A newborn boy is undergoing evaluation immediately after birth in the delivery room. He was born to a primigravida mother at 38 weeks gestation. The prenatal course was otherwise uncomplicated, with negative routine infectious serologies and normal anatomic ultrasound. The amniotic fluid was clear. The infant cries immediately and is actively moving all 4 extremities. He is taken to a warmer and dried with blankets. A minute after delivery, heart rate is 120/min. He grimaces and cries vigorously during brief manipulation and examination by the provider. His body is pink but extremities are cyanotic. Which of the following is the most appropriate next step in the management of this patient?

Question

A newborn boy is undergoing evaluation immediately after birth in the delivery room.  He was born to a primigravida mother at 38 weeks gestation.  The prenatal course was otherwise uncomplicated, with negative routine infectious serologies and normal anatomic ultrasound.  The amniotic fluid was clear.  The infant cries immediately and is actively moving all 4 extremities.  He is taken to a warmer and dried with blankets.  A minute after delivery, heart rate is 120/min.  He grimaces and cries vigorously during brief manipulation and examination by the provider.  His body is pink but extremities are cyanotic.  Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

11ec25c8_d605_9693_bc81_332e25579cc0_MD0003_00 This healthy, full-term newborn that is crying and moving vigorously has an Apgar score of 9. The first step in routine neonatal resuscitation is to dry and stimulate the infant. He does not require further resuscitation and should therefore be placed on his mother's chest for skin-to-skin care. Apgar score Newborns have an underdeveloped thermoregulatory center and are at risk for hypothermia; therefore, drying and warming the infant is essential to prevent loss of body heat. Warming methods include swaddling with warm blankets, placing the infant under a radiant warmer, and/or allowing skin-to-skin contact with the mother. Skin-to-skin contact not only provides warmth but also helps to initiate breastfeeding. In turn, early feeding helps prevent hypoglycemia and can decrease the risk of hyperbilirubinemia. For these reasons, routine newborn care (eg, vitamin K, hepatitis B vaccine, erythromycin eye ointment) can be postponed for an hour to allow for skin-to-skin time (Choice A). (Choice B) According to the neonatal resuscitation algorithm, a cardiac monitor is considered for bradycardia (<100/min), apnea, or gasping and should be attached if chest compressions are required. (Choice C) A sponge bath with soapy water is typically performed after 24 hours of life. Bathing in sterile solution is not required. In addition, immediate newborn care focuses on keeping the infant dry to maintain warmth. (Choice E) Suctioning the oropharynx to clear the airway is appropriate if secretions are present; however, this infant is crying vigorously with no excessive secretions. Tracheal suctioning is not recommended in routine resuscitation due to risk of vagal stimulation leading to apnea or bradycardia. Educational objective: Immediate routine neonatal resuscitation includes drying, stimulating, and warming. Healthy newborns should be placed on the mother's chest for skin-to-skin care, which provides warmth and allows early breastfeeding initiation. References: Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. (http://www.ncbi.nlm.nih.gov/pubmed/27550975) Part 13: Neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. (http://www.ncbi.nlm.nih.gov/pubmed/26473001)

A Newborn Boy Is Undergoing Evaluation Immediately After Birth in the Delivery