Neonatal resuscitation: Difference between revisions
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#*IV dextrose at 1.5 maintenance | #*IV dextrose at 1.5 maintenance | ||
#*Dialysis if ammonia >500 | #*Dialysis if ammonia >500 | ||
===Empiric Treatment for Unstable Neonates=== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Medication/Intervention''' | |||
| align="center" style="background:#f0f0f0;"|'''Indication''' | |||
| align="center" style="background:#f0f0f0;"|'''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 | |||
|- | |||
| Packed red blood cells||[[Anemia]]||10 mL/kg IV | |||
|- | |||
| Normal saline||Hypotension, dehydration||20 mL/kg IV | |||
|- | |||
| 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, 4mm for older infant | |||
|} | |||
==See Also== | ==See Also== | ||
Revision as of 01:28, 9 May 2016
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
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
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 |
| Packed red blood cells | Anemia | 10 mL/kg IV |
| Normal saline | Hypotension, dehydration | 20 mL/kg IV |
| 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, 4mm for older infant |
See Also
External Links
Video
{{#widget:YouTube|id=B6jEgEexbEU}}
References
- ↑ Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.