Lesson 5 Flashcards
After the baby has been successfully resuscitated, can baby be given back to mom immediately?
No, they may need ongoing support from NICU if they received PPV, or supplemental oxygen
Define hypoxic ischemic encephalopathy ( HIE )
A type of brain injury that happens after lack of oxygen to brain
When should babies not be allowed to become hypothermic or hypothermic ?
When they have HIE
What should be monitored after baby receives resuscitation? (8)
Blood oxygenation
Heart rate
Breathing rate
ECG
Blood pressure
Urine output
Fluid intake
Body temp
What initial studies could be necessary after baby receives resuscitation? (6) CCCBEL
Electrolytes including calcium
Blood glucose ASAP
Liver function (if indicated)
Complete blood count (if indicated)
Coagulation panel (if indicated)
Chest/abdomen xray (if indicated)
What’s ROSC
Return of spontaneous circulation
After ROSC what signs should be reviewed on baby for the neurological system?
Apnea
Seizures
Poor tone
Abnormal neurological exam
After ROSC what signs should be reviewed on baby for the pulmonary system?
Tachypnea (rapid breathing)
Grunting
Retractions
Nasal flaring
Low SpO2
After ROSC what signs should be reviewed on baby for the cardiovascular system?
Hypotension (low blood pressure)
Tachycardia (high heart rate 100+)
After ROSC what signs should be reviewed on baby for the renal (filters waste, kidneys) system?
Decreased urine output
Ademia
After ROSC what signs should be reviewed on baby for the gastrointestinal system?
Intolerant to feeding
Vomiting
Abdominal distention
After ROSC what signs should be reviewed on baby for the metabolic (chemical reaction in cells) system?
Metabolic acidosis (excess acid in body fluids)
Hypoglycemia (low blood sugar)
Electrolyte disturbances
After ROSC what signs should be reviewed on baby for the hemotologic (study of blood) system?
Pallor (deficiency of color of face)
Bruising
Petechiae (rash, round - reddish purple less than 2mm)
If hypotension is present what should be monitored?
Frequent blood pressure and heart rate monitoring
What could hypotension be associated with?
Tachycardia
If hypotension is present neonates may need ____ or in severe cases and introscope such as ____, or _____
Normal saline, dopamine, dobutamine
Pulling hypotension is more common in neonates who are ___ weeks gestation
34
What is pulmonary hypertension (blood pressure in lungs is high) treated with?
Supplemental oxygen
Ventilatory support
Inhaled nitric oxide
Extracorporeal membrane oxygenation (severe cases) (blood is pumped outside of the body to a heart-lung machine. The machine removes carbon dioxide and sends oxygen-rich blood back to the body.)
What can be used to diagnosis pneumonia and pneumothorax?
Chest xray
What are 3 electrolyte abnormalities
Hyponatremia (low sodium, body holds too much water)
Hyperkalemia (high potassium)
Hypocalcemia (low calcium)
Electrolyte abnormalities can usually be treated with supplementation except hyperkalemia may need specialist care and could need treated with _____ or _____,______
IV calcium, IV insulin and glucose
What can lead to metabolic acidosis (excess lactic acid)?
Extended periods of hypoxemia (low oxygen in blood)
What can treat acidemia (blood disorder low pH)?
Increased ventilation if it doesn’t normalize spontaneously
What is not used to treat metabolic acidosis?
Sodium bicarbonate
Is lactic acidosis the only cause of metabolic acidosis.
No, it’s important to find other causes
Is hypoglycemia relatively normal/abnormal in healthy neonates?
Normal
What can further diminish liver glycogen stores in hyperglycemic neonates?
Resuscitation
The definition of hypoglycemic neonates is hotly debated. So what judgement is needed
Clinical
What do you give neonates post resuscitation to treat hypoglycemia?
Dextrose or glucose gel
What type of glucose monitoring in neonates is notoriously inaccurate?
Heel prick (falsely low)
Hypoglycemia treatments should be guided by what?
Lab glucose plasma when possible
List common conditions after resuscitation (9) HPEMHGAHH
Hypotension
Pulmonary complications
Electrolyte abnormalities
Metabolic acidosis
Hypoglycemia
Gastrointestinal problems
Acute tubular necrosis
Hematologic abnormalities
Hypoxic ischemic encephalopathy
What gastrointestinal problems should providers look for in a neonate after resuscitation? What are clues to the signs?
Gastrointestinal bleeding
Ileus
Feeding intolerance
(Parenteral nutrition may be needed)
Clues: intolerance to feeding, vomiting, abdominal distention
What’s parenteral nutrition?
a medical treatment that delivers nutrients directly into a vein to provide calories, protein, vitamins, minerals, and fats
What’s the most common kidney complication of neonatal resuscitation?
Acute tubular necrosis
What does acute tubular necrosis cause? ___, &____
Urinary retention & electrolyte disturbances
What in acute tubular necrosis is associated with high urine output?
Late phases
In acute tubular necrosis what 2 things should be monitored closely?
Fluid and electrolytes and treat accordingly
With hematologic abnormalities what test run, can reveal anemia, thrombocytopenia, or elevated white blood count (suggests an infection)?
A simple complete blood cell count (CBC)
Neonates with _____ & _____ & _____ may develop Hypoxic ischemic encephalopathy.
Prolonged hypotension
Hypoxemia
Acidemia
Symptoms of Hypoxic ischemic encephalopathy may include:
(But these symptoms could also be caused from opioid withdrawal or infection)
Apnea
Seizures (occuring later)
Poor tone
Abnormal neurologic exam
What can help babies with Hypoxic ischemic encephalopathy (neurological issue) ? And when should treatment be implemented?
Therapeutic hypothermia, treatment ASAP even if it requires a transfer.
