Neonatal resuscitation: Difference between revisions
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#*IV [[antibiotics]] and [[fluids]] | #*IV [[antibiotics]] and [[fluids]] | ||
Revision as of 20:43, 10 September 2015
Use this note for the non-delivery related resuscitation of the newborn; see newborn resuscitation for immediate after-delivery resuscitation.
Background
Clinical Features
- Neonate in shock
- Neonate <1mo age
Differential Diagnosis
Sick Neonate
THE MISFITS [1]
- Trauma
- Heart
- Congenital heart disease
- Hypovolemia
- Endocrine
- Metabolic
- Sodium
- Calcium
- Glucose
- Inborn errors of metabolism
- Seizure
- Formula / feeding problems
- Intestinal Disasters
- Toxin
- Sepsis
Diagnosis
- Blood glucose (stat)
- 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)
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
Management
- Full sepsis work-up
- IV antibiotics and fluids
- Pressors if 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
External Links
- Pediatric Emergency Playbook Podcast http://pemplaybook.org/podcast/the-undifferentiated-sick-infant/
References
- ↑ Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.