Topics Discussed: apgar score; apgar score low; complications of pregnancy, childbirth and the puerperium; endotracheal tube; extremely low birth weight infant; guillain-barre syndrome; guillain-barre syndrome and pregnancy; hypoxic conditions, neonatal; infant, very low birth weight; inotropic agent; mechanical ventilation; meconium aspiration syndrome; mode of mechanical ventilation; neonatology; newborn resuscitation; perinatal resuscitation; pulmonary surfactants; respiratory distress syndrome, newborn; triage; umbilical artery catheterization; umbilical vein catheterization; weight for height.
- Approximately 4 million infants are born in the United States each year, with up to 10% requiring some resuscitation.
- Transition from fetal to neonatal physiology entails:
- Expansion of the lungs with spontaneous breathing
- Clearance of fetal lung fluid
- Rise in PaO2 from 25 mm Hg (fetus) to >50 mm Hg (neonate), facilitating a decrease in pulmonary vascular resistance and closure of the ductus arteriosus
- Increased left atrial venous return, facilitating closure of the patent foramen ovale
- Alterations in this transition will cause varying degrees of hypoxia in the infant.
- Initial response to hypoxia is apnea This primary apnea can be reversed with tactile stimulation.
- If hypoxia persists, the infant will begin irregular gasping respirations, which is followed by secondary apnea This apnea cannot be reversed with tactile stimulation, and ventilatory assistance must be provided.
- Please see Chapter 40 for definitions regarding asphyxiated infants, as there are definitive guidelines set jointly by the AAP and American College of Obstetricians and Gynecologists (ACOG) on when an infant can be termed "asphyxiated."
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