NORMAL VALUES:COMPLETE BLOOD COUNT TotalWBC Neutrophils Lymphocytes Monocytes Eosino Mean range Mean range % mea range

% Mea % m % 26 4.4 (fetal 30 Blood) Term 18.1 9-30 11 6-26 61 5.5 2-11 31 1.1 6 0. 2 j 4 2 12 22.8 13-38 15.5 6-28 68 5.5 2-11 24 1.2 5 0. Hrs. 5 . 24 18.9 9.4-34 11.5 5-21 61 5.8 231 1.1 6 0. 2 Hrs. 11.5 5 1 wk 12.2 5-21 5.5 1.5- 45 5 2-17 41 1.1 9 0. 4 S.T.A.B.L.E. Program, adapted from Nathan, Ginsburg, and Look (2003) and Brunetti and Cohen (2005) Age

Age 26-30 weeks 28 weeks 32 weeks Term 24 hours 1 week

Hemoglobin (g/dl) Hematocrit (%) Mean 13.4 14.5 15 16.5 18.5 17.5 -2SD mean 41.5 45 47 51 56 54 -2SD

13.5 14.5 13.5

42 45 42

Platelet Count Normal Value VLBW (<1500 gms) 275,000 +/- 60,000 Preterm (<2500 gms) 290,000 +/-70,000 Term - 310,000 +/-68,000

Normal Range = 215,000 335,000 = 220,000 360,000 = 242,000 378,000

In the Presence of neonatal sepsis the platelet count may be low Platelet count between 100,000 to 150,000 should be carefully evaluated especially if there has been a downward trend from previous sample Platelet count less than 100,000 are definitely abnormal and should be follow up again within 12-24 hours Platelet count less than 25,000 are dangerous low. Repeat the test and confirm accuracy.

AGE 0-24 hr 1-7 days 8-30 days

MINIMUM AND MAXIMUM HEART RATES IN NORMAL NEWBORNS MINIMUM MEAN MAXIMUM SD 85 119 145 16.1 100 133 175 22.3 115 163 190 19.9

HYPOGLYCEMIA Any plasma glucose level less than 50 mg/dl (2.8 mmol/liter) with symptoms that resolve with glucose treatment

SIGNS AND SYMPTOMS OF HYPOGLYCEMIA Jitteriness Irregular respiration Hypothermia/Temperature instability Poor suck or refusal to eat Lethargy Vomiting Apathy Cyanosis Hypotonia High-pitched or weak cry Apnea Seizure TEMPERATURE Normal Core Temperature is between 36 C to 37 C (MAINTAIN to 36.5 37.4) Detrimental Effect of Hypothermia Development of Acidosis Increased Metabolic Rate & Risk of Hypoglycemia Increased Oxygen Consumption and Risk of Hypoxia Coagulation defects RESPIRATORY RATE Newborn normal range: 40 60 /min RESPIRATORY SYSTEM WARNING SIGNS RR > 60 breaths /min with inc. work of breathing (moderate to severe retraction, grunting, nasal flaring) Increasing oxygen concentration To maintain oxygen saturation less than 90%. Rapidly increasing oxygen concentration to maintain O2 saturation > 90% Marginal oxygen saturation(<90) or > 50% oxygen. Note this may present without significant signs of respiratory compromise in infants with cyanotic heart disease. RR >60 plus very labored breathing (severe sternal, subcostal, intercostal, and or suprasternal retraction plus may have grunting and or nasal flaring) May have periods of periodic breathing or apnea Apnea or Gasping (an ominous, precardiac arrest)

EVALUATE RESPIRATORY DISTRESS 1. 2. 3. 1. 2. 3. COLOR Pink Blue extremities but centrally pink Centrally blue, gray, or very pale. PERFUSION Rapid (<3 seconds) capillary filling time over trunk and legs Slow capillary filling time (> 3 seconds) over trunk and legs. May have mottling of the skin Slow capillary filling time plus pale skin color and cool extremities. May have significant skin mottling.

SHOCK Inadequate vital organ perfusion and oxygen delivery An acute, complex state of circulatory dysfunction resulting in insufficient oxygen and nutrient deliveryto satisfy tissue requirement EVALUATING THE INFANTS FOR SHOCK Poor Peripheral Perfusion (signs of vasoconstriction and poor cardiac output) 1. > 3 seconds capillary filing time 2. Pallor 3. Mottling 4. Cool skin 5. Decreased peripheral pulses Heart Rate 1. Tachycardia (sustained HR >180 bpm at rest) 2. Bradycardia (<100 bpm) with very poor perfusion 3. Evaluate for the presence or absence of heart murmurs Respiratory Effort 1. Increased work of breathing/retraction 2. Tachypnia 3. Irregular respirations 4. Gasping NEONATAL INFECTION CLINICAL SIGN OF SEPSIS Respiratory distress - tachypnia, retraction, grunting

nasal flaring and apnea. - development of an oxygen requirement. Abnormal Skin Perfusion - Mottling, pale color, gray color, delayed capillary refill time. Temperature instability - hypothermia and rarely

hyperthermia. Feeding intolerance - Vomiting, abdominal distension, poor feeding pattern. Abnormal HR and BP - tachycardia, bradycardia, hypotension Abnormal Neurologic status - Lethargy, hypotonia, seizure