This document provides an overview of neonatal care topics relevant for paramedics. It covers routine care such as thermoregulation and common injuries seen in newborns. It also discusses several medical conditions paramedics may encounter, such as seizures, hypoglycemia, jaundice, fever, and congenital heart defects. For each topic, it outlines signs and symptoms as well as guidelines for assessment and basic management in the prehospital setting.

1. Neonatal Care
for paramedics
Nancy Caroline ch. 42

13. Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP.

17. ©Jones&BartlettLearning.©Jones&BartlettLearning.

27. Meconium Aspiration
Routine tracheal suction is no longer
recommended for a depressed newborn.

28. Meconium Aspiration
What we used to do:

30. Congenital Diaphragmatic Hernia

34. Premature and Low Birth Weight
Infants
• Premature:
Delivered before
37 weeks of
gestation
– Increased mortality
– Associated
morbidities
© American Academy of Orthopaedic Surgeons.

35. Seizures in the Newborn
• Suggest the presence of neurologic disorder
• Usually related to an underlying abnormality
• Prolonged seizures may cause brain injury.

36. Seizures in the Newborn
• Types of seizures:
– Subtle seizure
– Tonic seizure
– Spasm
– Myoclonic

37. Seizures in the Newborn
• Assessment and management
– Evaluate prenatal and birth history.
– Perform a careful physical exam.
– Obtain vital signs and oxygen saturation.
– Provide additional oxygen, assisted ventilation,
blood pressure evaluation, and IV access.

38. Hypoglycemia
• Blood glucose level of less than 45 mg/dL
– Imbalance between glucose supply and use
• May result in:
– Seizures
– Brain damage

39. Hypoglycemia
• May be at risk due to:
– Disorders related to
decreased glycogen
stores
– Increased use of glucose

40. Vomiting
• Uncommon during the first weeks of life
– May be confused with regurgitation
– Result of an abnormality
• Assessment Findings
– Distended stomach, signs of infection, increased
intracranial pressure, or drug withdrawal
• Management
– Focus on ensuring a patent airway
– Watch for bradycardia due to vagal stimulation

41. Neonatal Jaundice
• Considered pathologic when:
– Clinically visible in first 24 hours
– Serum bilirubin increases more than 5 mg/dL/d.
– Bilirubin exceeds 12 mg/dL.
– Conjugated bilirubin makes up greater than 20%
of total serum bilirubin concentration.
– Clinical jaundice persists for more than 1 week in
full-term infants or for more than 2 weeks in
preterm infants.

42. Thermoregulation
• Thermoregulation limited in newborns
– Average normal temperature of newborn—
37°C (99.5°F)
– Range for neonate—36.6°C to 37.2°C (97.9°F to
99°F)
© Jones & Bartlett Learning.

43. Hypothermia
• Drop in body
temperature to less
than 35°C (95°F)
• Newborns are sensitive
to environmental
conditions, especially
after delivery

44. Fever
• Rectal temperature greater than 38°C
(100.4°F)
• Newborn may not always present with fever in
an illness or infection.
• May be caused by overheating or dehydration

45. Fever
• Management
– Ensure a patent airway and adequate ventilation
– Administration of an antipyretic agent to a
neonate is of questionable benefit

46. DO NOT USE COLD PACKS ON NEWBORNS TO
TREAT FEVER

47. Fever
• Assessment and
management
– Examine for rashes.
– Obtain history.
– Note increased
respiratory rate and
work of breathing.
Courtesy of Centers for Disease Control and Prevention.

48. Common Birth Injuries in the Newborn
• Birth trauma injuries include:
– Those involving instruments during delivery
– Excessive molding of the head
– Caput succedaneum
– Cephalohematoma
– Linear skull fractures

49. Common Birth Injuries in the Newborn
• Birth trauma injuries include (cont’d):
– Brachial plexus injuries
– Facial nerve palsy
– Diaphragmatic paralysis
– Laryngeal nerve injury
– Spinal cord injury

50. Common Birth Injuries in the Newborn
• Clavicle—most frequently fractured bone
– Examination will show:
• Crepitus
• Palpable bony irregularity
• Possible lack of arm movement on affected side

51. Pathophysiology of Congenital Heart
Disease
• Congenital heart
disease (CHD)
– Most common birth
defect
– Can present with varying
degrees of
cardiorespiratory
compromise

52. Pathophysiology of Congenital Heart
Disease
• Cyanosis
– Visual detection is difficult.
– Detection methods include:
• Measuring oxygen saturation
• Pulse oximetry
• Monitoring oxygen saturation

53. Pathophysiology of Congenital Heart
Disease
• Noncyanotic disease (pink defects)
– Oxygenated blood is shunted from the left side of
the heart to the right side.
– Called a left-to-right shunt

54. Pathophysiology of Congenital Heart
Disease
• Patent ductus
arteriosus:
– Ductus arteriosus
does not close after
birth.
– If left untreated,
patient could
develop heart
failure. © Jones & Bartlett Learning.

55. Congenital Heart Anomilies
Transposition of great
vessels

56. Septal Defects
Atrial and Ventricular

57. Tetralogy of Fallot

58. Congenital Heart Anomilies

59. Neural Tube Defects