Question

A 2000-gram male infant was delivered at 34 weeks’ gestational age by cesarean section due to breech presentation, premature labor, and rupture of membranes. On physical examination the infant was non-dysmorphic, appeared vigorous, had spontaneous respirations, and the skin was pink and well perfused. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. One hour after admission to the neo- natal intensive care unit, the infant developed tachypnea and nasal flaring with moderate subcostal and substernal retractions. Bronchial breath sounds that were slightly diminished in intensity were present. Analysis of umbilical arterial blood revealed a pH of 7.37, a PaO2 of 50 mm Hg, and a PaCO2 of 30 mm Hg. To improve work of breathing, continuous positive airway pressure (CPAP) of + 6 cm H2O was initiated via nasal prongs. One hour later the infant’s vital signs were as follows: temperature 37.6°C under radiant heat, blood pressure 60/42 mm Hg, heart rate 130 beats per minute, oxygen saturation 94% to 96% while breathing 40% oxygen with CPAP, and blood glucose 70 mg/dL. The remainder of the examination was normal for the gestational age.

The infant’s respiratory status gradually improved, and over the next 3 days he was weaned from CPAP and transitioned to a nasal cannula and then to room air. Two days later, the infant was discharged home.

1. What are important components of the initial neonatal assessment?

Answer 1

1.Observe with initation of respiration

2.Assess APGAR score:Assess each of five items to be scored and recorded at 1 minute and at 5 minutes after birth,and at 10 minutes if neeed.,it includes heart rate,respiratory rate,muscle tone,reflexes and skin colour

3.Monitor body measurements such as length ,weight and head circumference.Length is 45 to 55 cm,weight 2.5 kg to 4 kg,head circumference 33 to 35 cm.

4.Note characterstics of cry

5.Monitor nasal flarring,grunting and so on

6.Assess central cynosis and acrocynosis

7.Obtain vital signs:Heart rate 120 to 160 beats per minute,respiration 30 to 60 breathslminute

8.Observe the newborn for signs of hypothermia

9.Assess for gross anomalies

10.Physical checkup of newborn this helps to identify any abnormal findings of newborn