{"title":"The ACoRN Process","authors":"","doi":"10.1093/med/9780197525227.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780197525227.003.0002","url":null,"abstract":"The ACoRN process chapter shows how ACoRN works, step by step. ACoRN’s goal is to identify and manage the unwell or at-risk newborn at, or very soon after, birth or resuscitation. Nine key steps in the ACoRN process are explained, assessing the requirement for resuscitation, followed by 8 systems-based chapters and Sequences (a system-based algorithm for care): respiratory, cardiovascular, neurology, surgical conditions, fluid and glucose, jaundice, thermoregulation, and infection. The ACoRN mnemonic determines the structure of the chapter: alerting signs, core steps, organization of care, response, next steps, and specific diagnosis and management. Essential components, such as the ACoRN Primary Survey, the Sequence, the prioritized Problem List, and the Level of Risk, are described. Diagrams and examples illustrate this process, and the first case scenario shows when and why stabilization should be initiated.","PeriodicalId":299220,"journal":{"name":"ACoRN: Acute Care of at-Risk Newborns","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122814033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Conditions","authors":"","doi":"10.1093/med/9780197525227.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780197525227.003.0006","url":null,"abstract":"The surgical considerations chapter focuses on conditions that require surgery soon after birth but first require stabilization. Such conditions include anterior abdominal wall defects, neural tube defects, and gastrointestinal obstructions. Gastroschisis and omphalocele are comparatively rare, but protecting such lesions at birth (e.g., by applying a bowel bag) is essential for stabilization. Neural tube defects occur on a spectrum and are more common, but taking immediate steps to prevent injury and infection is necessary. Gastrointestinal obstructions are signalled and/or differentially diagnosed by vomiting, the inability to swallow or handle secretions, delayed meconium, or abdominal distension. Causes of acute abdomen, such as necrotizing enterocolitis, volvulus, or gastrointestinal perforation are considered. Skills such as gastric or Replogle tube insertion, suctioning, and chest and abdominal radiograph interpretation are discussed in detail. Stabilization pathways and protocols are applied in two case scenarios.","PeriodicalId":299220,"journal":{"name":"ACoRN: Acute Care of at-Risk Newborns","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132386701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Respiratory","authors":"","doi":"10.1093/med/9780197525227.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780197525227.003.0003","url":null,"abstract":"Respiratory is the first system-based chapter because adequate oxygenation and ventilation support are critical for stabilizing unwell or at-risk newborns. Respiratory distress is an early, common sign that stabilization is needed. Stabilization includes identifying infants who require intervention; applying the Respiratory Sequence; using a scoring tool to differentiate mild, moderate, or severe respiratory distress and organizing care accordingly; initiating stabilization measures; and monitoring. Related procedures (e.g., intubation), supportive technologies (e.g., continuous positive airway pressure and mechanical ventilation), and monitoring tools (e.g., pulse oximetry) are described. Respiratory conditions include transient tachypnea of the newborn, respiratory distress syndrome, aspiration syndromes, pneumonia, persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hypoplasia. Specific diagnosis and management for each condition round out the chapter, with blood gas and chest radiograph interpretations as needed. Two case scenarios show different care pathways for mild, moderate, and severe respiratory distress.","PeriodicalId":299220,"journal":{"name":"ACoRN: Acute Care of at-Risk Newborns","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129379189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fluid and Glucose","authors":"","doi":"10.1093/med/9780197525227.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780197525227.003.0007","url":null,"abstract":"The fluid and glucose chapter focuses primarily on unwell newborns who need early blood glucose monitoring for hypoglycemia and immediate stabilization with intravenous dextrose solution. But infants can be at risk for low blood glucose for many reasons, and they too need specific attention and care, even when they are not symptomatic. Oral doses of dextrose gel may help to raise blood glucose levels, which also depend on whether an infant cannot feed or should not be fed (for any reason) and response to supplementation or managed oral feeding. Guidance includes glucose thresholds to aim for, determined by postnatal age, and testing intervals to expedite the normalization of blood glucose values. How to assess, measure, and anticipate fluid requirements in at-risk infants is explained in detail, and risks for hypoglycaemia, dehydration, and overhydration are considered. Two case scenarios examine different hypoglycaemia risks.","PeriodicalId":299220,"journal":{"name":"ACoRN: Acute Care of at-Risk Newborns","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126926979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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