Normal Newborn Resp. Rate???

  1. 0
    Hi all...

    When I was in school we learned that normal resp. rate for NBs is 20-60. Now I work as an LDRP nurse and one day I charted 28 for a baby, and my preceptor said no that was wrong and it looks bad in the chart. Mind you I always chart the baby's color, tone etc. so that was not an issue.
    Yesterday I had a different preceptor tell me that it can be as low as 20, that's fine.

    IS THERE A STANDARD? Noone at my hospital seems to know!! It's frustrating!!
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  3. 8 Comments so far...

  4. 0
    Whaley & Wong (the pediatric bible) says normal resps are generally 30-60, depending on gestational age. I have had babies sleeping deeply whose resps were 28. I always either a) arouse them and count resps at that point, or b) recount in about an hour. If baby is pink, satting fine, good tone, & heart sounds are fine, I'd follow up but not flip out about a RR of 28. Someone else please feel free to chime in.

    Same is true for HR. Normal NB heart rate is 120-160 but plenty of babes have HR in low 100-110s whilst sleeping. The NNPs don't care about it as long as it increases when they're awake and/or stimulated. And for anyone over 40wks, HR>100 is considered normal where I am.

    HTH.
    Last edit by Elvish on Apr 5, '07 : Reason: typo
  5. 0
    In Olds, Sally "Maternal-Newborn Nursing and Women's Health Care"
    normal respirations for a term newborn are 30 to 60 per minutes, counted for one full minute
  6. 0
    American Academy of Pediatrics and AWHON state in their perinatal guidline text the normal newborn respirations are 30 - 60 bpm.
  7. 0
    If a baby is sleeping soundly, his or her O2 sats were in the high nineties and capillary refill was quick, I wouldn't be too concerned about a respiratory rate of 20. At the same time, a rate of 60 would not concern me if the baby was worked up and crying. But a baby who is breathing at 60 for an extended period of time, nostrils flaring, and retracting...you bet that I would page the resident! The context and the patient's baseline are important considerations that should not be dismissed or taken lightly.

    My hospital states that 30-60 is the normal range, but this is just a guideline. As my instructors and preceptors have repeatedly said, look at the patient and not at the machine (this means the pulse ox, cardiac monitor, Dinamap, etc.)
  8. 0
    30-60 is what we consider normal in our OB unit. Not everyone though, is going to fit into the cookie cutter numbers that are laid out for us. Look at your patient and if he/she seems okay recheck in an hour. You'll probably get something closer the the "normal" range. We recently had a baby in our unit who had a heart rate in the 80s and respirs were low, too. The babies family practice doc called a neonatologist to consult, and he was told not to worry. He said if all else is normal including pulse oximetry and no signs of labored breathing (grunting, flaring, retractions) then that baby could tolerate it and it was not unheard of.
  9. 0
    Quote from BSNDec06
    If a baby is sleeping soundly, his or her O2 sats were in the high nineties and capillary refill was quick, I wouldn't be too concerned about a respiratory rate of 20. At the same time, a rate of 60 would not concern me if the baby was worked up and crying. But a baby who is breathing at 60 for an extended period of time, nostrils flaring, and retracting...you bet that I would page the resident! The context and the patient's baseline are important considerations that should not be dismissed or taken lightly.

    My hospital states that 30-60 is the normal range, but this is just a guideline. As my instructors and preceptors have repeatedly said, look at the patient and not at the machine (this means the pulse ox, cardiac monitor, Dinamap, etc.)

    VERY WELL SAID!
  10. 0
    Just make sure you chart what the baby is doing if the numbers are out of whack. If high, baby's crying, restless, etc. If low, baby is sleeping. Another vote for look at the patient, not the numbers. In kids especially, it's not the individual set that is worrisome (you can't exactly tell a baby to relax while you're trying to get a BP like you can an adult), it's if there's a trend going one way or another. If the numbers are going down over a period of time or up over a period of time, and there's nothing to explain, start looking deeper. Of course if one set is way out of whack and nothing is happening to explain it, look into it too!
  11. 0
    Your preceptor is wrong.You chart what you see, not what "looks good" .....

    as the others said, you are doing a whole-person assessment. IF a kiddo is pink, eupneic and resting, respers in 20s are entirely possible and may be normal for THAT kid, as a heart rate of 98-100 would be.

    I am so sorry for the inconsistency you see in your hospital. Just remember back to school-----chart objectively what you see and the numbers you note.


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