The Sick Kid

Question 1

Clinical indications for neonate distress

Answer 1

Decreased tone
Poor response to stimulation - weak cry
Respiratory distress recession, persistent expiratory grunting
Tachypnoea >60
HR <100
Extreme pallor
Urine output < 4 x wet nappies in 24hrs
Full sepsis evaluation should be considered with any neonate with a temp >38

Question 2

Principles of neonate resuscitation

Answer 2

A- supine, neutral head
B- if not breathing effectively and HR <100, poor muscle tone commence positive pressure ventilation at rate 40-60 per minute. Aim inspiratory time 0.3-0.5 seconds
Count- breathe-2-3-breath
Commence PPV in air (21%) initially in term infants
Apply pulse oximeter to R) hand
Titrate o2 according to pulse oximeter - wean o2 when Sats above 90%
C- if HR is below 60/min chest compressions and positive pressure ventilation at a ratio of 3:1 - increase FiO2 100%
Reassess after 30 secs
When Hr is above 60 cease chest compressions- continue PPV
If below <60 advance resus interventions

Question 3

Initial assessment of neonate

Answer 3

Tone
Breathing
HR

Question 4

Aim of ventilation in newborns

Answer 4

Clear lung liquid
Establish lung aeration
Enable gas exchange

Question 5

Effectiveness of ventilation is confirmed by observing 3 things

Answer 5

Increase in HR >100
Slight rise of the chest and abdo with each inflation
Oxygenation improves

Question 6

Clinical manifestations of sepsis in neonates

Answer 6

Early onset: first 48hrs post birth
Late onset: after 48 hrs
Pallor, lethargy, fever, temperature instability,
hypoglycaemia
Poor tone
Little crying
Mottled skin
Poor cap refill
Tachypnoea