hey guys welcome back so now we're going to talk about uh care of the newborn which again is in chapter 37 so care of the newborn we've now um realized in birth was imminent we've delivered this baby what do we do now well we know we have two patients we have Mom and we have baby we need to assess the baby using the abgar score the abore scoring system provides a good overall indication of the baby's condition and it should be done one minute after delivery and five minutes after delivery your book gives you a good um chart on the abore score and we're going to take it uh Port by Port so appearance appearance is going to determine how does the baby look is the baby a normal color for all over their body or do they have or they cyanotic or or they pale if the baby has blue hands and blue feets and their feets I'm sorry feet U blue hands and blue feet and but their core is still blue okay that's called acrocyanosis you need to know that term we're going to assess their pulse rate uh one of the most important signs of whether oxygen is reaching the newborn's tissue or not is following birth by deter or following birth is by determining their heart rate okay you're going to score these babies according to that abore chart Grimace or reflex irritability if the N does the newborn display no reflexive activity upon your stimulation or do they have some slight facial Gammas or are they coughing and sneezing and crying we want to irritate these babies we want to get their blood flowing and their oxygenation going okay activity we're determining their activity level during your assessment if the newborn is limp or displays no extremity movement does the newborn only provide some sort of flexion and activity movement when they're stimulated or is the newborn actively moving around moving their little Ms in their legs okay that's good signs we next determine their respiratory status is the newborn um not breathing at all they're res they have no respiratory effort is the newborn breathing slow or irregularly do they have a weak cry or or they do they have a strong cry and they're they're really irritated okay a good irritated newborn is what we want um so once you you score you give points according to the abore score you're going to Total those points okay and a total point of seven to 10 points you're going to provide routine care if that baby is awarded a total of four to six points you may need to stimulate them and give them some oxygen they're moderately depressed where they have or when they have zero to three points they are severely depressed okay we need to provide extensive care including but not limited to oxygenation via BVM and CPR if necessary okay all of this is going to be determined according to your abore score remember we do it after the first minute of birth and after the fifth minute of birth all right now let's talk about what we should do within the first 30 seconds of delivery we're going to dry these little babies we're going to warm them up we're going to provide an airway for them without providing hyperflexion so we're going to put them in a sniffing position we're going to suction if necessary we're going to stimulate them by flicking their little feet okay we don't turn them upside down by holding them by their feet and smacking their bottom no we don't do that anymore you just simply flick the little soles of their feet okay you want to get them crying now we want to determine their heart rate if their heart rate is less than a 100 or there are no gasping respiration or they are gasping or they're not even breathing immediately suction and provide positive pressure ventil if their breathing is present but it's labored and cyanosis is persistent position the babies and clear their airways okay provide Blow by oxygen if necessary next we want to determine their heart rate if their heart rate is greater than 100 assess their pulse sock respiratory rate and tital volume if their heart rate is less than 100 remember it's should be really hot if their heart rate is less than 100 immediately suction the airway and begin positive pressure ventilation now if their heart rate is less than 60 guys you need to begin compressions with positive pressure ventilation when their heart rate reaches a rate above 60 you can wean oxygen to achieve extra uterine pulso Symmetry and oxygenation value values and this can all be found on table 37-2 so the key if they're breathing good great that's what we want but if their heart rate is less than 60 I'm sorry less than a 100 we want to immediately suction and begin bagging them if their heart rate is less than 60 we're going to start compressions and start bagging them okay okay it's it's it's imperative to keep their respiratory status up because normally well I not let me not use the word normally respiratory compromise leads to cardiac compromise so we keep their airway open we keep their respiratory Center moving and working we keep them from going into cardiac arrest okay um if moonium is present and only if moonium is present do we suction right we said that in the previous review module or review um meeting suction their nose and mouth and begin positive pressure ventilation okay or you may begin um once you suction it they're starting to breathe adequately you may have to provide blowby oxygen only so positive pressure ventilations if their respirations are absent or depressed and there's poor muscle tone and their heart rate is less than 100 okay all right this was a short review but it's imperative that you read on uh care for the newborn there's a lot of information in there but I hit the highlights and know your appcore score