Neonatal resuscitation
Revision as of 18:54, 25 March 2015 by Rossdonaldson1 (talk | contribs)
Use this note for the non-delivery related resuscitation of the newborn; see newborn resuscitation for immediate after-delivery resuscitation
Background
Diagnosis
- Neonate in shock
- Neonate <1mo age
Work-Up
- 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
Differential Diagnosis
THE MISFITS
- Trauma
- Heart (Congenital Heart Disease) or Hypovolemia
- Endocrine- hypothyroidism, congenital adrenal hyperplasia
- Metabolic- sodium, calcium, glucose
- Inborn Errors of Metabolism
- Seizure- can be 2/2 trauma, metaboli
- Formula Problems- hyponatremia, hypocalcemia
- Intestinal Disasters- duodenal atresia, midgut volvulus, necrotizing enterocolitis, intussussception
- Toxin
- Sepsis
Treatment
- Full Sepsis work-up
- IV Abx 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