2 Neonatal Resuscitation, part 2 (Tintinalli)

Question 1

remarks on acrocyanosis

Answer 1

a normal finding in the first few days of life secondary to vasomotor instability and requires no specific evaluation or intervention

Question 2

persistent pulmonary hypertension of the newborn vs coarctation of the aorta

Answer 2

PPHN - the postductal PaO2 (lower extremity) is significantly lower than the preductal (right radial) PaO2

COA - reduced femoral pulses

Question 3

Hyperoxia test

Answer 3

Place the newborn in 100% hood for 10 mins

Cyanotic newborns with a pulmonary disorder can increase their PaO2 to >100 mm Hg (or SpO2 by >20%)

Question 4

If, after initial exam and testing, cyanotic heart disease cannot be ruled out, begin what?

Answer 4

an infusion of prostaglanding E1 starting at 0.05 mcg/kg/min, and titrate to the lowest effective dose to maintain ductal patency

Question 5

Treat hypoglycemia with

Answer 5

10% dextrose in water, 2mL/kg IV bolus, or 3.3 mL/kg/hour

Question 6

treatment of pneumothorax in the newborn

Answer 6

nontension:
nitrogen washout technique:
placing the baby in a 100% oxygen hood for 6-12 hours may accelerate clearance of the airleak
-this is CONTRAINDICATED in preterm newborns due to concerns of O2 toxicity to the lungs and retinas

TENSION:
1. 18- or 20- gauge 1-inch percutaneous catheter
2. local anethetic
3. elevate the neonate’s affected side with towels under the back
4. insert catheter into the 4th ICS at AAL (nipple line)

Question 7

remarks on congenital diaphragmatic hernia

Answer 7

m/c: posterolaterally through the foramen of Bochdalek

restrosternal foramen of Morgagni

most are left-sided

Question 8

ultimate morbidity and mortality in CDH is determined by

Answer 8

both the extent of hypoplasia of the contralateral lung and wheter or not the liver is located in the thorax and associated anomalies

total lung volumes >45% of normal are predictive of survival

Question 9

characteristic respiratory pattern in CDH

Answer 9

“seesaw” side-to-side respiratory pattern

Question 10

IVF in omphalocoele

Answer 10

IV 10% dextrose in water at 1.5x maintenance (i.e., 5-6 mL/kg/hour or 120-150 mL/kg/24 hours) to compenstae for the additional insensible water loss

Question 11

IVF in gastroschisis

Answer 11

IV 10% dextrose in water at 6-7 mL/kg/hour (150 mL/kg/24h)

Question 12

antibiotics in omphalocoele and gastroschisis

Answer 12

ampicillin 50-100 mg/kg IV
gentamicin 4-5 mg/kg IV

Question 13

VACTERRL

Answer 13

Vertebral anomalies
Anal atresia
Cardiac anomalies
Tracheo
Esophageal fistula
Radial anomlies
Renal anomalies
Limb anomalies

Question 14

treatment of tracheoesophageal fistula

Answer 14

1. reverse Trendelenburg (head-up) to help prevent passage of gastric contents through the TEF into lungs
2. placing the NGT into the esophageal pouch on low intermittent suction to prevent buildup and possible aspiration of oral secretions
3. NPO. D10W are best

Question 15

management in congenital diaphragmatic hernia (CDH)

Answer 15

1.) rapid endotracheal intubation is the treatment of choice with a rate of 40-50 breaths per min and lowest peak inspiratory pressures that allow for normal chest rise

2.) gentle hyperventilation to a PCO2 between 30 and 35 mmHg may help lower pulmonary vasculature resistance and allow for an easier stabilization phase before surgical correctionn.

bag-mask ventilation will inflate the GI contents in the chest and will further compromise ventilation