) According to London, the newborn's pulse should be between 110-160 beats per minute (bpm), but it can be as low as 80 bpm if the infant is sleeping and as high as 180 bpm if the infant is crying. Bpm should be measured by auscultating the apical pulse for one full minute. Respirations should be between 30-60 respirations per minute, and should be counted for one full minute. For blood pressure, the systolic should be between 50-70 mm Hg and the diastolic should be between 30-45 mm Hg. The temperature should be between 36.5-37.5*C (97.7-99.4*F).
d) Respiratory distress can be recognized in the newborn by observing skin color, vital signs and breathing effort. Depending on the severity of respiratory distress, the skin can have pallor, mottling, cyanosis, jaundice or edema. The newborn could have tachypnea, which is a respiratory rate of 60 or more breaths per minute, or have apnea, periods of non-breathing lasting 20 seconds or more. The infant may have labored breathing as evidenced by retractions (suprasternal, substernal or intercostal) on inspiration, nasal flaring, grunting on expiration or an increased anteroposterior diameter, which indicates air trapping. Upon auscultation of the lungs, diminished breath sounds, fine rales or rhonchi may be heard.
e) The Apgar scoring system assesses heart rate, respiration, muscle tone, reflex response and skin color. The heart rate is the most important assessment and is scored based on whether the heart rate is more than 100 bpm, less than 100 bpm or absent. Respiration is the next most important and is scored as vigorous crying, slow/irregular respiratory effort or absent. Muscle tone assesses the degree of flexion and is scored as active movement of extremities, some flexion of extremities or flaccid. Reflex response is evaluated by response to stimuli and is measured as vigorous cry, grimace or absent. Skin color is scored as pink body and extremities, pink body and blue extremities or pale or blue.
#2 Newborn Equipment
The radiant warmer is used to maintain a neutral thermal environment for the newborn. As discussed earlier, hypothermia can lead to serious health problems such as hypoxia, metabolic acidosis and even shock. Immediately following birth, the baby is placed in the radiant warmer and is dried off by the nurse. It is also used whenever the infant needs to be unclothed, for example when performing assessments, interventions or bathing, or if the infant's temperature is below 36.5*C (97.7*F).
Suction catheter and suction source
The suction catheter is used to remove mucous from the newborn's mouth when there is excessive secretions or respiratory distress. As the newborn adjusts to extrauterine life, it is essential to keep the airway passages open and clear. One end of the suction catheter is hooked up to low suction, while the other end is inserted into the infant's nose or mouth, 3-5 inches. Suction is applied as the tubing is gently pulled out.
Resuscitation bag, mask and oxygen source
If suctioning is not effective and further resuscitation measures are needed, the newborn is administered oxygen through a mask. It's important to have the correct sized mask; it…