Basic Infant Stabilization

1
Basic Infant Stabilization

• Kristen Smith RNC/CM NICU
• Perinatal Outreach Coordinator

2
Goal

• Refresh the knowledge of those in outlying
  hospitals that are no longer delivering babies.

3
Why?

• All hospitals need to prepare for resuscitation,
  stabilization, and transport of infant (sick or
  well).
• All patients deserve and expect safe, quality
  care.
• Errors can occur in virtually all areas of care.

4
Get ready!

• Prepare -- make sure your hospital has the
  equipment you need to deliver a baby and
  resuscitate not only the mother but also the baby
  if needed. (Bag, mask, Ett, etc.)
• Think How will I provide a warm environment for
  the baby? (Warmer, warm blankets, Isolette,
  thermal mattress.)

5
If possible it is always better to deliver High
Risk mothers and babies at a Regional facility.

• The best transporter for baby is the mothers
  womb. Be very weary though, you do not want to
  deliver a baby on the side of the road!

6
Delivery!!!
7
Provide Thermal Management1st step in NRP
(Neonatal Resuscitation)

• Dry thoroughly.
• Remove wet linen.
• Provide a warm environment.
• Take the infants temperature Q15-30 until WNL
  and then Q1 hour.
• Remember that normal for an infant is 97.6-99.2
  axillary.

8
Heat loss through

• Conduction putting a baby on a cold surface,
  not pre-warming the warmer.
• Convection drafty area or people running past
  the area the baby is in.
• Evaporation not removing the wet linens.
• Radiation having the warmer next to a cold wall.

9
Always remember!

• Dry and remove the wet linens within a
• 20 second time frame.
• DO NOT use hot water bottles/gloves next to the
  skin, can cause burns.
• There are thermal mattresses on the market if you
  think this would help in your area.
• Always use your warmers on Servo mode!

10
Case
11
Evaluating Respirations2nd step in NRP

• Position shoulder roll to open airway.
• Suction (mouth and nose) if needed to clear
  airway.
• Remember that babies are changing from fetal
  to neonatal circulation and breathing so they
  are emptying the fluids out of their lungs.
• If the baby has a good cry with effective
  respiratory effort, go to checking the HR.

12
Increased work of breathing ?

• Respiratory Rate gt60.
• Increased effort shown by retractions, nasal
  flaring and/or grunting.
• Requiring Oxygen.
• (color dusky/oximitry low)

• Apnea is NEVER normal in a newly born infant.
• A weak cry or gasping sounds are an ominous sign
  of exhaustion and arrest!

13
So what do you do?
14
Assist ventilations for 15-30 seconds.

• Pressure should be 20-40 initially then decreased
  to 15-20.
• More importantly look for chest rise!
• Rate at 40-60 breaths per minute.
• If you bag a baby for a couple minutes you
  will need to place an OG tube to help get the air
  out of the stomach. Leave the OG open as a vent
  if needed.

15
Reasons for Respiratory Problems

• Respiratory Distress Syndrome (RDS)
• Transitory Tachypnea of the Newborn (TTN)
• Pneumonia/Aspiration Syndrome from Meconium or
  Amniotic Fluid (cause of surfactant deficiency).
• Obstruction mass, hernia, pneumothorax.

16
Okay --- now your 1st30 seconds after
deliveryhave gone by!

• Whats next?

17
Evaluate Heart Rate

• gt100 ?
• 60-100 bagging (even if baby crying)
• lt60 ?
• Chest compressions ratio 3/1 (90/30).
• Finger position.
• Re-check HR Q30 seconds.

18
Color

• Pink ?
• Blue -- requires stimulation to cry, if no
  improvement then whiff with O2.
• Pale -- Bag/mask ventilation may be needed
  especially if poor muscle tone.
• Remember that hands/feet can remain slightly
  cyanotic for awhile in babies but central
  cyanosis should not be evident.

19
Biggest hint!

• Keep the baby PINK!

20
NRP meds

• Epinephrine may repeat Q 3-5
• IV, UVC, Ett rapid administration
• 0.1-0.3 ml/KG (110,000 concentration)
• Narcan 0.1 mg/KG IM
• CAUTION!!!
• NS 10ml/KG IV, UVC over 5-10
• (Blood if blood loss evident.)

21
If infant is sickcall the NICU!

• Start a PIV (24G) to quickly provide glucose to
  normalize blood sugar levels.
• Blood sugar should be gt50.
• You can also use this PIV to give other meds like
  a bolus and/or antibiotics.

22
Glucose

• D 10 at 80 ml/KG/day.
• Recheck 15-30 after initiation.
• If lt50 then give 2 ml/KG of D 10 over 15.
• If still lt50, may repeat.
• If gt50 then continue monitoring every 30 until 2
  tests gt50 then hourly x2.
• Goal is a blood sugar level of 50-110.

23
Babies at High Risk forLow Blood Sugars

• Premature
• SGA
• LGA
• Sick Infants using sugar more quickly.
• Stress, Infection, Shock, RDS, Cardiac Problems,
  Hypothermia.

24
Apgars

• Done at 1 minute, 5 minutes and 10 minutes of
  age.
• Only a tool for assessing infants condition at
  birth.
• Does not determine if you resuscitate, you do not
  wait to do that.

25
Apgar Scoring Chart
26
Promote Breastfeeding

• There are advantages to mother and baby!
• Can assist with prevention of hypoglycemia in
  baby with the early intake of colostrum.
• Promotes bonding!
• Helps stimulate moms natural Pitocin to aid in
  the involution of the uterus.
• Do Not let baby feed if there is Respiratory
  Distress!

27
Continue checking vital signs!

• Every hour for 1st few hours.
• If baby is being transported we will want to know
  Temperature, HR and rhythm, Respiratory
  rate/effort, O2 need and Oximitry, Blood Pressure
  and Perfusion/Pulses, Neurological Status, Urine
  Output, Glucose level and if feeding or has a PIV.

28
Beyond the Basics

• STABLE program
• Sugar monitoring including umbilical line
  placement
• Temperature review
• Airway (including blood gases, chest X-rays,
  needle aspiration and intubation)
• Breathing
• Labs (including CBC review, antibiotic TX and
  shock)
• Emotional support and evaluation.

29
Thank You!