Assessment of the Neonate Fred Hill, MA, RRT. Reduction in Pulmonary Reserve Thorax is more flexible...
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Transcript of Assessment of the Neonate Fred Hill, MA, RRT. Reduction in Pulmonary Reserve Thorax is more flexible...
Reduction in Pulmonary Reserve
• Thorax is more flexible• Heart is larger in proportion
to thorax• Abdominal contents are
larger in proportion to thorax
Breathing and Coughing
• Newborns are “obligate nose breathers”
• Neonates lack a cough reflex• Smaller airways, but epithelial
cells are similar in size• Breathing rate = 30-50 vs 12-20;
premature = 40-60• Heart Rate = 100-140 vs 60-80
Upper Airway Anatomy
• Tongue is larger in proportion to oropharynx. More lymphoid tissues in pharynx.
• Larynx is more anterior and higher.• Epiglottis is larger and stiffer in proportion,
lies more horizontal, omega shaped• Cricoid cartilage is narrowest portion of
upper airway (~7 years changes to glottic area)
• Carina is only 4 cm below vocal cords• Tracheal diameter: 4 mm vs 16 mm
Other Considerations
• Ribs are more horizontal (not bucket handle). Rely primarily on diaphragmatic breathing.
• Breath sounds transmit well due to thin thoracic wall, but harder to localize sounds.
Other Aspects of Newborn
• Higher metabolic rate: 100 cal/kg vs 40-50 cal/kg
• Reactions to medicines not predictable– High metabolic rate– Immature liver and kidneys
• High surface area to body weight ratio
Gestational Age Assessment
• Dubowitz Gestational Age Assessment– 11 physical signs– 10 neurologic signs– Useful in the first 5 days of life
• Ballard Gestational Age Assessment– 6 neurologic signs– 6 physical signs– Before 42 hours of life (ideal 30 to 42
hours)
Size for Gestational Age
• Two reasons for low-birth-weight infant– Prematurity– Growth retardation
• Size for gestational age– Appropriate for gestational age (AGA)– Large for gestational age (LGA)– Small for gestational age (SGA)
Signs of Respiratory Distress
• Synchrony of chest/abdomen movements
• Retractions– Lower chest (lateral ribs)– Xiphoid (substernal)
• Nasal flaring• Expiratory grunting• Cyanosis• Tachypnea
Endotracheal Tube Suctioning
• Two people– One to perform suctioning– One to monitor and provide support as
needed• Depth of catheter insertion
determined by length of ET tube; only to tip
• Size of suction catheter as per ETT size
• Suction pressure: -50 to -80 mm Hg
Oxygen
• Hazards– Retinopathy of prematurity– Bronchopulmonary dysplasia
• Oxygen Hood (Oxyhood)– High flow device– Usually <0.6 FiO2– Flows >7 lpm– Appropriate temperature of gas
• Cannulas: always humidified with newborns, 1/8 to 1 lpm typical flows or 0.2 to 1 lpm