Neonatal Assessment

RC 290

Labor: 3 Stages

Stage 1 : Cervical dilatationStage 2: Birth of babyDelivery of placenta

Normal time for all three stages is 12-20 hours

Dystocia

Caused by:Uterine dysfunctionImpaired fetal descent

Abnormal presentation or CPD

Dystocia Complications

Increased chances of:Placenta AbruptioCord compressionPROM

May cause infection and/or hypothermia

Falsely low fetal scalp pH

Normal Delivery: Vertex Presentation

Abnormal Presentations

Complete BreechFootling Breech

Breech Complications

Trauma to neonate and/or motherAsphyxia due to cord compressionProblems associated with premature birth

Cord Problems

Nuchal CordCord around infants

neckMay compress cord

Prolapsed CordCord comes out

before babyCord 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 ClosuresForamen Ovale

Increased left heart pressure functionally closes itMay take two months to seal anatomicallyAn increase in RIGHT heart pressure could cause it to re-open

in the first two monthsDuctus Arteriosus

Rising PO2 causes it to constrictFunctionally closes in 15 hoursAnatomic close takes three weeksA decrease in PO2 in the first three weeks may allow it to

reopenDirection 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 birthHeart rate, Respiratory rate, and Color are

used as the basis for resuscitation need

Totals:0-2 = severe distress3-6 = moderate distress7-10 = 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 Age80% of all births

SGA: Small for Gestational Age10% of all births

LGA: Large for Gestational Age10% of all births

AGA

A preemie can be AGA (yet still premature!

LGA

Usually seen with diabetic mothersMay cause dystociaA 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 SGASmoking, 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

ThinLoose, dry skinMinimal sub-Q fatMinimal hair

SGA Problems

AsphyxiaMeconium aspirationPulmonary HemorrhageIntracranial HemorrhageHypoglycemiaHypothermiaPolycythemia

Application Time