Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNOB/GYN: Care of the Newly Born - 7083

CARE OF THE NEWLY BORN

Prehospital Management of a Newborn InfantHistory

Due date, gestational age Multiple gestation Meconium Difficulties with delivery Congenital disease Medications (maternal) Maternal risk factors ( smoking,

substance abuse)

Signs and Symptoms Respiratory distress Peripheral cyanosis or mottling Central cyanosis (abnormal) Altered level of responsiveness Bradycardia

ASSESSMENT Airway failure (secretions,

respiratory drive) Infection Maternal medication effect Hypovolemia Hypoglycemia Congenital heart disease. Hypothermia

TREATMENT GUIDELINESR-EMR E-EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial Patient Contact for mother and child (2000). Dry infant and keep warm. Remove any wet linens from around the infant. Use bulb syringe to suction mouth and nose. Position infant so that the neck is slightly extended and down to facilitate

drainage of secretions. Cover the head; for stable infants, place the baby with the mother with skin to

skin contact.

R Stimulate infant and note APGAR scores (A1) at 1 and 5 minutes. Assess heart rate and respirations. For bradycardia (HR <100) use BVM for 30 secs at 40-60 breaths/minute with

100% FIO2. For HR <60, Peds Airway Protocol and commence CPR (3 compressions to 1

ventilation) Reassess and transport to receiving facility. ALS intercept for respiratory failure.

E

If amniotic fluid was stained with meconium, visualize hypopharynx and perform deep suction until free of meconium.2

For HR 60-100, go to Peds Airway Protocol. IV/IO protocol for ongoing HR <100.2

For HR >100, monitor and reassess 5 minute APGAR and continue Oxygen if required.

Consider Administration of D10 (if available - see below for dilution) for hypoglycemia.

A

ALS required for signs of distress in the Newborn. IV/IO protocol for ongoing HR <100. Epinephrine .01 mg/kg (0.1 ml/kg epinephrine 1/10,000) for ongoing distress q

3-5 mins.P

** Call Medical Control for Respiratory Failure and bradycardia in the newly born failing to respond to initial BVM. Consider Naloxone for ongoing respiratory suppression and bradycardia.** M

2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/17/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNOB/GYN: Care of the Newly Born - 7083

Record APGAR score (A1) at 1 minute and 5 minutes after birth. Consider hypoglycemia in an infant.CPR in infants is 120 compressions/minute with a 3:1 compression to ventilation ratio.It is extremely important to keep the infant warm. Breast feeding will stimulate uterine contraction.Maternal sedation or narcotics will sedate infant (Naloxone is effective but may precipitate seizures).D10 = D50 diluted (1 cc of D50 plus 4 cc of NS/ 10cc of D50 plus 40 cc NS).QA 100% of all infants with prehospital Respiratory Failure.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/17/2023 page 2 of 2