EMS Pediatric Populations - Neonatal Emergencies

EMTs should be well-equipped to manage neonatal emergencies, including using the APGAR assessment and knowing when to initiate resuscitation.

Here's a guide for EMS providers on common neonatal emergencies:

APGAR Assessment:

The APGAR score is a quick assessment tool used to evaluate the newborn's overall condition at one and five minutes after birth.

It assesses the following five parameters, each scored from 0 to 2:

A - Appearance (skin color):

    0: Blue or pale

    1: Body pink, extremities blue

    2: Completely pink

P - Pulse (heart rate):

    0: Absent

    1: Below 100 beats per minute

    2: Above 100 beats per minute

G - Grimace response (reflexes):

    0: No response to stimulation

    1: Grimace or weak response to stimulation

    2: Vigorous response, cough, or sneeze

A - Activity (muscle tone):

    0: Limp or floppy

    1: Some flexion of limbs

    2: Active motion

R - Respiration (breathing rate and effort):

    0: Absent

    1: Slow or irregular breathing

    2: Good, strong cry

A total score of 7-10 is generally considered normal, 4-6 suggests moderate distress, and 0-3 indicates severe distress.

Common Neonatal Emergencies:

Meconium Aspiration:

• Presence of meconium in amniotic fluid.

• Suction the airway, provide respiratory support, and transport promptly.

Neonatal Sepsis:

• Signs may include poor feeding, temperature instability, and respiratory distress.

• Administer antibiotics and provide supportive care. Transport promptly.

Respiratory Distress Syndrome (RDS):

• Common in preterm infants.

• Provide respiratory support and transport to a facility with neonatal intensive care capabilities.

Neonatal Hypoglycemia:

• Low blood glucose levels can lead to seizures.

• Administer glucose gel or IV dextrose and transport for further management.

Neonatal Jaundice:

• Evaluate for jaundice and assess bilirubin levels.

• Phototherapy may be needed. Transport if severe.

When to Initiate Resuscitation:

Initiate neonatal resuscitation if the newborn exhibits severe distress, has a low APGAR score, or encounters the following conditions:

• Absent or Gasping Respirations:

• Provide positive pressure ventilation with a bag-mask device.

• Heart Rate Below 60 bpm:

• Initiate chest compressions if the heart rate remains below 60 bpm after adequate ventilation.

• Meconium Aspiration with Poor Respiratory Effort:

• Suction the airway and provide respiratory support.

• Cyanosis Persisting Despite Oxygen Administration:

• Ensure effective ventilation and consider advanced airway management.

• Profound Bradycardia or Cardiac Arrest:

• Initiate cardiopulmonary resuscitation (CPR).

EMTs must receive specific training in neonatal resuscitation and stay current with guidelines.

Communication with the receiving facility and early initiation of interventions are critical for improving outcomes in neonatal emergencies.