Neonatal Assessment

RC 290

Labor: 3 Stages

�Stage 1 : Cervical dilatation

�Stage 2: Birth of baby

�Delivery of placenta

Normal time for all three stages is 12-20

hours

Dystocia

Caused by:

�Uterine dysfunction

�Impaired fetal descent

�Abnormal presentation or CPD

Dystocia Complications

Increased chances of:

�Placenta Abruptio

�Cord compression

�PROM

�May cause infection and/or hypothermia

�Falsely low fetal scalp pH

Normal Delivery: Vertex

Presentation

Abnormal Presentations

Complete Breech

Footling Breech

Breech Complications

�Trauma to neonate and/or mother

�Asphyxia due to cord compression

�Problems associated with premature birth

Cord Problems

�Nuchal Cord

�Cord around infants

neck

�May compress cord

�Prolapsed Cord

�Cord comes out

before baby

�Cord compression

and asphyxia

A & P Changes: Respiratory

�Chest compression in

birth canal expels

fluid from airways.

The re-coil of the

chest helps initiate

the first breath

�-60-80 cmH2O

generated for first

breath

� First Vt is about 80 ml

� Take four breaths to establish FRC� After 4th breath FRC is

about 80 ml

� Initial breath “helped” by:

� Chest wall re-coil

� Tactile stimulation

� Temperature change

� ABG changes

A & P Changes: Circulatory

�Left heart pressure increases when cord is clamped and placenta is no longer part of system

�Right heart pressure drops as lungs expand and make PVR decrease

�Shunts close

Shunt Closures

�Foramen Ovale

�Increased left heart pressure functionally closes it

�May take two months to seal anatomically

�An increase in RIGHT heart pressure could cause it to re-open in the first two months

�Ductus Arteriosus

�Rising PO2 causes it to constrict

�Functionally closes in 15 hours

�Anatomic close takes three weeks

�A decrease in PO2 in the first three weeks may allow it to reopen

�Direction of shunt will be from higher pressure vessel to lower pressure vessel

Delivery Room Assessment:

Apgar Score

Apgar Score (cont.)

�Taken at 1 and 5 minutes after birth

�Heart rate, Respiratory rate, and Color are

used as the basis for resuscitation need

Totals:

�0-2 = severe distress

�3-6 = moderate distress

�7-10 = minimal distress

Apgar Score and scalp pH

�Apgar may be low with a normal scalp

pH is mother has too much anesthesia

�Apgar may be normal with a low scalp

pH if fetus sustained chronic, low grade

stress in utero

Silverman-Anderson Score-assess respiratory status only-

High score shows problems – just the opposite of the Apgar

Assessment of Gestational

Age: The Dubowitz and

Ballard Exams- gestational age based on physical and

neurologic signs-

Intrauterine Growth Rate

�After gestational age is determined, it is compared to birth weight to determine if intrauterine growth is appropriate

�AGA: Appropriate for Gestational Age

�80% of all births

�SGA: Small for Gestational Age

�10% of all births

�LGA: Large for Gestational Age

�10% of all births

AGA

�A preemie can be AGA (yet still

premature!

LGA

�Usually seen with diabetic mothers

�May cause dystocia

�A preemie can still be LGA!

SGA

�A preemie, a term, or a post-term can all be

SGA!

�Chronic, low-grade stress in utero causes SGA

�Smoking, pre-eclampsia, malnutrition, infection,

opiate drugs, placental problems, renal disease, and

hypertension

�These factors are also the same ones that cause

L/S ratios to hit 2:1 prior to 35 weeks!

SGA Appearance

�Thin

�Loose, dry skin

�Minimal sub-Q fat

�Minimal hair

SGA Problems

�Asphyxia

�Meconium aspiration

�Pulmonary Hemorrhage

�Intracranial Hemorrhage

�Hypoglycemia

�Hypothermia

�Polycythemia

Application Time