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Neonatal Intensive Care Unit—NICU

Apgar—measured at 1 and 5 min of life, give a total value between 0–10; scores of 7–10 = normal; no established predictive value; indicator of need for care after birth

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  0 1 2
Heart rate Absent <100 bpm >100 bpm
Breathing Absent Irregular, shallow, weak cry Good, crying
Reflexes Absent Grimace Cough, sneeze
Muscle tone flexion Flaccid Good tone, some flexion of extremities Spontaneous, well-flexed extremities
Color Blue, pale Body pink, extremities blue Entirely pink

Quick Systems Review for Newborns

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Neuromuscular/musculoskeletal systems Movement/range of all four extremities; presence of flexion, muscle tone, symmetry, primitive reflexes—Moro, suck, rooting, grasp; anterior fontanel soft and flat; length; weight
Cardiovascular system HR and rhythm on auscultation, BP, color (may have transient acrocyanosis, otherwise pink), pulses—strong/equal bilateral, capillary refill (<3 sec in peripheral tissues, not nail beds), edema
Respiratory system Auscultation of lungs (minimal fine crackles often right after birth), RR >60/min, any labor with respiratory effort, nasal flaring or grunting
Genitourinary system Boy—urethral opening at tip of penis; girl—labia minora and majora intact, hymenal tag may be visible
GI system Abdomen soft, no visible distention, cord attached and clamped, anus patent
Eye, ears, nose, throat Eyes clear, palates intact, nares patent, ears in place with correct alignment
Skin Color (pink or acrocyanotic); note skin lesions, bruising or mottling, abrasions, birthmarks, caput/molding, integrity

Signs of Stress in Newborns

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• Bradypnea Respirations ≤30/min
• Tachypnea Respirations ≥60/min
• Abnormal breath sounds Crackles, wheezing, rhonchi, expiratory grunting
• Respiratory distress Nasal flaring, retractions, labored breathing, apnea

Signs of Neonatal Abstinence Syndrome

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• GI system Poor feeding, vomiting, regurgitation, diarrhea, excessive sucking
• CNS Irritability, tremors, shrill cry, incessant crying, hyperactivity, little sleep, excoriations on face, convulsions
• Metabolic, vasomotor, respiratory Nasal congestion, tachypnea, sweating, frequent yawning, increased RR >60/min, fever >37.2°C

Common Equipment in NICU

Note: Numbers correspond to image that follows.

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Apnea monitor (1) Electrode(s) placed on chest to monitor respiratory rhythm, alarm alerts with apnea incidents
Arterial line (2) Catheter inserted and sewn in artery; monitors BP directly, measures O2, CO2; access blood samples
Central line (3) Catheter inserted in vein up to the level of the vena cava, used for delivery of fluids, meds, blood
Electrocardiography (4) Electrodes attached to chest to monitor heart rhythm
Endotracheal tube (5) Open-ended tube placed within trachea to maintain open airway, may be connected to a ventilator
Feeding tubes—nasogastric, gavage (6) Tube placed through the nose to the stomach to allow fluid ...

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