Page 74 - 2026 SMOG

NEWBORN CARE AND DISTRESS
Signs and Symptoms
• Full-term delivery?
• Meconium staining of amniotic fluid?
• Any signs of dehydration? (sunken fontanelles, tearless, decreased UOP, and dry mouth, skin,
and tongue)
• Fluid Overload? (SOB, ankle/sacral edema, increased JVP, and crackles in lungs)
• History of delivery method? (SVD, C/S, forceps, vacuum, breech)
• Cord management? (cleaned and secured)
• Determine APGAR after the first APGAR
60 seconds of care and repeat SCORING 0 POINTS 1 POINT 2 POINTS
q5min ACTIVITY Absent Arms and Active
• Score of 6 or less = IMMEDIATE (MUSCLE TONE) legs flex movement
RESUSCITATION PULSE Absent Below Over
˚ Severely depressed: 0–3 100bpm 100bpm
˚ Moderately depressed: 4–6 GRIMACE Flaccid Some Active
˚ Excellent condition: 7–10 (REFLEX extremity away, cough)
motion (pull
flexion
IRRITABILITY)
APPEARANCE Blue, pale Body pink, Completely
(SKIN COLOR) extremities pink
blue
RESPIRATIONS Absent Slow, Vigorous cry
irregular
Treatment
• Does the patient have good tone? Is the airway open? (breathing/crying)
˚ Use a bulb syringe to clear the mouth/nose, dry and stimulate (foot tap/back rub), keep
warm, find APGAR score, and monitor SpO and treat hypoglycemia (glucose <40mg/dL)
2
• Does the patient have an HR <100, apnea or gasping, labored breathing, or persistent cyanosis?
˚ Attempt to clear the airway if needed, provide PPV via BVM: 30–60 breaths/min for an
SpO of 94–99%
2
˚ Intubate if NO chest rise
• Does the patient have an HR <60?
˚ Provide chest compressions and PPV (120event/min: 90 compressions interspersed with
30 ventilations)
˚ Consider intubation
˚ Epinephrine (0.1mg/mL) 0.01–0.03mg/kg IV/IO q3–5min (0.1–0.3mL of 0.1mg/mL
10cc Cardiac Epi vial)
˚ Consider hypoglycemia (D12.5 1mL/kg IV; dilute D50 to ¼ strength or 1mL D50 in
3mL NS)
˚ Consider Shock (IVF or Blood 10mL/kg IO)
˚ Consider pneumothorax (Intubation)
Notes, Cautions, Warnings
• Routine oral, nasal, or any other suctioning is not recommended, regardless of whether the fluid
is meconium or clear.
Reference: 2025 American Academy of Pediatrics Neonatal Resuscitation Guidelines

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