Download - Orientation t o the world of newborn
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Orientation to the world of newborn
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Topics coveredThe NICU
◦where to go◦what to do
Delivery room set up Review of neonatal resuscitation
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Learning ObjectivesUnderstand
◦various mode of thermoregulation◦importance of communication◦steps in resuscitation of newborn
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The NICU2nd floor at Lakeside HospitalPlease be at NICU by 7.30am3 minute scrub prior to entering
NICUWear gloves for all patient
contact Wash hands between patientsPlease use the baby’s individual
stethoscope (found at baby’s bedside)
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Scrub before entering NICU
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Waterless Hand Wash
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The NICUAttend at least 1 delivery with
NNP or residentsIf parents ask questions, please
refer them to medical teamMute cell phone & talk softly
around babiesPlease wear scrubs while in the
NICU
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The NICUPeople 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
Nancy Wood Kathy Smith Shelly Holcomb Julie Evans Angie Noya
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The NICUAssigned 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
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Isolation Room – Gown & Glove
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Isolette
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The NICUPresent patients during rounds
(usually starts around 8.30-9.00am)◦ Brief history and current problems◦ Issues overnight◦ Vital signs, current weight & change
in weight◦ Brief review of physical examination
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The NICUPresent 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
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The NICURounds usually end by 11.30amNoon 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◦ Check up on your patient◦ Review assessment and plan with
residents
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The Delivery RoomNeed to wear
◦ Head cover◦ Mask◦ Shoe cover◦ You may be asked to scrub and wear
scrub gown to receive babyStand around radiant warmerSpeak softly Be aware of sterile fields!
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Hats, masks, shoe covers before entering OR
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Scrub area in OR
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Neonatal ResuscitationMost newborn transition to
extrauterine life without complications
~10% require some intervention10-20% from above require
aggressive intervention
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Preparation prior to deliveryAdequate 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
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Preparation prior to deliveryObtain information from OB
nurses◦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
Pass above information to rest of team!
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Preparation prior to deliveryEquipments
◦Radiant warmer ◦Warm blankets (lots of it!)◦Stethoscope◦Plastic wrap for babies <1000g◦Bag-mask ventilation ◦Oxygen blender◦Laryngoscope ◦Endotracheal tubes◦Suction
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Preparation prior to deliveryRadiant warmer
◦Switch on when enter delivery room◦Provides radiant heat ◦Make sure sides are up to prevent
convective heat lossWarm dry blankets
◦Provides conductive heat◦Prevents evaporative heat loss
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Radiant warmer in DR
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Preparation prior to deliveryCheck equipments
◦Put on gloves!◦Resuscitation bag, air flow & oxygen◦Suction device (bulb and wall
suction)◦Meconium aspirator (if meconium
present)◦Laryngoscope and endotracheal tube
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Preparation prior to deliveryEnsure have adequate personnel Assign roles to team members
◦Be specific (who, what, when)◦Be aware of what and how team
members are performingVocalize findings/difficulties to
team membersDo not be afraid to CALL FOR
HELP
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Initial ResuscitationProvide warmth
◦Turn on radiant warmer◦Place baby on warm dry blanket
Dry and Stimulate◦Dry baby with warm dry blanket◦Remove wet linen from baby
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Initial ResuscitationAirway
◦Clear airway with bulb syringe Mouth 1st, nose 2nd
◦Position baby to open airway
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Initial ResuscitationBreathing
◦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
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Initial ResuscitationPick 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
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Flow-inflating bag
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Initial resuscitationBreathing
◦Term infant may require peak PIP 20-30 cmH20 initial inflation pressure
◦Provide 30-60 breaths a minute
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Initial resuscitationCirculation
◦Assess color, tone and heart rate◦Palpate brachial and umbilicus for
pulse◦Tap out heart rate◦Chest compression if needed
2 different techniques
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Assessing Heart Rate
Palpation for brachial pulse
Palpation for umbilical pulse and Auscultation by stethoscope
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Chest compression techniques
2 finger technique
2 hand technique – thumbs side-by-sideover midsternum
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Transport Isolette
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Apgar ScoresDeveloped by Virginia Apgar in
1953To assess effectiveness of
resuscitative effortsAssess heart rate, respiration,
color, tone and grimace
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Apgar Scores (How Ready Is This Child?)
0 Points 1 Point 2 PointsHeart 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
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Assessment of tone
Normal tone in term newborn
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Assessment of color
Acrocyanosis
Cyanotic newborn
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Algorithm of resuscitationBirth
Term?Amniotic fluid clear?Breathing?Good tone?
WarmPositionClear airwayDry, stimulate, reposition
Yes Routine care- Warm- Dry- Clear Airway- Assess colorNo
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Algorithm of resuscitation
Evaluate breathing, HR, Color & tone
HR <100 or apnea 30sPositive pressure ventilation
HR <60 30sEnsure effective inflation Start chest compression
HR <60 30s
Medications
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www.exutero.wordpress.comVisit this link while in NICU
rotationFor Students: review articles Complete test (may work in
group)For Interns: complete 4
consecutive (weekly) resident readiness tests◦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).
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THANK YOU!
QUESTIONS?