This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Respiratory rate 40 to 60/min 60 to 80/min > 80/min
Oxygen requirement1 none ≤ 50% > 50%
Retractions none mild to moderate
severe
Grunting none with stimulation continuous at rest
Breath sounds on auscultation easily heard
throughout decreased barely heard
Prematurity > 34 weeks 30 to 34 weeks < 30 weeks
1 A baby receiving oxygen prior to the setup of an oxygen analyzer should be assigned a score of “1”
Adapted from Downes JJ, Vidyasagar D, Boggs TR Jr, Morrow GM 3rd. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin Pediatr 1970; 9(6):325-31. Total score: Mild: < 5; Moderate: 5 to 8; Severe: > 8 Interpretation of blood gas results (p. D-4):
1. Normal, acidosis or alkalosis? 2. Respiratory, metabolic, mixed or
compensated?
Blood gas values (p. D-4):
pH PCO2 BD Interpretation
↓ ↑ Normal Respiratory acidosis
↓ Normal ↑ Metabolic acidosis
↑ ↓ Normal Respiratory alkalosis
↑ Normal ↓ Metabolic alkalosis
Normal Acceptable values for acute respiratory distress
The following Alerting Signs identify babies who require observation for the development of hypoxic ischemic encephalopathy.
When indicated, therapeutic hypothermia should only be initiated after: completion of Neonatal Resuscitation (NRP), and the ACoRN Primary Survey and Sequences consultation with the clinical transport coordinator and following a strict protocol.
Therapeutic normothermia involves active thermal management to avoid hyperthermia. The aim of therapeutic normothermia is to maintain the axillary temperature between 36.0oC and 36.5oC.
Criteria for Initiation of Therapeutic Hypothermia (Appendix F): The following must all be met prior to initiating therapeutic hypothermia
NRP and ACoRN Sequences completed
At risk of HIE Alerting Sign present
Moderate to severe HIE present as per the Clinical Assessment of Neurological Dysfunction table
Gestational age is ≥ 35 weeks
Postnatal age is ≤ 6 hours
No absolute contraindications (e.g. cardiorespiratory instability, severe coagulopathy, etc)
Clinical assessment of neurological dysfunction (p. 5-9, F-5):
The presence of moderate or severe HIE is defined as seizures or signs present in at least three of the six categories below, or by the regionally recommended scoring system.
Category Mild Moderate Severe
Level of alertness “hyperalert” lethargy stupor or coma
Spontaneous activity normal decreased activity no activity
Posture mild distal flexion
arms flexed, legs extended
arms and legs extended
Tone normal hypotonic flaccid
Primitive reflexes weak suck, strong Moro
weak suck, incomplete Moro
absent suck, absent Moro
Autonomic (one of) Pupils Heart rate Respirations
dilated reactive
tachycardia
normal
constricted
bradycardia
periodic breathing
dilated or non-reactive
variable heart rate
apnea
Seizures none absent or present absent or decerebrate Adapted from Sarnat HB et al: Neonatal encephalopathy following fetal distresss: A clinical and encephalographic study. Arch Neurol 33:695,1976. Jitteriness versus Seizures (p. 5-4):
Adapted from Volpe JJ. Neurology of the Newborn. 5th Edition. Philadelphia: WB Saunders Company, 2008 Documentation of abnormal movements (p. 5-31):
Time/ duration
Suppress by holding
Origin/ spread
Eye/mouth movements
Level of alertness Autonomic changes
Other signs
09:00 h 20 sec
No Right arm, then all extremities
Eyes deviated to left Normal crying, auditory and visual responses when not seizing
No No
Observation Jitteriness Seizures
Abnormal gaze or eye movement no yes
Movements exquisitely sensitive to stimuli yes no
Predominant movement tremor clonic jerking
Movements cease with passive flexion yes no
Autonomic changes (e.g., tachycardia, increase in blood pressure, or apnea)
A well term baby born to an asymptomatic mother with a negative prenatal GBS screen or > 4 hours of intrapartum antibiotics, does not need specific intervention. Such a baby has no Alerting Signs for infection, and does not enter the Infection Sequence
A baby who has ACoRN alerting signs with * should have diagnostic testing for sepsis and antibiotic therapy; except term and late preterm babies with mild respiratory distress lasting < 4 hours who are otherwise well and have no risk factors for infection.
First-line antibiotics in sepsis occurring in the first 3 days of life are ampicillin and an aminoglycoside (usually gentamicin). If meningitis cannot be ruled out in an unwell baby, cefotaxime should be added.
Notes re Transport
The sending facility needs to prepare the following material to go with the baby:
a copy of o prenatal, labour and delivery records o the mother’s chart with all relevant neonatal history o the baby’s chart o laboratory data
radiographs o note on the last chest radiograph if the endotracheal tube has been repositioned and no new
radiographs have been taken
clearly labeled specimens if requested, for example o the baby’s blood cultures (aerobic ± anaerobic) o a maternal blood sample o a cord blood sample from the placenta, useful mainly for a direct antibody (Coombs’) test
the placenta, wrapped in a sealed plastic bag or placed in a bucket with a lid (no additives or preservatives)
signed consent forms for transport, admission and care at the receiving hospital, and for transfusion of blood products
contact information for the baby’s parents and family physician.
Adapted: PPPESO. Neonatal Transport. Perinatal Nursing Guidelines (3rd Ed). Ottawa, ON: Perinatal Partnership Program of Eastern and Southeastern Ontario, 2001.