Pulmonary Assessment of Newborn

Overview:

This tool facilitates the pulmonary assessment of term to near-term newborns experiencing respiratory distress. Resuscitation follows NRP guidelines for depressed newborns. Given that the majority of NICU admissions are respiratory-related, accurate pulmonary assessment is vital for appropriate treatment. Respiratory distress in newborns can stem from various stressors, emphasizing the need for critical thinking, precise assessment, and tailored treatment based on the underlying cause, be it pulmonary, cardiac, infectious, neurologic, or other. 

1. Maternal History and Preparation:

Maternal history, if obtainable pre-delivery, aids in gauging potential effects of medications and conditions impacting fetal lung maturity. Drug abuse and premature rupture of membranes can influence fetal lung development. Attention to maternal drug abuse is crucial, with caution against reversing narcotics at birth due to potential neonatal seizures. NICU respiratory therapists (RTs) play a pivotal role in preparing warmers for delivery, adhering to NRP guidelines. 

2. Four Critical Life Functions: 

• Ventilation: Breathing air in and out. 

• Oxygenation: Getting oxygen to the blood. 

• Circulation: Moving blood through the body. 

• Perfusion: Getting blood and oxygen into tissues. 

3. Ventilation Assessment: 

• Maintain airway via "sniffing" positioning. 

• Assess breathing and respond per NRP. 

• Clear airway using less invasive measures first. 

• Auscultate breath sounds, observe respiratory pattern, rate, and effort. 

• Note chest shape and signs of increased respiratory effort. 

• Provide ventilator support as indicated. 

4. Oxygenation Assessment: 

• Observe baby's color for cyanosis. 

• Differentiate between acrocyanosis and central cyanosis. 

• Provide blow-by oxygen as necessary, monitoring the baby's response. 

• Assess color through central cyanosis, acrocyanosis, pallor, or mottling. 

• Use pulse oximetry and provide oxygen as indicated. 

5. Circulation Assessment: 

• Assess heart rate, palpating the umbilical stump or auscultating the chest. 

• Respond to heart rate per NRP guidelines. 

• Recognize secondary apnea as a common cause of decreased heart rate at birth. 

• Evaluate heart rate, point of maximal impulse, and pulse strength. 

6. Perfusion Assessment: 

• Measure blood pressure, remembering the neonatal range. 

• Evaluate sensorium, temperature, and urine output. 

7. Transition Period: 

• A normal transition lasts up to one hour, involving adaptation to extra-uterine life. 

• Changes include fetal circulation adjustments, thermoregulation, and initiation of breathing. 

Why is it Important for an RT to understand how to do a pulmonary assessment of the newborn?

Pulmonary assessment of newborns is crucial for respiratory therapists (RTs) because it helps identify early signs of respiratory distress or abnormalities, such as tachypnea, grunting, or retractions, which could indicate conditions like respiratory distress syndrome (RDS), pneumonia, or meconium aspiration. RTs use a thorough assessment, including observation, auscultation, and monitoring vital signs like oxygen saturation, to evaluate the infant’s breathing and oxygenation status. Early detection allows RTs to intervene quickly with interventions like suctioning, oxygen therapy, or ventilation support. By understanding the signs of respiratory distress and knowing how to assess lung function, RTs can prevent complications and ensure that newborns receive the appropriate care to stabilize their respiratory status and promote healthy lung development.