UnIT.9:.REVIEW:.IS.THE.BABY.SICK?.IDEnTIFYInG.AnD.CARInG.FOR.SICK.AnD.AT-RISK.BABIES
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A. Heart Rate (Normal is approximately 120 to 160 beats per minute.)*
Observe Think Act
Tachycardia
(.180 beats per
minute [bpm])
Hypovolemia
Anemia
Acidosis
Sepsis
Hyperthermia
Congestive heart failure
Arrhythmia
Attach oximeter and adjust Fio2 to achieve
Spo2 5 88% to 92%.
Check hematocrit, blood pressure, blood gas,
temperature.
Consider cultures and antibiotics.
Electrocardiogram if rate .220 bpm.
Bradycardia
(,100 bpm)
Hypoxia
Hypothermia†
Acidosis
Sepsis
Congenital heart block
Attach oximeter and adjust Fio2 to achieve
Spo2 5 88% to 92%.
Give oxygen if saturation is below target
range.
Check arterial blood gas, temperature.
Consider cultures and antibiotics.
Electrocardiogram if persistent.
Murmurs Functional
Congenital heart disease
If murmur persists, obtain chest x-ray and
echocardiogram, if available.
If baby cyanotic
Give oxygen and check oximetry and arte-
rial blood gas.
Consult cardiology or regional center staff.
*Newborn heart rates and respiratory rates are variable and should be counted for 1 full minute. Assess the whole
baby when interpreting a high or low heart or respiratory rate.
†Warm a severely chilled baby according to guidelines in Book I: Maternal and Fetal Evaluation and Immediate
Newborn Care, Unit 7, Thermal Environment.
B. Temperature (Normal is approximately 37.0°C [98.6°F].)
Observe Think Act
Hyperthermia
(.37.5°C; .99.6°F)
Overheated environment
Sepsis (rarely)
Check environmental temperature.
Consider cultures and antibiotics.
Hypothermia
(,36.5°C; ,97.7°F)
or
Unstable
temperature
Sepsis
Shock
Acidosis
Excessive heat loss
Necrotizing enterocolitis
Check environmental temperature.
Check and correct routes of heat loss.
Check blood pressure, blood gas, white blood
cell (WBC) count with differential.
Warm baby.*
Consider cultures and antibiotics.
Consider abdominal x-ray.
*Warm a severely chilled baby according to guidelines in Book I: Maternal and Fetal Evaluation and Immediate
Newborn Care, Unit 7, Thermal Environment.
Subsection: Vital Signs and Observations
Review the observe, think, and act categories for each vital sign, as well as color, activity, and
feeding. Some material in this and the subsequent section appears nowhere else in the Perinatal
Continuing Education Program books.
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