Neonatal intubation: Difference between revisions

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==General considerations==
#REDIRECT[[Intubation (peds)]]
*Anatomical differences of neonates (compared to adults/big kids):
**Large occiput--> may need shoulder roll to get ear to sternal notch aligned
**Relatively larger tongue, small mouth
**More anterior larynx
**Larger/floppier epiglottis
**Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement
 
*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>
 
==Equipment/sizes/numbers==
*ETT tube size:
**Full term newborn - 3.5-4 uncuffed
**Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
*Blade:
**Preemie <1.5kg: 00
**Full term newborn: 0
**Neonate/infant: 1
*ETT depth
**Newborn/neonate: uncuffed ETT x 3 (cm at lip)
**Preemie: weight in kg +1 (cm at lip)
*LMA size
**Weight in kg/20 + 1
*Apneic O2 by NC for newborn/neonate: 5L/m
*Routine vent settings
**FiO2 100%--> wean
**PEEP 4-5
**TV 8-10cc/kg
**RR 25-35
**I-time 0.5s
 
==Drugs==
*[[Atropine]] premedication
**Controversial
**Neonates VERY prone to [[PALS: Bradycardia|bradycardia]] with myriad stimuli, including the vagal stimulation of laryngoscopy
**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
**0.01-0.03 mg/kg IV/IO
 
*Sedation
**[[Ketamine]] ''not'' approved for <3mo <ref>https://reference.medscape.com/drug/ketalar-ketamine-343099</ref>
**[[Fentanyl]] 1mcg/kg
**[[Etomidate]] 0.3mg/kg
*[[Neuromuscular blocking agents|Paralytic]]- consider double dose in shock
**[[Rocuronium]] 1.2mg/kg
***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated
**[[Succinylcholine]] 1.5mg/kg
 
==See Also==
*[[Neonatal resuscitation]], [[newborn resuscitation]]
*[[Pediatric jet ventilation]]
*[[The difficult airway]]
 
==External Links==
 
 
==References==
<references/>
 
[[Category:Procedures]]
[[Category:Pediatrics]]
[[Category:Critical Care]]

Latest revision as of 18:08, 18 May 2020

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