Neonatal resuscitation

Background

See Newborn Resuscitation for after-delivery issues

Diagnosis

  1. Neonate in shock
  2. Neonate <1mo age

Work-Up

  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

DDx

THE MISFITS

  1. Trauma
  2. Heart (Congenital Heart Disease) or Hypovolemia
  3. Endocrine- hypothyroidism, congenital adrenal hyperplasia
  4. Metabolic- sodium, calcium
  5. Inborn Errors of Metabolism
  6. Seizure- can be 2/2 trauma, metaboli
  7. Formula Problems- hyponatremia, hypocalcemia
  8. Intestinal Disasters- duodenal atresia, midgut volvulus, necrotizing enterocolitis, intussussception
  9. Toxin
  10. Sepsis

Treatment

  1. Full Sepsis work-up
    1. IV Abx and fluids
  2. pressors if CHD suspected
  3. Intubate and give PGE
    1. Sides effects of PGE include apnea (10%)
  4. if Inborn errors suspected
    1. IV dextrose at 1.5 maintenance
    2. dialysis if ammonia >500

See Also

Newborn Resuscitation