Neonatal resuscitation: Difference between revisions
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''See [[3.5kg (newborn)|newborn critical care quick reference]] for vital signs and drug doses, and equipment sizes.'' | ''See [[3.5kg (newborn)|newborn critical care quick reference]] for vital signs and drug doses, and equipment sizes.'' | ||
==Background== | ==Background== | ||
*Neonate <1mo age | |||
==Clinical Features== | ==Clinical Features== | ||
*Neonate in shock | *Neonate in shock | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
===Workup=== | |||
*Blood glucose (stat) | |||
*[[Sepsis (peds)|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=== | |||
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 | ||
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** 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 | ||
{{Pediatric hypoglycemia chart}} | |||
==Management== | ==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)) | |||
==See Also== | ==See Also== | ||
Revision as of 01:32, 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
- Neonate <1mo age
Clinical Features
- Neonate in shock
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
Workup
- 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)
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:
|
| 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
- 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))
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.