Neonatal Emergencies

Question 1

Neonatal Airway Considerations

Answer 1

• head is larger in proportion
• natural sniffing position
• obligate nose breathers - suction mouth first
• Bulb suction, DeLee suction, 10 or 14F catheters
• NG tubes in all intubated neonates

Question 2

Neonatal Period

Answer 2

Birth to 28 Days

Question 3

Meconium

Answer 3

• Sterile
• Deep suction only if the neonate is not vigorous
• Surfactant is inactivated by meconium

Question 4

Isolette

Answer 4

• Device for infants to maintain heat, provide oxygen, and protect from environment
• Infants and peds lose heat quicker due to large surface area:mass

Question 5

Top Neonatal Killers

Answer 5

Top 3 neonatal killers in the first 24 hours are sepsis, respiratory complications, cardiac problems

Question 6

Neonatal Sepsis

Answer 6

• Commonly group B strep
• Occurs in utero - premature rupture of membranes (PROM)
• Treatment: Ampicillin + Gentamycin

Question 7

Infant Seizures

Answer 7

• S/Sx - lip smacking, tongue thrusting, eye fluttering
• Common Causes: hypoglycemia, opioid withdrawal, interventricular hemorrhage

Question 8

Febrile Seizures

Answer 8

• Rate of temp. change more important than overall temp
• Each 1 degree Celsius change > 37C, HR increases 10BPM
• Does not require further workup if cause is known

Question 9

Choanal Atresia

Answer 9

• Congenital disorder where the back of the nasal passage is blocked by abnormal tissue during fetal devlopment
• Likely requires intubation due to obligate nose breathing

Question 10

Respiratory Distress Syndrome (RDS)

Answer 10

• Also called hyaline membrane disease (HMD)
• Surfactant deficiency
• Increased work of breathing, tachypnea
• # 1 killer of premature infants
• Consider use of surfactant when transporting preterm infants

Question 11

Persistent Pulmonary HTN of the Newborn

Answer 11

• Right to left shunt
• Characterized by marked pulmonary HTN that causes hypoxia
• Likely will have a PFO and patent ductus arteriosus
• Consider surfactant administration

Question 12

Omphalocele

Answer 12

• “O” abdominal ring, protrusion of the viscera
• attached to the umbilical cord
• high morbidity
• treat like an evisceration
• requires surgical repair

Question 13

Gastrochesis

Answer 13

• Abdominal contents coming out of the body on ONE SIDE of the umbilical cord
• Treat like an evisceration
• Requires surgical repair
• Less serious than an Omphalocele

Question 14

Ventriculoperitoneal Shunt (VP Shunt)

Answer 14

• Treatment for increased CSF in congenital hydrocephalus
• CSF can build up causing increased ICP
• Intracranial hematoma
• Cerebral edema
• Brainstem herniation
• Often presents with gastric distention, mental status change, decreased LOC, vomiting, seizures
• Rx: mannitol and raise head of bed

Question 15

Shaken Baby Syndrome

Answer 15

Causes Diffuse Axonal Injury

Bulging fontanelles, increased ICP, retinal hemorrhages

Question 16

Neonatal CHF

Answer 16

Evidenced by cardiomegaly and hepatomegaly. Stop IV fluids, administer digitalis.

Question 17

Ventricular Septal Defect (VSD)

Answer 17

Most common cardiac defect in neonates. Hole between the ventricles.

Question 18

Patent Ductus Arteriosus (PDA)

Answer 18

• Should close at birth becoming ligamentum arteriosum
• PGE1 is what keeps the PDA open
• Indocin is the drug of choice for closing a PDA, oxygen will also help close it
• Cyanotic lesions are often PDA dependent
• PDA problems found on physical exam by checking femoral pulses
• If femoral pulses absent, possible coarctation of the aorta

Question 19

Tetralogy of Fallot

Answer 19

• Right to left shunt
• Pulmonary Stenosis
• Aortic Coarctation
• Transposition of the great vessels
• VSD
• Tet spells characterized by sudden cyanosis and syncope
• Treat with knees to chest, morphine, may need RSI if it does not resolve.

Question 20

Umbilical Cord

Answer 20

Normally has 2 arteries, 1 vein. If only has 1 artery and 1 vein, referred to as “single artery cord”, renal system likely to be effected.