NICU Vital Signs 101
What are our “normal” Neonatal vital signs and how do we assess them? How do NICU Nurses assess our babies?!
NICU NURSE VITAL ASSESSMENT
Part of what makes the NICU so unique is the complexity of our population. Even a few weeks difference in birth Gestation holds HUGE differences in our monitoring & plan of care.
Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, doctors, nurses, and other health care providers continually assess the health of the baby, observing for signs of problems or illness.
In general, the NICU vital signs we monitor are:
1. Heart Rate
2. Respiratory Rate
3. Oxygen Saturation
4. Blood Pressure
NICU VITAL SIGNS & RANGES
First & foremost, AGE! Gestational Age plays a HUGE factor for vital signs within normal limits!!
Assessing a baby's physical maturity is an important part of care. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby.
An examination called The Dubowitz/Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz/Ballard Examination evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery. Information often used to help estimate babies' physical and neuromuscular maturity are shown below.
General NICU Vital Ranges: 1. Heat Rate: 100-200 2. Respiratory Rate: 10-100 3. Temp 36.5 C - 37.5 C 4. Oxygen Sats - 85-100% 5. Blood pressure: depends on gestation 6. Pain (NPASS 0-8)
Each vital sign varies depending on how many weeks gestation the baby was born & is currently corrected.
For example, a micropreemie (22-25 weeks) will typically display higher heart rates, irregular breathing patterns, fluctuating temperatures based on environment, oxygen saturations with lower thresholds (70-85% up 85-100% within 1 minute)
Other measurements are also taken of each baby. These include the following:
Head circumference. The distance around the baby's head.
Abdominal circumference. The distance around the abdomen.
Length. The measurement from crown of head to the heel.
NICU NURSE ASSESSMENTS
1. General appearance.
Physical activity, tone, posture, and level of consciousness
Color, texture, nails, presence of rashes
3. Head and neck:
Appearance, shape, presence of molding (shaping of the head from passage through the birth canal)
Fontanels (the open "soft spots" between the bones of the baby's skull)
Clavicles (bones across the upper chest)
Eyes, ears, nose, cheeks.
Palate, tongue, throat.
Breath sounds, breathing pattern.
7. Heart sounds and femoral (in the groin) pulses.
Presence of masses or hernias.
9. Genitals and anus.
For open passage of urine and stool
10. Arms and legs.
Movement and development.
A baby's birthweight is an important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg).
In general, small babies and very large babies are at greater risk for problems.
Babies are weighed daily in the nursery to assess growth, fluid, and nutrition needs. Newborn babies may often lose 5 to 7 percent of their birthweight.
This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back by 2 weeks of age.
Premature and sick babies may not begin to gain weight right away.
Most hospitals use the metric system for weighing babies. This chart will help you convert grams to pounds. You can also download a conversion app on your phone!!!
NICU MEDICAL EQUIPMENT
Vital sign monitors are used in NICUs provide information in numerical and waveform formats.
2. ECG LEADS
Heart rate & pulse are monitored with a 3 lead ECG stickies placed over chest & lung areas. In most cases, a 12-lead ECG is not used on a neonatal patient because of the limited size of their body.
Temperatures are usually taken via axillary (armpit). If a baby is in an isolette, a skin probe (attached to the baby) displays the babies temperature. This is how we keep them nice and toasty.
4. PULSE OX PROBE
A pulse ox probe (attached to hand, wrist, or foot) monitors the oxygen saturation.
5. BLOOD PRESSURE
Blood pressure cuffs are based on weight. And are “teeny tiny” to “line backer” AKA 1kg -5kg. (UAC arterial lines can be used too)
6. PAIN SCORING
Pain is scored every 3-4 hours with some form of standard pain scale. “NPASS” most common.
Every NICU has slightly different acceptable ranges & much research is in the works for our NICU patient population.
NICU Nurse Essential Resources
March of Dimes! Resources for parents & providers
Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN student, a Barco Uniforms Ambassado & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or firstname.lastname@example.org