2.11 Newly Born Care

EMT/ADVACNED EMT/PARAMEDIC STANDING ORDERS

• 1.0 Routine Patient Care —dry, warm, position, stimulate.

• For newly born requiring resuscitation, see 2.12 Resuscitation of the Newly Born.

• Reassess airway by positioning and clearing secretions (only if needed):

• Place the newly born 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 2.12 Resuscitation of the Newly Born.

• Clamp and cut the umbilical cord:

• After initial assessment and after the cord stops pulsating.

• Leave a minimum of 6 inches of cord.

• Prevent heat loss by rapidly drying and warming:

• Remove wet linen, wrap newly born in blankets or silver swaddler (preferred) and cover newly born’s head.

• Assess breathing by providing tactile stimulation:

• Flick soles of feet and/or rub the newly born’s back.

• If newly born is apneic or has gasping respirations, nasal flaring, or grunting, proceed to 2.12 Resuscitation of the Newly Born.

• 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 2.12 Resuscitation of the Newly Born.

• Assess skin color; examine trunk and face; and mucus membranes.

• Record APGAR score at 1 minute and 5 minutes (see chart).

Clinical Note: 

PEARLS:  

• Newly born 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.