Neonatal resuscitation: Difference between revisions

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''Use this note for the non-delivery related resuscitation of the newborn; see [[newborn resuscitation]] for immediate after-delivery resuscitation.''
''Use this note for the non-delivery related resuscitation of the newborn; see [[newborn resuscitation]] for immediate after-delivery resuscitation.''
''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==
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==Clinical Features==
==Clinical Features==
*Neonate in shock
*Neonate in [[pediatric shock|shock]]


==Differential Diagnosis==
==Differential Diagnosis==
{{Sick neonate DDX}}
{{Sick neonate DDX}}


==Diagnosis==
==Evaluation==
===Workup===
===Workup===
*Blood glucose (stat)
*Blood glucose (stat)
*[[Sepsis (peds)|Sepsis]] workup
*[[Sepsis (peds)|Sepsis]] workup
*[[ECG]]
*[[ECG]]
*Ammonia to  rule in Inborn Errors^
**Treatable conditions include [[SVT]]
**Need to look up values for neonate. Ammonia is high as liver is immature (i.e. that's why neonates are jaundice)
*Ammonia, pyruvate and [[lactate]] to  rule in [[inborn errors of metabolism]]
**Need to look up values for neonate. Ammonia is high as liver is immature (i.e. that's why neonates are jaundice). Ammonia > 200 requires dialysis


===Evaluation===
===Evaluation===
If hypoxic or evidence of CHF assume CHD
If [[hypoxia|hypoxic]] or evidence of CHF assume CHD
* CHF in neonate = hepatomegaly, wheezing, gallop
*[[CHF]] in neonate = [[hepatomegaly]], [[wheezing]], gallop
* if unclear do Hyperoxia test
*if unclear, do Hyperoxia test
** place infant on 100% O2 for 10 minutes
**place infant on 100% O2 for 10 minutes
** check ABG, if O2<100 torr, highly predictive of CHD
**check ABG, if O2<100 torr, highly predictive of CHD
** some use Pulse Ox <95%, less sensitive  
**some use Pulse Ox <95%, less sensitive  
*Abdominal xrays may help rule in intestinal disaster early
*[[KUB|Abdominal xrays]] may help rule in intestinal disaster early


{{Pediatric hypoglycemia chart}}
{{Pediatric hypoglycemia chart}}
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*Full [[sepsis]] work-up
*Full [[sepsis]] work-up
**IV [[antibiotics]] and [[fluids]]
**IV [[antibiotics]] and [[fluids]]
*Pressors if CHD suspected
*[[Pressors]] if CHD suspected
*[[Intubate]] and give [[PGE]]
*[[Intubate]] and give [[PGE]]
**Sides effects of [[PGE]] include apnea (10%)
**Sides effects of [[PGE]] include apnea (10%)
*If inborn errors suspected
*If [[inborn error of metabolism]] suspected
**IV [[dextrose]] at 1.5 maintenance
**IV [[dextrose]] at 1.5 maintenance
**Dialysis if ammonia >500
**[[Dialysis]] if ammonia >200


{{Empiric Treatment for Unstable Neonates))
{{Empiric Treatment for Unstable Neonates}}


==See Also==
==See Also==

Revision as of 18:47, 6 October 2019

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

Differential Diagnosis

Sick Neonate

THE MISFITS [1]

Evaluation

Workup

  • Blood glucose (stat)
  • Sepsis workup
  • ECG
    • Treatable conditions include SVT
  • Ammonia, pyruvate and lactate to rule in inborn errors of metabolism
    • Need to look up values for neonate. Ammonia is high as liver is immature (i.e. that's why neonates are jaundice). Ammonia > 200 requires dialysis

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:

  • 6 mL/kg/h for first 10 kg
  • + 3 mL/kg/h for 11–20 kg
  • + 1.5 mL/kg/h for each additional kg >20 kg
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

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
Gentamicin Infection 2.5 milligrams/kg IV
Packed red blood cells Anemia 10 mL/kg IV
Normal saline Hypotension, dehydration 5-10 mL/kg IV aliquots (up to 60-80 mL/kg)
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, 3.5mm for older infant; cuffed tube prefered if not premature

See Also

External Links

Video

{{#widget:YouTube|id=B6jEgEexbEU}}

References

  1. ↑ Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.
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