Newborn Care
Newborn Care
EMT/ADVANCED EMT/PARAMEDIC STANDING ORDERS
- For newborns requiring resuscitation, see Newborn Resuscitation Protocol.
- Routine Patient Care—dry, warm, position, stimulate.
- Assess airway by positioning and clearing secretions (only if needed):
- Place the newborn on back or side with head in a neutral or slightly extended position.
- Routine suctioning is discouraged even in the presence of meconium-stained amniotic fluid. Suction oropharynx then nares only if the patient exhibits respiratory depression and/or obstruction, see Newborn Resuscitation Protocol.
- Clamp and cut the umbilical cord:
- After initial assessment and after the cord stops pulsating but no less than 1 minute.
- Place the umbilical clamps approximately 8 and 10 inches from the baby.
- Prevent heat loss by rapidly drying and warming:
- Remove wet linen, wrap newborn in blankets or silver swaddler (preferred) and cover newborn’s head.
- Consider placing newborn skin-to-skin on the mother’s chest or abdomen.
- Assess breathing and stimulate by providing tactile stimulation:
- Flick soles of feet and/or rub the newborn’s back.
- If newborn is apneic or has gasping respirations, nasal flaring, or grunting, proceed to Newborn Resuscitation Protocol (75 Medical).
- Assess circulation, heart rate, and skin color:
- Evaluate heart rate by one of several methods:
- Auscultate apical beat with a stethoscope.
- Palpate the pulse by lightly grasping the base of the umbilical cord.
- If the pulse is < 100 bpm and not increasing, proceed to Newborn Resuscitation Protocol (75 Medical).
- Assess skin color; examine trunk and face; and mucus membranes.
- Evaluate heart rate by one of several methods:
- Record APGAR score at 1 minute and 5 minutes (see chart) only if newborn does not require resuscitation. APGAR score is less important than assessment and intervention.
- See Pediatric Color Coded Appendix A2 for vital signs.
- When possible, transport newborn in child safety seat.
| Feature | 2 Points | 1 Point | 0 Points | |
|---|---|---|---|---|
| APGAR Scale | ||||
|
Activity (Muscle Tone) |
Active Movement |
Arms and legs flexed (Weak, some movement) |
Limp or flaccid | |
| Pulse | Over 100 bpm | Below 100 bpm | Absent | |
|
Grimace (Irritability/reflexes) |
Cry, sneeze, cough, active movement | Grimace (some flexion of extremities) | No reflexes | |
|
Appearance (Skin Color) |
Completely pink | Body pink, Extremities blue | Blue, pale | |
| Respiration |
Vigorous cry Full breaths |
Slow, irregular, or gasping breaths, weak cry | Absent |
PEARLS:
- Newborn infants are prone to hypothermia which may lead to hypoglycemia, hypoxia and lethargy. Aggressive warming techniques should be initiated including drying, swaddling, and warm blankets covering body and head.
- Raise temperature in ambulance patient compartment.