Respiratory care is guided by the Apgar score which is obtained at one minute and five minutes after birth through observation of the newborn. The caregiver assesses the newborn for heart rate, respiratory effort, muscle tone, reflex irritability, and color. The newborn receives scores of 0, 1, or 2 for each category and all five scores are added together. An infant scoring less than 4 is in grave danger and requires immediate resuscitation. A score of 4 to 6 indicates that the newborn's condition is serious and that the baby may require clearing of the airway and oxygen therapy. A score of 7 to 10 indicates that the infant is doing well. The highest score a newborn can receive is 10.
Respiratory care of the newborn can be separated into two general categories: care of the healthy, term newborn and care of the high-risk newborn.
Respiratory care of the healthy, term newborn
RESPIRATORY EFFORT. A healthy, term newborn generally releases a lusty, spontaneous cry within 30 seconds after delivery. By one minute, the newborn normally maintains regular, but often rapid respirations. If the mother received large amounts of narcoticanalgesia or a general anesthetic in labor or birth the baby's respirations might be depressed. The administration of a medication to counter this effect, such as naloxone (Narcan) may be indicated.
The newborn should be able to maintain a clear airway with little assistance and should have a respiratory rate of 30 to 60 breaths per minute. Physical signs of respiratory distress are retractions (the skin is pulling against the ribs), nasal flaring, and grunting. The lungs should sound clear when listened to with a stethoscope (auscultated).
Care of the normal newborn's respiratory status includes the following actions:
Assess the baby's respiratory rate every 15 minutes for 1 hour. Observe for an increase in respiratory rate, the development of retractions, nasal flaring, or grunting.
Position the newborn with the head down and on one side to aid in the drainage of secretions from the respiratory tract.
Suction the baby's mouth first with a bulb syringe and then the nose. Suctioning the nose before the mouth can induce the aspiration of secretions through the mouth.
Frequently change the baby's position to encourage the drainage of secretions thereby helping the lungs to aerate and expand.
Keep the baby warm either by wrapping loosely with a blanket and placing a hat on the baby's head or by placing the baby under a radiant warmer. Check the baby's temperature frequently at first. A cold baby experiences an increase in metabolic rate that raises oxygen requirements resulting in a more rapid respiratory rate.
Nadine M. Jacobson R.N., The Gale Group Inc., Gale, Detroit,