Pediatric Treatment Guidelines New Guidelines 2007 Edition
Karen Scruggs, MD Michael T. Johnson, MD Copyright © 2007 by Current Clinical Strategies Publishing. All rights reserved. This book, or any parts thereof, may not be reproduced or stored in a retrieval network without the written permission of the publisher. The reader is advised to consult the drug package insert and other references before using any therapeutic agent. No warranty exists, expressed or implied, for errors and omissions in this text. Current Clinical Strategies Publishing 27071 Cabot Road Laguna Hills, California 92653 Phone: 800-331-8227 Fax: 800-965-9420
[email protected] Internet: www.ccspublishing.com/ccs Printed in USA
ISBN 1-929622-74-0
Neonatology Normal Newborn Care I. Prenatal pediatric visit A. The prenatal pediatric visit usually takes place during the third trimester of the pregnancy. Maternal nutrition, the hazards of alcohol, cigarette smoking and other drugs, and the dangers of passive smoking should be discussed. Maternal illnesses and medications should be reviewed. Prenatal Pediatric Visit Discussion Issues Maternal History General health and nutrition Past and present obstetric history Maternal smoking, alcohol, or drug use Maternal medications Infectious diseases: Hepatitis, herpes, syphilis, Chlamydia rubella Maternal blood type and Rh blood groups Family History Newborn Issues Assessment of basic parenting skills Feeding plan: Breast feeding vs formula Car seats Circumcision of male infant II. Delivery A. Neonatal resuscitation 1. All equipment must be set up and checked before delivery. The infant who fails to breath spontaneously at birth should be placed under a radiant warmer, dried, and positioned to open the airway. The mouth and nares should be suctioned, and gentle stimulation provided. 2. The mouth should be suctioned first to prevent aspiration. Prolonged or overly vigorous suctioning may lead to bradycardia and should be avoided unless moderate-to-thick meconium is present in the airway. 3. The infant born with primary apnea is most likely to respond to the stimulation of drying and gentle tapping of the soles of the feet. The infant who fails to respond rapidly to these measures is experiencing secondary apnea and requires positive pressure bag ventilation with oxygen. 4. Adequate ventilation is assessed by looking for chest wall excursions and listening for air exchange. The heart rate should be assessed while positive pressure ventilation is being applied. If the heart rate does not increase rapidly after
ventilation, chest compressions must be started by an assistant. If the infant fails to respond to these measures, intubation and medications are necessary. Epinephrine can be administered via the endotracheal tube. Apgar scores are used to assess the status of the infant at 1 and 5 min following delivery.
Apgar Scoring System Sign
0
1
2
Heart rate
Absent
Slow (
