Unsettled neonate/infant

Question 1

Causes - neonates

THE MISFITS

Answer 1

T- Trauma - accidental + NAI
H - Heart - congenital/acquired
E - Endocrine - CAH : Low Na, HCO3, Glu, High: K

M - Metabolic - hypoglycaemia
I - Inborn errors of metabolism - Aminoacidopathy
S - Sepsis
F - Formula error - too much/little
I - Intraabdominal catastrophe - intussusception, NEC,Hirschsprung
T- Toxins
S- Seizures

Question 2

Neonatal hypoglycaemia
- Causes
define - BGL <2.6 <48hrs

Answer 2

Prematurity
IUGR
Hypothermia
Sepsis
DM
Macrosomia
Pancreatic dysfunction

Question 3

Neonatal hypoglycaemia
- Ix

Answer 3

Vbg, BSL, Ketones, Insulin, C peptide
Cortisol

Question 4

Neonatal hypoglycaemia
- Mx
Target >4

Answer 4

Oral - milk feed (<1 y.o), Glucose 15g (>1 y.o)
IV 10% dextrose 2-5ml/kg
IM glucagon 0.03-0.1ml/kg

Question 5

Early steps in Neonatal resus

Answer 5

Dry & Wrap
Stimulate
Call Paeds
O2 Monitoring (R hand - preductal)
O2 - 15L NRB or T piece
Access- IV/IO/Umbilical
Fluid bolus - 10-20ml/kg
IV abx - Cefotaxime 50mg/kg, Gent 5mg/kg (or severe benpen 90mg/kg + Cefotaxime)
Check BSL - 2ml/kg 10% dextrose

Question 6

Neonatal Intubation - Equipment

Answer 6

Bag/valve mask/neopuff/anaesthetic circuit
* ETT size 3.5 cuffed (Accept 3 and 4)
* Paed cap/capnography
* Laryngoscope size 1 & 2 miller and/or mc blade
* Ventilator
* Suction catheter
* Oropharyngeal/nasopharyngeal airways
* Stylet/bougie
* LMA (Size 1)

Question 7

Neonatal Intubation - Drugs

Answer 7

3 & 3.5mmETT uncuffed /2.5 & 3.0 if cuffed tube
Suxamethonium: 1-2mg/kg
Midazolam: 0.15 mg/kg
Fentanyl : 2-3 mcg/kg (may cause chest wall rigidity)
Or Ketamine 1-2 mg/kg