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Discussion

newborn assessment

I'd like to see how others go thru the newborn assessment. Starting at delivery.. how do you find the first pulse? by the umbilical cord...what about resp.? what steps after that...eye oint, vit. k, the intitial assessment the whole nine yards! I'm just interested in seeing if we all do it the same or if the routine varies from person to person.. Thanks, Brandy I'm working on getting me a routine down...any hints are appreciated

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I only use the cord if I've got the baby and am trying to decide if it needs chest compressions or just PPV. The usual situation is a baby that is vigorous and placed immediatly on Mom's abdomen. I dry it off quickly and give it a clean dry blanket then raise Mom's gown and place it skin to skin with her. I then do TPR (with stethescope). My preference would be for Mom to keep holding baby until after it's nursed for the first time, but my hospital requires a weight and length to admit the baby. So, I take it after a few minutes to weigh and measure. I sometimes give the Vit K then, sometimes not. I do usually wait for the Erythromycin until after nursing or one hour (the order reads to "give within the first hour after birth") because I like to let Mom and baby look at each other for awhile. Babe's vision is blurry enough without the gunk in his eyes.

As long as the baby is vigorous, with good color and tone, I leave it with Mom. When I take it to weigh, I do a quick look for anything obviously abnormal, but hold the initial assesment until I give the bath or until Mom is ready to let go of the baby for a while.

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anyone else??? surely someone has some tips!!!

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I'm kind of out of my thread right now, as I work in a Level III NICU, but this is how I manage a baby "fresh outta the oven" :

Keep in mind, I'm only talking about term babies here, I would manage a 24 weeker TOTALLY differently.

1: The infant is placed in the preheated RW, dried, stim and bulb sx while I feel for an umbilical HR. (ffo2 given at this point)

2. If HR >100, at this point I make sure the infant IS breathing, assess for retractions, flaring, color and grunting, check breath sounds with stethescope while confirming apical HR.

3. If HR 100, return to blowby, continue to assess color, resp effort and HR. if still

At this point, infant should be crying, pink, blowby should be weaned. Footprints, emycin is given, and temp taken. Infant is then weighed and placed in mom's arms.

The infant is not fully assessed by L&D staff, but taken almost immediately with mom to Mom/Baby

When in NICU, I assess my baby as follows:

1. Ant/post fontanelles

2. eyes, ears, nose, temp, color

3. heart rate, tones, murmur, arterial lines, sites, BP

4. Lung sounds, ET tube, ventilator.

5. Belly, circumference, bowel sounds OG/NG tube, aspirate

6. ROM

7. Pedal pulses, cap refill.

8. Any umbilical lines, picc lines, peripheral IV's, central lines, chest tubes

I'm sure I've missed something, but that's what I do. I know you don't do all that in L&D, but that's what I had to contribute!

For immediate assessment, for full term kid. Baby is on moms abdomen, watch closely for respirs and spontaneous cry, feel cord for pulse. bulb sxn prn. If pink and vigorous, dry babe and leave with mom for a short while, do TPR(listen for apical and lung sounds) with baby on mom. At this point, I am usually busy with writing bands, giving OB suture, hanging pit, moms VS... When mom is cleaned up, weigh baby, length, head, chest. Erythro then vit K. More TPR and full assessment. Wrap and give to mom/dad. Feed within 1 hour, bath at three hours in nursery where BP's and dubowitz are done.

:balloons: :balloons: :balloons: Did you know June 7 1909 is the bith aniversary of Virginia Apgar ? :balloons: :balloons: :balloons:

You cant find any pulse on newborn... what i know is, you use your stethoscope right away:) to find his/her rate... am i right?

You cant find any pulse on newborn... what i know is, you use your stethoscope right away:) to find his/her rate... am i right?

Peripereral pulses are definitely palpable on a newborn, even though they are considered unreliable in assessing HR.

Palpation of the periperal pulses is an important part of the initial assessment, as differences in the strength of pulses from the left to the right sides of the body, or upper to lower extremities can indicate certain cardiac defects.

For NICU babies palpation of femoral and pedal pulses is important to ensure adequate circulation when a umbilical arterial catheter is in place.

And remember, in infant CPR, it is the brachial pulse that is checked.

They can be tricky to find, so just keep practicing!

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