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Nicu pocket guide N I C U Pocket Guide For Respiratory Therapists CContributors Charles Williams RRT Sonia Goede RRT Carissa Yackus RRT CContents Assessment of the Newborn Common Newborn Cardiopulmonary Disorders Normal Vital signs Normal ABGs Signs of Re

N I C U Pocket Guide For Respiratory Therapists CContributors Charles Williams RRT Sonia Goede RRT Carissa Yackus RRT CContents Assessment of the Newborn Common Newborn Cardiopulmonary Disorders Normal Vital signs Normal ABGs Signs of Respiratory Distress APGAR Scoring Primary Apnea vs Secondary Apnea Airway Management and Mechanical Ventilation Positive Pressure Breaths Neopu ? Infant Resuscitator Nasal CPAP Intubation Mechanical Ventilation High Frequency Ventilation Miscellaneous and Special Considerations Survanta Delivery Pneumothorax Free Flow Oxygen Special Situations Resuscitation Flowchart CCommon Newborn Cardiopulmonary Disorders TTNB ?? Transient Tachypnea of the Newborn Delayed clearance or absorption of fetal lung uid RDS ?? Respiratory Distress Syndrome Immature lungs surfactant de ?ciency causing alveolar instability and collapse BPD ?? Bronchopulmonary Dysplasia Chronic lung disease due to administration of high levels of oxygen MAS ?? Meconium Aspiration Syndrome Aspiration of fetal bowel contents causing airway obstruction and chemical pneumonitis PPHN ?? Persistent Pulmonary Hypertension of the Newborn Elevated pulmonary vascular resistance causes a right-to-left shunt bypassing the lungs resulting in arterial hypoxemia P I E ?? Pulmonary Interstitial Emphysema Pulmonary Air Leaks ? Pulmonary Interstitial Emphysema ?? air within the pulmonary interstitial tissue ? Pneumothorax ?? air within the pleural space ? Pneumomediastinum ?? air within the anterior mediastinum ? Pneumopericardium ?? air within the pericardial sac surrounding the heart CNormal Vital Signs Birth weight g Blood Blood Pressure Pressure Systolic Diastolic mmHg mmHg Heart Respirato Rate ry Rate SpO - - - - - Term - - - - - - - - - - - - - Normal Newborn Blood Gases - - pH PCO Capillary - - PO - HCO - Arterial - - - - Venous - - - CNewborn Signs of Respiratory Distress Tachypnea - RR breaths min Cyanosis - Peripheral cyanosis is common Central cyanosis usually indicates an arterial pO mm Hg Nasal Flaring - Sign of air hunger Expiratory Grunting - Neonate attempting to maintain positive pressure on expiration and prevent alveolar collapse Retractions ? Intercostal - between the ribs ? Supraclavicular - above the clavicles ? Subcostal - below the rib margins CAPGAR Scoring ? Provides a quick assessment for depression upon delivery ? Perform at minute and minutes after birth CPrimary vs Secondary Apnea Primary Apnea ? Initial response to hypoxemia ? Initial tachypnea then apnea bradycardia decreased neuromuscular tone ? Responds to stimulation blow-by O Secondary Apnea ? Follows primary apnea ? Deep gasping respirations followed by apnea bradycardia decreased neuromuscular tone and hypotension ? Will only respond to assisted ventilation w supplemental O if not done death brain damage rapidly ensues ? If a baby does not begin breathing immediately after being stimulated he or she is likely in secondary apnea and will require positive-pressure ventilation Continued stimulation Will NOT help CPositive Pressure Breaths Recommended Pressures Initial breath After delivery - cm H Normal lungs later breaths - to cm H Diseased or immature lungs ?? to cm H Try to maintain a rate of to breaths per minute By saying aloud ? ? ?