Special Considerations Flashcards
What is used for pneumothoraces?
18 or 20 gauge pretty tedious catheter-over-needle device perpendicular at mid clavic ic 2 space.
Then remove the needle from The catheter, and catheter connects to a 3-way stopcock is connected to a 20 mL syringe
If appropriate gauge percutaneous catheter not available, 19 – or 21 – gauge butterfly needle maybe used. In this case, the stopcock can be connected directly to the tubing of the butterfly needle to be careful not to punctured the long
How to approach babies with diaphragmatic hernia?
Intubate the trachea expeditiously instead of prolonged resuscitation with PPV by mask. Place a large orogastric catheter 10F to evacuate the stomach contents… A double lumen sump tube (replogle tube) is best
What is neonatal narcan concentration? dosing?
1.0-mg /mL solution. 0.1 mg / kg. Consider if baby not adequately ventilating Despite PPV and mom used in past 4 hours.
Beware of w/ d seizure induction!
Complications of prolonged resusc?
Pulmonary htn- persistent pulmonary hypertension of the newborn, usually > or = 34 wks.
Pna/ lung comps - due to aspiration or congenital infection; pneumothx
Metabolic acidosis- sodium bicarb meet increase serum pH but can worsen intracellular acidosis. Therefore you must have adequately ventilated lungs in order to administer
Hypotension
Renal failure from acute tubular necrosis due to perinatal compromise. Look at urine. Subsequent fluid shifts and lyte derangement a can occur.
Seizures - think hypoxic-ischemic encephalopathy (HIE) or metabolic
Apnea- think HIE
Hypoglycaemia- due to metabolism under conditions of oxygen deprivation which use more glucose. Initial catecholamine surge causes higher glucose levels but shortly could go stores from glycogen or depleted. Can lead to neurologic dysfunction because brain requires glucose.
Feeding problems- can lead to alias, gastrointestinal bleeding, and even necrotizing enterocolitis.
Neurologic dysfunction SQL he can include sucking patterns and coordination of sucking, swallowing, and breathing taking several days to become normal.
Temp management- don’t overheat! Cold damage as well. But therapeutic hypothermia instituted after resuscitation has improved neurologic outcomes in some late preterm and term babies with moderate to severe hypoxic ischemic encephalopathy.
What are requirements for therapeutic hypothermia?
1) just stational age greater than or equal to 36 weeks
2) evidence of acute perinatal hypoxic ischemic event.
3) ability to initiate hypothermia within six hours after birth. Period
This require special equipment.
Approach to pharyngeal airway malformation (Robin syndrome)
What is first action? Second?
First should be to turn the baby onto stomach (prone).
This will let the tongue fall forward.
If not successful, achieve their way through inserting a large catheter (12F) or small endotracheal tube (2.5 mm) through the nose, with the tip located deep in the posterior your pharynx, past the base of the tongue but not into the trachea.
These are preferred because intubation is difficult in this population.
Last line is LMA
What are ventilating considerations for the very premature baby?
Consider CPAP at 5-6 cm h2o if sport breathing.
PPV is required, use the lowest inflation pressure necessary to achieve an adequate response.
If the baby has been into beaded, use PEEP generally at 2 to 5 cm H2O is sufficient.
Consider giving surfactant if the baby is significantly preterm. Babies should be fully resuscitated before surfactant is given.
What are ways to decrease the chances of neurologic injury and preterm newborn?
Before 32 weeks just station, premature babies have a fragile network of capillaries in an area of the brain called the germinal matrix. Rupture can be caused by rapid changes in blood pressure, CO2 levels, volume of blood and brain, and obstruction of the venous drainage from the head.
Handle baby gently.
Avoid placing baby in a head down (Trendelenburg) position
Avoid delivering excessive PPv or CPAP…can increase the pressure leading to pneumothorax or can obstruct venous return from head.
Use a exhibitor and blood gases to adjust ventilation and oxygen concentration gradually and appropriately.
Do not give rapid infusions of fluid.
Any other special precautions?
Monitor blood glucose do to lower glycogen stores.
use polyethylene wrap for those less than 29 weeks.
Monitor baby for apnea and bradycardia. Respiratory control is often unstable.
Give appropriate amount of oxygen and ventilation.
Initiate feedings slowly and cautiously while you maintain nutrition intravenously. They may have Bal ischemia and are at risk for early feeding intolerance and later problems with malfunction such as necrotizing enterocolitis. Best approaches IV nutrition drink first few days and initiating feeds cautiously with expressed breastmilk
Increase suspicion for infection. Chorioamnionitis could’ve been the cause of premature labor. Fetal infection may be cause of perinatal asphyxia
Draw blood cultures and administer antibiotics therapy promptly after birth if any chance baby could be infected..
