Care of the Newborn

Initial Steps Post-Delivery

Assess Mother and Baby: Remember, there are two patients – the mother and the newborn.
Apgar Score: To assess the baby's condition:
- Conducted at 1 minute and 5 minutes after birth.
- Provides a good overall indication of the baby's health.
- Components include appearance, pulse, grimace, activity, and respiratory status.

Appearance: Check the baby's color:
- Normal color vs. cyanotic or pale.
- Acrocyanosis: Blue hands and feet, core pink.
Pulse: Important indicator of oxygen reaching tissues.
Grimace (Reflex Irritability):
- No reflexive activity vs. slight facial grimace vs. active coughing/sneezing.
- Encourage irritation to get blood flowing and oxygenation going.
Activity: Measure movement:
- Limp or no movement vs. some movement when stimulated vs. active movement.
Respiratory Status:
- Not breathing vs. slow/irregular breathing vs. strong cry.

Immediate Actions:
- Dry and warm the baby.
- Ensure airway without hyperflexion (sniffing position).
- Suction if necessary.
- Stimulate by flicking soles of feet (do not turn upside down and smack bottom).
Heart Rate Assessment:
- Less than 100: Suction airway, provide positive pressure ventilation.
- Greater than 100: Assess pulse oxygen saturation, respiratory rate, and tidal volume.
- Less than 60: Begin compressions with positive pressure ventilation.

Maintain Respiratory Status: Essential to avoid cardiac compromise.
- Respiratory issues can lead to cardiac issues.
- Keep airway open and respiratory center functioning.

Meconium Presence:
- Suction nose and mouth only if meconium is present.
- Begin positive pressure ventilation if necessary.

Ensure thorough understanding of the Apgar score.
Quick, effective response is crucial for newborn health.
Refer to chapter 37 for comprehensive details and tables like 37-2 for guidelines.