Question

A 2000-gram male infant was delivered at 34 weeks’ gestational age by cesarean section due to breech presentation, premature labor, and rupture of membranes. On physical examination the infant was non-dysmorphic, appeared vigorous, had spontaneous respirations, and the skin was pink and well perfused. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. One hour after admission to the neo- natal intensive care unit, the infant developed tachypnea and nasal flaring with moderate subcostal and substernal retractions. Bronchial breath sounds that were slightly diminished in intensity were present. Analysis of umbilical arterial blood revealed a pH of 7.37, a PaO2 of 50 mm Hg, and a PaCO2 of 30 mm Hg. To improve work of breathing, continuous positive airway pressure (CPAP) of + 6 cm H2O was initiated via nasal prongs. One hour later the infant’s vital signs were as follows: temperature 37.6°C under radiant heat, blood pressure 60/42 mm Hg, heart rate 130 beats per minute, oxygen saturation 94% to 96% while breathing 40% oxygen with CPAP, and blood glucose 70 mg/dL. The remainder of the examination was normal for the gestational age. The infant’s respiratory status gradually improved, and over the next 3 days he was weaned from CPAP and transitioned to a nasal cannula and then to room air. Two days later, the infant was discharged home. 1. What are important components of the initial neonatal assessment? 2. What was concerning about this patient’s respiratory status, and what should the healthcare team continue to monitor? 3. What intervention would you consider if the CPAP + 6 did not improve the infant’s work of breathing?

1. What intervention would you consider if the CPAP + 6 did not improve the infant’s work of breathing?

Answer 1

newborn is called from birth to 28 days. after birth New born was assessed.

Components of assessment are history collection (antenatal history, labour history) and physical examination. Newborn intilally assessed by apgor score

	criteria	0 points	1 points	2 points
A	ACTIVITIY	Absent	flexed arms and legs	active
P	PULSE	absent	below 100.bpm	over 100bpm
G	GRIMACE	no response o stimulation	minimal response to stimulaton	prompt response to stimulation
A	APPEARENCE	pale	pink body,blueextremities	pink
R	RESPIRATION	absent	slow irregular	vigrous cry

Total score 10

normal 7-10

baby is mildly depressed 4-6

baby is moderately depressed 0-3

after intial assessment, new born was assessed for general body examination and systemic examination. then the baby was assessed subsequently and daily

The baby was delivered before 37 weeks of gestational age. the baby has lack of surfactant due to immaturty of the lungs. SUrfactant helps to decrease surface tension of alveoli.

Health provider continue to monitor baby vital signs included temperature, heart rate respiratory rate, blood pressure, and breath sounds, subcostel and substernal retractions , arterial blood gas analysis which shows po2 pco2, saturation, blood counts and glucose. babay was assessed for cardiac status in monitor which shows heart rate.

if baby doesnot improve with CPAP +6 L of oxygen via nasal prongs, intubation is the ideal choice to save the baby inorder to adminster surfactant. surfactant has to be administered to baby via endotracheal tube.