Neonatal resuscitation: Difference between revisions

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''See [[Newborn Resuscitation]] for immediate after-delivery resuscitation''
''Use this note for the non-delivery related resuscitation of the newborn; see [[newborn resuscitation]] for immediate after-delivery resuscitation.''


''See [[3.5kg (newborn)|newborn critical care quick reference]] for vital signs and drug doses, and equipment sizes.''
==Background==
==Background==
*Neonate <1mo age


==Diagnosis==
==Clinical Features==
#Neonate in shock
*Neonate in shock
#Neonate <1mo age


==Work-Up==
==Differential Diagnosis==
#Blood glucose (stat)
{{Sick neonate DDX}}
#Sepsis workup
#ECG
#Ammonia 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)


==Evaluation==
===Workup===
*Blood glucose (stat)
*[[Sepsis (peds)|Sepsis]] workup
*[[ECG]]
**Treatable conditions include SVT
*Ammonia,pyruvate and lactate 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). Ammonia > 200 requires dialysis
===Evaluation===
If hypoxic or evidence of CHF assume CHD
If hypoxic or evidence of CHF assume CHD
* CHF in neonate = hepatomegaly, wheezing, gallop
*[[CHF]] in neonate = hepatomegaly, wheezing, gallop
* if unclear do Hyperoxia test
*if unclear do Hyperoxia test
** place infant on 100% O2 for 10 minutes
**place infant on 100% O2 for 10 minutes
** check ABG, if O2<100 torr, highly predictive of CHD
**check ABG, if O2<100 torr, highly predictive of CHD
** some use Pulse Ox <95%, less sensitive  
**some use Pulse Ox <95%, less sensitive  
*Abdominal xrays may help rule in intestinal disaster early
*Abdominal xrays may help rule in intestinal disaster early


==DDx==
{{Pediatric hypoglycemia chart}}
THE MISFITS
# Trauma
# Heart (Congenital Heart Disease) or Hypovolemia
# Endocrine- hypothyroidism, congenital adrenal hyperplasia
# Metabolic- sodium, calcium, glucose
# Inborn Errors of Metabolism
# Seizure-  can be 2/2 trauma, metaboli
# Formula Problems- hyponatremia, hypocalcemia
# Intestinal Disasters- duodenal atresia, midgut volvulus, necrotizing enterocolitis, intussussception
# Toxin
# Sepsis


==Treatment==
==Management==
#Full Sepsis work-up
*Full [[sepsis]] work-up
## IV Abx and fluids
**IV [[antibiotics]] and [[fluids]]
#pressors if CHD suspected
*Pressors if CHD suspected
#Intubate and give PGE
*[[Intubate]] and give [[PGE]]
##Sides effects of PGE include apnea (10%)
**Sides effects of [[PGE]] include apnea (10%)
#if Inborn errors suspected
*If inborn errors suspected
## IV dextrose at 1.5 maintenance
**IV [[dextrose]] at 1.5 maintenance
## dialysis if ammonia >500
**Dialysis if ammonia >200
 
{{Empiric Treatment for Unstable Neonates}}


==See Also==
==See Also==
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*[[PALS (Main)]]
*[[PALS (Main)]]


[[Category:Peds]]
==External Links==
[[Category:Airway/Resus]]
*[http://pemplaybook.org/podcast/the-undifferentiated-sick-infant/ Pediatric Emergency Playbook Podcast: The Undifferentiated Sick Infant]
**[http://traffic.libsyn.com/pemplaybook/Undifferentiated_Sick_Infant.mp3 The Undifferentiated Sick Infant (mp3 only)]
 
==Video==
{{#widget:YouTube|id=B6jEgEexbEU}}
 
==References==
<references/>
 
[[Category:Pediatrics]]
[[Category:Critical Care]]

Revision as of 02:26, 28 September 2017

Use this note for the non-delivery related resuscitation of the newborn; see newborn resuscitation for immediate after-delivery resuscitation.

See newborn critical care quick reference for vital signs and drug doses, and equipment sizes.

Background

  • Neonate <1mo age

Clinical Features

  • Neonate in shock

Differential Diagnosis

Sick Neonate

THE MISFITS [1]

Evaluation

Workup

  • Blood glucose (stat)
  • Sepsis workup
  • ECG
    • Treatable conditions include SVT
  • Ammonia,pyruvate and lactate 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). Ammonia > 200 requires dialysis

Evaluation

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

Pediatric Hypoglycemia Dextrose Chart

Category Age Glucose Treatment Initial IV Bolus Maintenance Dose
Neonatal <2mo <40 D10W 2.5-5 mL/kg 6 mL/kg/h
Pediatric 2mo-8yrs <60 D25W 2 mL/kg

D10W:

  • 6 mL/kg/h for first 10 kg
  • + 3 mL/kg/h for 11–20 kg
  • + 1.5 mL/kg/h for each additional kg >20 kg
Adult >8yrs <70 D50W 50mL (1 amp) OR 1 mL/kg
  • Consider diluting the D25W or D50W bolus, with NS 1-to-1, as those concentrations may be sclerosing to veins
  • Recheck 5 minutes after dose and repeat dose if low.
  • Consider glucagon IM/SQ if IV access is not readily available

Management

Empiric Treatment for Unstable Neonates

Medication/Intervention Indication Dose/Size (for neonate)
Glucose Hypoglycemia 5–10 mL/kg of 10% dextrose in water IV
3% normal saline Symptomatic hyponatremia 3–5 mL/kg bolus IV
Calcium Hypocalcemia 50–100 milligrams/kg calcium gluconate or 20 milligrams/kg calcium chloride IV
Cefotaxime Infection 50 milligrams/kg IV
Ampicillin Infection 50 milligrams/kg IV
Gentamicin Infection 2.5 milligrams/kg IV
Packed red blood cells Anemia 10 mL/kg IV
Normal saline Hypotension, dehydration 5-10 mL/kg IV aliquots (up to 60-80 mL/kg)
10% dextrose in one fourth normal saline Metabolic disease 1.5 maintenance (6 mL/kg/h for the first 10 kg)
Endotracheal intubation Hypoventilation or frequent apnea <3mm for preemie; 3mm for term neonate, 3.5mm for older infant; cuffed tube prefered if not premature

See Also

External Links

Video

{{#widget:YouTube|id=B6jEgEexbEU}}

References

  1. Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.