Tachypnea or Bradycardia Retractions Noisy Respirations (>60 or <30

resps/min) (subcostal, intercostal, sternal, suprasternal) (grunt, stridor, wheeze)

‘Seesaw’ respirations Pallor or Central Cyanosis Prolonged apneic episodes

(abdomen rises; chest falls) or bradycardia with apnea

Respiratory distress

Administration of warmed, Clear airway Surfactant Administration

humidified O2 (if SpO2<92%) (bulb syringe, percussion cup , to supplement O2 & ventilation
via hood, nasal cannula, mechanical suction)
positive pressure mask or
endotracheal tube

Fluid & Electrolyte Mechanical Ventilation Maintenance of Hemoglobin

Management if blood gas values indicate (14-24g/dl) & maintenance of
severe hypoxemia or severe temp (36.5-37.2˚C)
hypercapnia
**After ABG & O2 saturation levels are within normal limits, spontaneous & resps are present, respiratory interventions
are gradually weaned; ABG & O2 levels are monitored throughout**
(information collected from Mathai, Raju & Kanitkar, 2007; Lowdermilk & Perry, 2007).

Maintenance of the Neonates Body Temperature (36.5-37.2˚C)

 Neonate stays with mom Birth Neonate not with mom for 1-2 hours
(teach mom the importance
of keeping baby warm)

Place thoroughly dried & swaddled neonate

Place neonate directly on mom’s abdomen under a radiant warmer until temp stabilizes
& cover with warm blanket (kangaroo care)

Set temperature of warmer at 36-37˚C &

Keep temperature of room at 23.8-26.1˚C ensure thermistor probe is attached to neonate

**If HYPOTHERMIA occurs**

Progressively warm the neonate over a period of 2-4 hours
(NOTE: Rapid warming may cause apneic spells or acidosis)

(information collected from UCSF Children’s Hospital, 2004; Lowdermilk & Perry, 2007).

Fluid and Electrolyte Imbalance

Lack of Urination Excessive Urination Dry skin and/or sunken Weight loss >10% *
anterior fontanel

Fluid and Electrolyte Imbalance:

potential dehydration; fluid overload; hypernatremia; hyponatremia;
hypocalcemia; hypermagnesemia; compromised renal function

Order serum electrolyte Monitor intake Ensure fluid requirements are met
levels & monitor closely & output (day 1-2: 40-60ml/kg; >day 2: 100-150ml/kg/24hrs)

*Preterm infants can lose up to 15% of birth weight; with full term appropriate for gestation age infants, only 10% is acceptable. After
week 1, a preterm infants weight loss or gain should not be >2% of previous days weight.

(information collected from UCSF Children’s Hospital, 2004; Lowdermilk & Perry, 2007).

Neonatal Nutritional Impairment

Lack of coordinated Resp distress w/ aggressive Inability to suck d/t Asphyxiation & potential
suck-swallow reflex ventilator support congenital anomaly necrotizing enterocolitis

Gavage feeding Gastrostomy feedings Total Parental Nutrition

Breast milk/formula Breast milk/formula Feedings are stopped;

given via nasogastric given via surgically intestine is suctioned & TPN
or orogastric tube to inserted tube in the is initiated; IV antibiotics
eliminate the work of abdomen; small boluses if necrotizing enterocolitis
sucking for neonate as per doctor’s orders is diagnosed

Teach parents about interventions; If mom plans to breastfeed,

Encourage nonnutrive sucking where possible encourage pumping while
babe is on TPN
(information collected from Cochran, 2007; Lowdermilk & Perry, 2007).

Prophylactic Interventions
Low plasma concentration Risk of 0.5-1mg Vit K Normal newborns produce
of Vitamin K hemorrhage via IM injection Vitamin K by day 8
or IV for preterm
**use extreme caution when administered via IV; rapid administration can cause cardiac arrest**

Potential of developing
ophthalmia neonatorum
(inflammation of the eye Eye prophylaxis Erythromycin gel Parents sign refusal
resulting from gonorrhea instilled in eye form if medication is
 or chlamydia) unwanted

Clamp umbilical cord Early detection of Assess stump of cord Cord will
Immediately after birth hemorrhage or for edema, erythema separate in
(remove clamp approx Infection and drainage 10 to 14 days
24 hrs after birth or after
bleeding has stopped)
(information collected from Croucher & Azzopardi, 1994; Lowdermilk & Perry, 2007).