Susan was born at the 38th week of gestation by normal spontaneous delivery with a birth weight of 2.33 kg.
On the second day after birth, she had a fever with an axillary temperature of 39\deg C, a respiratory rate of 72 breaths per minute, desaturation (SpO2 85% on room air) with noisy breathing, weak in crying, and lethargy昏睡.
She was then transferred to the Neonatal Intensive Care Unit (NICU) as per the Paediatricians order for further management.
On admission to the NICU, the physical assessment was as follows:
• Axillary temperature: 39.5\deg C
• Heart Rate: 160 bpm and regular
• Respiratory rate: 70 bpm👆🏻 with noisy breathing, nasal flaring and intercostal retraction. (high RR)
• SpO2: 90% on 30% O2 via face mask.
• Blood pressure: 60/ 30 mmHg (Low BP)
• Cold extremities and mottled skin
Normal vital sign
Age Category Age Range Normal Respiratory Rate
Infant 0-12 months 30-60 per minute
Toddler 1-3 years 24-40 per minute
Preschooler 4-5 years 22-34 per minute
School age 6-12 years 18-30 per minute
Laboratory result:
• Blood culture: Group B Streptococcus (GBS).
• Cerebrospinal fluid culture: NAD
• Completed blood picture:
• Hb: 12.0 g/dL👇🏻 (The reference ranges for Hb concentrations in children are as follows : Newborn: 14-24 g/dL. 0-2 weeks: 12-20 g/dL. 2-6 months: 10-17 g/dL.)
• WBC: 13 x10Ʌ9/L (Healthy newborn infants may have a WBC count from 13,000 to 38,000 per mm3 (13.0 to 38.0 \times 109 per L) at 12 hours of life. By two weeks of age, this decreases to approximately 5,000 to 20,000 per mm3 (5.0 to 20.0 \times 109 per L), and gradually declines throughout childhood to reach adult levels of 4,500 to 11,000 per mm3 (4.5 to 11.0 \times 109 per L) by about 21 years of age)
• Platelet count: 200 x 10Ʌ9/L (normal range 1-7 day : 200-500 x10^9/L)
• C-reactive protein: 20 mg/L (CRP levels in healthy full-term and preterm infants may range from 2 to 5 mg/L during the first few days of life. During the neonatal period, an established upper normal CRP level of 10 mg/L has been identified in many studies.)
What is the role of midwives in intrapartum period according to the scenario?