Neonatal resuscitation

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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