Neonatal Emergencies Flashcards
Neonatal Airway Considerations
- 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
Neonatal Period
Birth to 28 Days
Meconium
- Sterile
- Deep suction only if the neonate is not vigorous
- Surfactant is inactivated by meconium
Isolette
- Device for infants to maintain heat, provide oxygen, and protect from environment
- Infants and peds lose heat quicker due to large surface area:mass
Top Neonatal Killers
Top 3 neonatal killers in the first 24 hours are sepsis, respiratory complications, cardiac problems
Neonatal Sepsis
- Commonly group B strep
- Occurs in utero - premature rupture of membranes (PROM)
- Treatment: Ampicillin + Gentamycin
Infant Seizures
- S/Sx - lip smacking, tongue thrusting, eye fluttering
- Common Causes: hypoglycemia, opioid withdrawal, interventricular hemorrhage
Febrile Seizures
- 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
Choanal Atresia
- 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
Respiratory Distress Syndrome (RDS)
- 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
Persistent Pulmonary HTN of the Newborn
- Right to left shunt
- Characterized by marked pulmonary HTN that causes hypoxia
- Likely will have a PFO and patent ductus arteriosus
- Consider surfactant administration
Omphalocele
- “O” abdominal ring, protrusion of the viscera
- attached to the umbilical cord
- high morbidity
- treat like an evisceration
- requires surgical repair
Gastrochesis
- 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
Ventriculoperitoneal Shunt (VP Shunt)
- 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
Shaken Baby Syndrome
Causes Diffuse Axonal Injury
Bulging fontanelles, increased ICP, retinal hemorrhages
Neonatal CHF
Evidenced by cardiomegaly and hepatomegaly. Stop IV fluids, administer digitalis.
Ventricular Septal Defect (VSD)
Most common cardiac defect in neonates. Hole between the ventricles.
Patent Ductus Arteriosus (PDA)
- 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
Tetralogy of Fallot
- 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.
Umbilical Cord
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.
