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The Newborn
TRANSITION TO AIR BREATHING .................. 606
CARE IN THE DELIVERY ROOM .................... 607
EVALUATION OF NEWBORN CONDITION ............ 610
PREVENTIVE CARE.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
ROUTINE NEWBORN CARE ....................... 614
Normaly the newy born child begins to cry almost immediatey ater its exit from the vulva. This act indicates the establishment of respiration, which is accompanied by important modications in the circulatory system.
-J. Whitridge Williams (1903)
In most instances at delivery, the newborn is healthy and vigorous, but at times, special care may be needed. For this reason, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (20 17b) recommend that every birth should be attended by at least one qualified individual. This person should be skilled in the initial steps of newborn care and positive-pressure ventilation, and their only responsibility is management of the newborn. his usually is a pediatrician, nurse practitioner, anesthesiologist, nurse anesthetist, or specially trained nurse. However, in their absence, the responsibility for neonatal resuscitation falls to the obstetrical attendant. hus, obstetricians should be well versed in measures for immediate care of the newborn.
The number and qualiications of personnel who attend the delivery will vary depending on the anticipated risk, the number of babies, and the hospital setting. A qualiied team with full resuscitation skills should be present for high-risk deliveries and immediately available for every resuscitation (Wyckof, 2015). This team should not be on call at home or in a remote area of the hospital. Moreover, team training through frequent simulation practice is recommended for all who may be called to attend deliveries (Perlman, 2015).
Immediately following birth, the newborn must promptly convert from placental to pulmonary gas exchange. Pulmonary vascular resistance must fall, pulmonary perfusion must rapidly rise, and unique fetal vascular shunts must begin to close to separate the systemic and pulmonary circulations (Rudolph, 1979). These shunts include the patent ductus arteriosus and patent foramen ovale, described in Chapter 7 (p. 129). Lung aeration is not only critical for pulmonary gas exchange. Recent studies suggest that it is signiicantly responsible for initiating cardiovascular changes at birth (Hooper, 2016).