Neonatal resuscitation
Background
See Newborn Resuscitation for after-delivery issues
==Diagnosis==
Neonate in shock
Neonate <1mo age
Work-Up
Blood glucose (stat)
Sepsis workup
ECGAmmonia to rule in Inborn Errors* 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
Full Sepsis work-up- IV Abx and fluids, pressorsif CHD suspected- Intubate and give PGE- Sides effects of PGE include apnea (10%)if Inborn errors suspected- IV dextrose at 1.5 maintenance- dialysis if ammonia >500
See Also
Peds: Newborn Resuscitation