Neonatal resuscitation

Background

See Newborn Resuscitation for after-delivery issues

Diagnosis

1. Neonate in shock
2. Neonate <1mo age

Work-Up

1. Blood glucose (stat)
2. Sepsis workup
3. ECG
4. Ammonia to rule in Inborn Errors^
   1. Need to look up values for neonate. Ammonia is high as liver is immature (i.e. that's why neonates are jaundice)

If hypoxic or evidence of CHF assume CHD

• CHF in neonate = hepatomegaly, wheezing, gallop
• if unclear do Hyperoxia test
• place infant on 100% O2 for 10 minutes
• check ABG, if O2<100 torr, highly predictive of CHD
• some use Pulse Ox <95%, less sensitive
• Abdominal xrays may help rule in intestinal disaster early

DDx

THE MISFITS

1. Trauma
2. Heart (Congenital Heart Disease) or Hypovolemia
3. Endocrine- hypothyroidism, congenital adrenal hyperplasia
4. Metabolic- sodium, calcium
5. Inborn Errors of Metabolism
6. Seizure- can be 2/2 trauma, metaboli
7. Formula Problems- hyponatremia, hypocalcemia
8. Intestinal Disasters- duodenal atresia, midgut volvulus, necrotizing enterocolitis, intussussception
9. Toxin
10. Sepsis

Treatment

1. Full Sepsis work-up
   1. IV Abx and fluids
2. pressors if CHD suspected
3. Intubate and give PGE
   1. Sides effects of PGE include apnea (10%)
4. if Inborn errors suspected
   1. IV dextrose at 1.5 maintenance
   2. dialysis if ammonia >500

See Also

Newborn Resuscitation