Neonatal resuscitation

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

Clinical Features

• Neonate in shock
• Neonate <1mo age

Differential Diagnosis

Sick Neonate

THE MISFITS

• Trauma
• Heart
  • Congenital heart disease
  • Hypovolemia
• Endocrine
  • hypoglycemia
  • Hypothyroidism
  • Congenital adrenal hyperplasia
• Metabolic
  • Sodium
  • Calcium
  • Glucose
• Inborn errors of metabolism
• Seizure
• Formula / feeding problems
  • Hyponatremia
  • Hypocalcemia
  • FPIES / Food protein-induced enterocolitis syndrome
• Intestinal Disasters
  • Duodenal atresia
  • Midgut volvulus
  • Necrotizing enterocolitis
  • Intussusception
• Toxin
• Sepsis

Diagnosis

1. Blood glucose (stat)
2. Sepsis workup
3. ECG
4. Ammonia to rule in Inborn Errors^
   1. 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

1. Full sepsis work-up
   • IV antibiotics and fluids
2. Pressors if CHD suspected
3. Intubate and give PGE
   • Sides effects of PGE include apnea (10%)
4. If inborn errors suspected
   • IV dextrose at 1.5 maintenance
   • Dialysis if ammonia >500

See Also

• Newborn Resuscitation
• PALS (Main)

External Links

• Pediatric Emergency Playbook Podcast: The Undifferentiated Sick Infant
  • The Undifferentiated Sick Infant mp3