Why is S.T.A.B.L.E. Important for Maternal Child Care Providers?

Maternal Child Program - STABLE Program Provider Course for New Grads and Re-Entry Nurses

S.T.A.B.L.E. is the best class to take for stabilization of a sick baby after birth.  Every baby nurse should take S.T.A.B.L.E. We will learn the catastrophic event that will occur if an infant that has a low blood sugar.  The brain needs brain food to keep the infant maintaining physiological processes.  The brain is the electronic transformer – all processes are initiated in the brain.  Maintaining adequate blood sugar is vital for all babies and especially important for sick babies. Skin-to-skin can prevent hypoglycemia (Birth and Beyond Breastfeeding) by placing the baby on the mother’s chest after birth.  Since you cannot feed a sick baby for fear of aspiration and intestinal obstruction, you must provide the infant with D10W for brain food.  We will learn how much D10W in correlation with blood sugar levels should be given.

Maintaining temperature is very important.  When an infant’s skin becomes cold, the skin sends messages to the brain and in turn the brain sends out norepinephrine.  Norepinephrine causes peripheral vasoconstriction and the blood is shunted to the core of the body.  The vasoconstriction of the peripheral circulation also causes vasoconstrictive results of the pulmonary system.  Now, the blood can’t get to the lungs to pick up the needed oxygen in the lungs and therefore, shunts through the Foremen Ovale.  Now, the blood is hypoxemic and when the blood arrives to the tissues, the tissues become hypoxic.  Therefore, the body must resort to anaerobic metabolism and lactic acid is produced.  When lactic acid is used instead of oxygen the pH drops and the infant becomes acidotic.

How does hypothermia prevent hypoglycemia? When the baby gets cold he uses up more glycogen to keep warm.  When he must utilize his glucose stores to keep warm, then the blood sugar drops and infants become hypothermic along with hypoglycemic.   Make sense?

Therapeutic hypothermia is a means of improving outcomes for the brain injured infant.  This is accomplished by inducing hypothermia under a controlled environment.  To accomplish this the hospital must use specialized equipment. (S.T.A.B.E.) (Neonatal Resuscitation)

In Birth and Beyond Breastfeeding, we learn the best way to keep an infant warm is on the mother’s chest for skin-to-skin thermogenesis. It has been traditional to place a hat on the baby to reduce heat loss – but actually little hats do more harm than good.(To Hat or not to Hat) Studies done (McCall 2010) show that hats do not keep babies warm.  Further studies (Pretorius 2006) hats on baby’s head may actually may cause the baby to overheat.

We all know that a patent airway is important but partial airway obstruction can cause some real problems. If an infant has to increase his or her work of breathing to accommodate a partially obstructed airway, he or she will fatigue and progress into respiratory failure.  Obstructed airways can be a result of retained lung fluid, pneumothorax, pneumonia, and meconium aspiration are discussed. We will review the Neonatal Resuscitation guidelines of intubation and positive pressure ventilation that you learned in your Neonatal Resuscitation class.

Blood gases are notoriously difficult for most nurses.  S.T.A.B.L.E. has done a great job in taking the mystery out of blood gas interpretation.  I enjoy teaching this part because I can make it so very understandable.  If the pH is outside the limits of normal, the infant is said to be uncompensated (he has not compensated for what is happening to him).  If the respiratory component (CO2) is abnormal that makes the blood gas a respiratory problem.  If the metabolic component (HCO3) is abnormal that makes the blood gas a metabolic problem. Then we can figure out what to do.

The CBC is discussed to determine if the infant has or will have an infection.  It is the neutrophil that is discussed.  There can be immature neutrophil and mature neutrophils and we will determine the difference and how to calculate the probability of an infection by understanding the immature neutrophil is a young warrior and is not experienced enough to go to battle, whereas, the mature neutrophil is a more experienced warrior and more capable of going the battle.  Lots of immature warriors going to battle is bad thing!

The emotional aspect of a sick infant is overwhelming for the parents.  We will discuss what we should do and say to the parents and helpful strategies to help the parents cope.

The test is relatively easy.  You will be able to pass the test without any difficulty. You will enjoy this class and learn a great deal in a relaxed environment.

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