Respiratory problem are often the case in newborns. It accounts for nearly half of neonatal deaths. Research by Kumar & Bhat (1996, p.93) states that Respiratory Depression (RD) is a common neonatal problem that generally occurs in preterm infants due to surfactant deficiency which relates to antenatal history of immature lung development and term infants of diabetic mothers. To describe some of the common diagnosis associated with RD are: Transient Tachypnea of the newborn (TTNB) was found to be common in both term and preterm babies. Hyaline membrane disease (HMD) was common among pre terms, and meconium aspiration syndrome (MAS) among term and post-term babies. Fatality for RD was found to be 19%, being highest for HMD (57.1%), followed by MAS (21.8%) and infection (15.6%). Therefore, it is crucial to recognise the signs of RD and ensure prompt treatment is rendered to minimize mortality and mobility in newborns at the delivery wards. Accurate physical assessment is done on the newborn on the first and fifth minute at birth to determine if the newborn is getting enough oxygen. By administering APGAR scoring - based on each of the components that are assessed in the APGAR scoring are : Cardiovascular (heart rate, color of the skin), fetal respiratory (quality of breathing and neuromuscular function (tone and reflexes based on fetal tone and response to external stimuli). According to Apgar cited in Letko(1996, p.299) the leading concerns was the ability to rapidly identify newborns requiring resuscitative measures in improving the prognosis. It is done to prevent respiratory depressed newborns from being incorrectly assessed, while minimizing delivery of oxygen and other unnecessary treatment to healthy newborns. Giacoia stated in Letko (1996, p. 300) indicates that a low APGAR score implies an abnormal condition in the newborn, but it does not suggest a specific etiology. Hypotonia in newborn with neuromuscular disorder, for example, may be mistakenly diagnosed to be the cause of birth asphyxia when the newborn is unable to establish or maintain breathing. Maternal sedation and analgesia likewise may decrease tone and responsiveness, resulting in lower score.
Managanaro (1994, p. 99) added that infants with 1-min APGAR score was influenced by the mode of delivery and by gestational age rather than asphyxia. Instead, 5-min APGAR score had a high correlation with metabolic acidemia. Infants with low APGAR scores, presented with metabolic acidemia and arterial desaturation have the highest occurance of neonatal intensive care unit .admission and poor neonatal outcome. Therefore, study suggests that the 5-min APGAR score is necessary for immediate assessment and care of the neonate.
Scoring APGAR is subjective in terms of interpretation and may lead to biasness. Therefore to correct this deficit, midwives are scoring APGAR at 1 and 5 minute intervals as recommended by Apgar supported in Letko( 1996, p. 300). Letko (1996, p. 302) furthermore, points out by determining oxygenation status by observing cyanosis is an inaccurate method. The manipulating factor consists of the examiner’s skill, adequate lighting, newborn’s skin condition, peripheral perfusion, and hemoglobin level. Physiological changes in the newborn such as functional closure of ductus arteriosus, ductus venosus, and foramen ovale may cause the newborn looking cyanosed. Midwives’ ability to differentiate central and peripheral cyanosis is critical for initiating treatment. Letko (1996, p.302) explains when present throughout the body, including the mucous membranes and tongue, this condition is termed central cyanosis. When limited to the extremities, it is termed peripheral cyanosis or acrocyanosis.
In comparison, central cyanosis refers to central cyanosis is more detrimental as it can result in range of disorder in areas such as cardiac, metabolic and neurological disorders. Newborns may require supplemental oxygen therapy to...
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