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==Differential Diagnosis==
==Differential Diagnosis==
Common Newborn Problems
Common Newborn Problems
# Hypoxia
* [[Hypoxia]]
## Primary apnea
** Primary apnea
## Secondary apnea
** Secondary apnea
# Hypothermia
* [[Hypothermia]]
# Hypoglycemia
* [[Hypoglycemia]]
# Meconium asp
* [[Meconium aspiration]]
 
==Consider DDx (esp if older neonate)==
#Sepsis
#Congenital Heart Dz (PGE)
#Inborn  Error of Metabolism (lactate)


==Diagnosis==
==Diagnosis==
Assessment Triad
Assessment Triad
# Respiration- adequacy, difficulty
# Respiration- adequacy, difficulty
# HR >100, umbilical
# HR >100, umbilical
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###(1-2 meQ/kg)
###(1-2 meQ/kg)
   
   
===^Hypoglycemia (give D10W)===
===^[[Hypoglycemia]] (give D10W)===
*>2.5 kg = <40 mg/dL
*>2.5 kg = <40 mg/dL
*<2.5 kg = <30 mg/dL
*<2.5 kg = <30 mg/dL

Revisión del 18:47 25 mar 2015

Background

Newborn Vital Signs

HR RR SBP^

>100 40-80 60-70

^<3kg (premature) SBP = 40-60

Differential Diagnosis

Common Newborn Problems

Diagnosis

Assessment Triad

  1. Respiration- adequacy, difficulty
  2. HR >100, umbilical
  3. Color

Treatment

Resucitation Inverse Pyramid

  1. Dry, warm, position, suction, stimulate
    1. position: neutral (towel --> thorax)
    2. suction: oral then nasal
    3. stim: along spine or feet
    4. check glucose^
  2. Oxygen (use liberally)
  3. Ventilate (40-60 breaths/min @ 20-25 cmH20)
    1. BVM (indications)
      1. Apnea/gasping
      2. HR <100/min
      3. Persistent cyanosis
    2. ET^^ (indications); ETT size = Gest age (wks) / 10
      1. BVM ineffect after 30s
      2. Suction meconium**
  4. Chest compressions (indications)
    1. HR <60 after above x 30 sec
      1. 120/min (resp 3:1)
      2. Stop when HR > 60
  5. Medications^^^^
    1. Epi (0.01-0.03 mg/kg)
    2. D10W (4 mL/kg = 0.2gm/kg)
    3. Nalaxone (0.4 mg/kg)
      1. For opiod use <4hrs
    4. NS (10 mL/kg boluses)
    5. Dopamine gtt
      1. (5-20 mcg/kg/min)
    6. NaHCO3 - prolonged resus
      1. (1-2 meQ/kg)

^Hypoglycemia (give D10W)

  • >2.5 kg = <40 mg/dL
  • <2.5 kg = <30 mg/dL

^^Meconium Suctioning Indications

  1. Meconium + -->
    1. absent/depressed resp
    2. poor muscle tone
    3. HR <100

(2 passes w/ ET + suction)

^^^Newborn Vent Settings

Pressure Cycled: RR 30+, PIP 20/2 (Preemie 15/2)

^^^^Umbilical vein catheterization

Preemie (<23-24 wks or 500 gms)

  1. rapid volume may inc risk of IVH
  2. usually ETT immed

Equipment

  1. blankets, warmer, umbilical clamps
  2. Bulb suction or wall suction
  3. Catheters (5F,8F,10F)
  4. Meconium aspirators
  5. BVM
  6. ETT 2.5-4.0 w/ stylets
  7. Blades 0 & 1
  8. IV catheters (22 & 24 g)
  9. Umbilical caths (3.5 F & 5F)
  10. syringes, 3 way stop cocks
  11. Epi 1:10,000
  12. Naloxone 0.4 mg/ml or 1 mg/ml
  13. NaHCO3 4.2% or 8.4%
  14. NS & D10W

See Also

Source

Obtenido de «https://www.wikem.org/w/index.php?title=Newborn_resuscitation&oldid=34551»