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Remember to look at the whole baby.
Numbers are just numbers!!
| THE HARDWARE |
WHERE IT SHOULD BE |
| UAC (high-lying) |
Insertion depth = BW(kg) X 3 + 9cm;
T6 - T10 |
| UVC (high-lying) |
Insertion depth = 1/2UAC + 1cm;
at or little above the diaphragm |
| UVC (low-lying) |
insert 2-3cm for emergency use |
| Endotracheal Tube |
Weight(kg) + 6 = cms at the lip;
T2 - T4;
check for chest rise, equal air entry and lack of gastric air |
| Pulse oximeter |
foot, hand, great toe or thumb (large infant), wrist (micropremie);
light emitter and detector of probe must be facing each other through baby's extremity to be accurate!! |
| Oral or Nasal Gastric Tube |
Insertion depth = Distance(cm) xiphoid process to ear lobe to tip of nose;
listen for air pushed in stomach (1-2cc); aspirate (should get back air & any stomach contents) |
| Skin Temperature Probe |
Supine - exposed area of abdomen (best reading over liver area);
Prone - soft tissue of right or left flank;
do NOT place under baby or on bony area (i.e. spine or ribs) |
| ENDOTRACHEAL TUBE SIZE |
<1kg 2.5mm
1 - 2kg 3.0mm
2 - 3kg 3.5mm
3 - 4kg 3.5 to 4.0mm |
| TOTAL FLUID VOLUME |
TFV = ml/kg/day
IV rate = TFV ÷ 24 =ml/hour |
CALCULATIONS FOR GTTS
Alert: watch whether using mcg or mg! |
Order: mcg/kg/min
dose(mcg) x wt.(kg) = mcg/min
mcg/min x 60(mins/hr) = mcg/hr
mcg/hr ÷ 1000 = mg/hr
mg/hr ÷ ml/hr (IV rate) x total volume (ml in syringe or bag)
= quantity on hand (mg in bag or syringe)
Order: mg/kg/hr
dose(mg) x wt.(kg) = mg/hr
mg/hr ÷ ml/hr (IV rate) x total volume (ml in syringe or bag)
= quantity on hand (mg in bag or syringe)
To determine rate based on dose & concentration:
mg/hr ÷ quantity on hand(mg) x total volume(ml)
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| URINE OUTPUT |
Urine total ÷ hours (i.e. 24 for a day, 8 or 12 for a shift)
UOP should be ≥ 1 ml/kg/hour |
1000 mcg = 1 mg;
1000 mg = 1 gram;
1000 grams = 1 kg;
1 kg = 2.2046 pounds;
1 ounce = 28.35 grams;
1 pound = 453.6 grams;
1 teaspoon = 5 mls;
| VITAL SIGNS |
Temperature |
Heart Rate |
Respirations |
Mean Blood Pressure |
| Normal |
97.8o to 99.0oF
(36.5o to 37.2oC) |
120 - 160/min.; some healthy term infants have a low, resting heart rate (90 - 110/min.) |
40 - 60/min; variable, may count rates of 30 - 65 in a healthy infant |
The Old Adage:
MBP = gestational age ± 5;
today many providers prefer MBP = GA + 5 or refer to a chart;
increases with GA, weight and age of life
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| Common Considerations for Below Normal Values |
low fat stores, hypoglycemia, hypoxia, acidosis, sepsis, environmental factors (air temp., drafts, cold surfaces, wetness), skin probe problem, phototherapy (false high reading of skin probe; if shiny probe cover used w/phototx - cover shiny part w/tape) |
bradycardia (HR < 80-100 depending on institution), apnea, hypoxia, acidosis, sepsis/infection, hypovolemia (IV ok? correct rate?), arrhythmias (indwelling UAC or UVC in good position?) |
apnea (0 respirations for >20 secs. or accompanied by bradycardia) vs. normal periodic breathing, central apnea (no resp. effort) vs. obstructive (secretions, positioning, anomalies, equipment-related), with or without retractions (respiratory vs. cardiac/other etiology), prematurity, sepsis, hypoxia, anemia, polycythemia, gastric reflux (raise HOB, position left side or prone, slow gavage feed), cardiac (i.e. PDA, CHD), neurologic (i.e. IVH, seizures), narcotics, pain, adenosine, maternal magnesium therapy |
hypovolemia (check IV & rate), sepsis, decreased cardiac output, PPHN, tension pneumo (rapid destabilization), UAC or equipment related (dampened waveform? reduced pulse pressure? bubbles in transducer or arterial line?), check tubing and pump if on vasopressors (disconnect before fixing to avoid bolus), pain |
| Common Considerations for Above Normal Values |
infection, narcotic withdrawal, environmental factors, skin probe not on or in bad position, phototherapy (turn NTE/ISC down; turn back up when phototx dc'd), excessive activity (large infants), IV prostaglandins |
anemia, hypoxia, sepsis, supraventricular tachycardia (HR > 220 & QRS < 0.08 seconds), caffeine & other methylxanthines, hyperthermia/over-heated infant, pain |
respiratory distress, TTN, pneumothorax, anemia, hypoxia, sepsis, cardiac (i.e. PPHN, CHD), hyperthermia/over-heated infant, narcotic withdrawal, pain |
shock, cardiac, renal, bronchopulmonary dysplasia, IVH, PDA, fluid overload (correct total fluid volume?), UAC or equipment related (check level of transducer & zero), vasopressor bolus (recent line change? check tubing and pump), pain |
| ARTERIAL BLOOD GASES |
pH |
PCO2 |
PO2 |
Bicarbonate |
Base* |
| Normal |
7.30 - 7.45 |
35 - 45 |
50 - 80 |
19 - 26 |
-4 - +4 |
| Respiratory Acidosis |
low;
normal if compensated |
high |
normal unless accompanied by hypoxia |
normal;
high if compensated |
normal;
may be high if compensated |
| Metabolic Acidosis |
low;
normal if compensated |
normal;
low if compensated |
low |
low |
| Metabolic Alkalosis |
high; normal if compensated |
normal; high if compensated |
high |
high |
CBG CO2 normal values are 35 - 50. CBG PO2 values are falsely low and irrelevant to care.
Acidosis and alkalosis may have mixed etiology - both respiratory and metabolic.
*Base excess or deficit reflects the amount of base that would be needed to return to normal. |
| APGAR SCORES (1 min, 5 min then Q 5 mins til score ≥7 |
0 |
1 |
2 |
Heart rate/pulse
(apical or umbilical) |
Absent |
less than 100 |
more than 100 |
Respirations
(rate and effort) |
Absent or gasping |
Slow, irregular, labored, poor cry |
Normal, good cry |
Grimace
(reflex irritablilty to stim, i.e. oral or nasal suctioning) |
No response to stim |
Minimal response to stim (grimace only) |
Grimaces, coughs or sneezes, withdraws |
Tone
(flexion and movement) |
Floppy, no tone, no spontaneous movements |
Slightly flexed, minimal movement |
Flexed, active |
| Color |
Cyanotic or pale |
Acrocyanosis |
Pink all over |
| NRP REVIEW - A quick reference - not a complete study guide!! |
| 1st 30 seconds |
30 - 60 seconds
Evaluate respirations, heart rate & color |
60 - 90 seconds |
| Baby's Status |
Interventions |
Baby's Status |
Interventions |
Baby's Status |
Interventions |
| Term baby w/clear fluid; breathing or crying; w/good tone |
Warm, clear airway, dry and assess color; "routine care" |
Pink & breathing w/HR>100 |
Observe |
HR>60, apneic |
PPV* |
| Premature, apneic or hypertonic |
Warm; position and clear airway as needed; dry, stimulate and reposition |
Central cyanosis |
Give oxygen |
HR<60 |
PPV* & compressions |
| Meconium in fluid; baby vigorous - good resp. effort; HR>100; w/good tone |
Warm; suction mouth and nose; dry, stimulate and reposition |
Apneic or HR<100 |
PPV* |
HR<60, PPV* and compressions administered for 30 secs. |
Epinephrine |
| Meconium in fluid; baby not vigorous - i.e. poor resp. effort; heartrate <100; poor tone |
Intubate and suction trachea (use meconium aspirator), suction mouth and nose |
Breathing effectively after PPV & HR>100 |
Post-resuscitation care |
*Intubation may be considered at several points. |
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