If you are in the process of giving neonatal life support, you will need to know several important parameters in order to give the best care possible. These include capillary refill time, heart rate, and blood pressure. Initially, your aim is to maintain a Neonate‘s heart rate, blood pressure, and temperature at normal levels. The most accurate physical examination method is called auscultation along the left chest. You can determine the heart rate by counting the number of beats per minute divided by 6 seconds and multiplying by 10.

Physical characteristics

There are many differences in physical characteristics between neonates and adults. Both groups have large bodies and large surface areas, and both have higher insensible fluid loss and decreased pulmonary compliance. The primary difference between neonates and adults is the amount of air they can breathe in one breath. Neonatal respiratory mechanics are different, as their airway has smaller alveoli and is not as flexible. As a result, the lungs in neonates are more susceptible to oxygen desaturations.

When examining neonates, a physician must observe their movements. These movements are often sporadic, well-coordinated, and non-symmetrical. Likewise, bilaterally identical repetitive movements of the extremities may indicate seizures. Other physical characteristics of neonates to watch for are twitches of the eyelids or facial muscles, as well as flaccidity. While infants may appear to be relaxed, they should never be left alone for prolonged periods.

Lung surfactant

The lung produces a protein and lipid substance known as surfactant. It is important for pulmonary function because it increases inflation stability and reduces the work of breathing. It also has innate host defense properties. Premature babies with deficiency of surfactant are at high risk for respiratory distress syndrome. Early-onset preterm infants with respiratory distress syndrome have low lung surfactant, and a lack of surfactant in newborns may lead to respiratory failure and death before clinical surfactant is available. Some rare mutations of this protein can disrupt the synthesis of surfactant.

The lungs are made of cells called Type II alveoli, which secrete surfactant. The surfactant plays two roles. It decreases atmospheric pressure on the alveoli, which expand during inhalation and collapse inwards during exhalation. Without surfactant, the alveoli cannot exchange gas with the atmosphere, and therefore oxygen cannot reach the blood stream or tissues and organs. In this way, surfactant is essential for lung development.

Immune repertoire

The immune repertoire of the neonate is composed of a large number of molecules that are expressed throughout life. These molecules include TCR-? and IgH molecules. The researchers analyzed these molecules to build the repertoire. The repertoire contains a complete set of descriptive data, and a comparison of the neonate immune repertoire and adults’ immunoglobulin TCR repertoire showed that neonates had altered usage of the Vb gene. The authors conclude that these differences are likely to explain the impaired CTL response observed in neonates.

The fetal immune repertoire can help define the risk of infection for premature infants. But the repertoire of fetal T cells was not known until recently, due to technical reasons. Recent advances in the field have made it possible to analyze the repertoire of T cells and B cells in human fetuses at 12 to 26 weeks gestation. The results showed a gradual increase in B cell diversity compared to that of adult T cells.

Central perfusion

Detecting and evaluating neonatal central perfusion has become an important part of the intensive care of newborn infants. Current assessment techniques are based on clinical signs and findings, but significant technologic advancements have paved the way for continuous bedside evaluation. Functional echocardiography can help physicians assess perfusion in neonates, and its use in the neonatal intensive care unit can help to tailor therapy based on the underlying pathophysiology. However, before incorporating it into routine practice, there are still a number of limitations to be overcome before it is ready to be widely adopted.

A common method of cerebral perfusion in neonates is a combination of arterial cannula placement and a single-port system. In a recent study, Lim and colleagues used dual arterial cannulas, one into the innominate artery and the other into the aortic root. These devices were connected to a roller pump and provided simultaneous support for myocardial and cerebral perfusion. However, there were some limitations of this method, including a higher incidence of postoperative troponin-I levels and the need for more inotropic support for the neonates.

Severe respiratory distress

A newborn infant with severe respiratory distress will display classic clinical signs of this syndrome. These include respiratory rate greater than 60 breaths per minute (bpm) and tachycardia that exceeds 160 beats per minute. Other signs of respiratory distress include nasal flaring, grunting, and chest wall recessions. Pulse oximetry, full blood count, and C-reactive protein should be ordered, as well as arterial blood gas measurements and a chest radiograph, to rule out any congenital anomalies.

In addition to these clinical signs, respiratory distress can lead to meconium aspiration syndrome and transient tachypnoea. These newborns have large lung volumes and may not be able to respond to a standard respiratory care plan. Thus, it is important to recognize symptoms of respiratory distress in neonates and seek immediate medical attention. The extra work of breathing causes respiratory failure, which manifests as impaired oxygenation and respiratory acidosis. Without prompt intervention, respiratory arrest may result.

Sepsis

The treatment of sepsis in neonates varies widely, depending on several factors, including the age of the newborn, site of infection, suspected causative organism, microbial resistance pattern, and available resources. Most experts agree that antibiotic therapy should begin as soon as the neonate is suspected of having sepsis. However, there are some key factors to consider, including whether the baby is suffering from a viral infection or is merely suffering from an acute inflammatory response syndrome.

One of the first things to remember is that sepsis in neonates can be classified according to the time of onset. The most common cause of neonatal sepsis is an infection in the umbilical cord, respiratory distress, or prematurity. Other common risk factors include low birth weight, invasive procedures, and admission to the NICU. A positive blood culture in a neonate with sepsis is the gold standard.