Neonatology Book

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Neonatal Airway AssessmentAka: Newborn Initial Assessment

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  1. See Also
    1. Neonatal Breathing Assessment
    2. Neonatal Circulation Assessment
    3. Neonatal Perfusion Assessment
    4. Neonatal Distress Causes
  2. Background
    1. Performed immediately after delivery for all newborns
    2. Entire initial assessment should not exceed 30 seconds
    3. Newborns need only these steps in 90% of cases
  3. Approach
    1. Place infant under radiant heater
    2. Meconium suctioning via Endotracheal Tube (if needed)
      1. Indications (perform before too many respirations)
        1. Thick meconium stained and
        2. Not vigorous (depressed tone, respirations, pulse)
      2. Technique
        1. Cords visualized with laryngoscope
        2. Clear mouth with 12-14F suction catheter if needed
        3. Insert ET Tube to below cords, suction and withdraw
        4. Repeat insertion as needed to clear below cords
    3. Suction mouth, then nose
      1. Also suctioned at perineum with delivery of head
    4. Dry thoroughly
    5. Remove wet linen
    6. Position with slight neck extension (sniffing position)
      1. Consider small rolled blanket under shoulders
    7. Provide tactile stimulation
      1. Drying and suctioning are usually sufficient
      2. Additional measures
        1. Flick soles of feet
        2. Gently rub trunk
      3. Do not delay Resuscitation for continued apnea
        1. Response to stimulation should be within seconds
        2. Immediately move to next step if no response
        3. Secondary apnea will not respond to stimulation
      4. Avoid harmful measures
        1. Do not shake, slap or squeeze infant
        2. Do not forcefully flex thighs onto abdomen
    8. Assess need for further Resuscitation
      1. Infant not breathing or Heart Rate less than 100
        1. Resuscitation: See subsequent assessment below
      2. Central Cyanosis
        1. Administer free-flow 100% oxygen
        2. See Neonatal Perfusion Assessment
      3. No identified problems
        1. Baby may be placed on mothers chest and observed
  4. Approach: Subsequent Assessment (Resuscitation)
    1. Neonatal Breathing Assessment
    2. Neonatal Circulation Assessment
    3. Neonatal Perfusion Assessment
  5. References
    1. Kattwinkel (2000) Neonatal Resuscitation, AAP-AHA

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