Neonatal Management

Document Sample
Neonatal Management Powered By Docstoc
					 SOME ASPECTS IN
Neonatal Management
             BY:
     RUBANA BAABBAD MD
  CONSULTANT NEONATOLOGIST
            Contents:


Resuscitation
APGAR Score

Management of Premature Infant

Management of Infant Diabetic Mother

Premature vs dysmature
Delivery Room Resuscitation
ANTICIPATION & RECOGNITION OF
NEONATE IN DISTRESS:
Primary Apnea: due to brief hypoxia
Recovers with stimulation and oxygen
supplement.

Secondary Apnea:with prolonged hypoxia.
Requires assisted ventilation and oxygen.
Assume all times that it is secondary and
resuscitate immediately.
Goals of Resuscitation:

1) Minimizing Immediate Heat
Loss
2) Establishing Normal
Respiration and Lung
Expansion
3) Increasing Arterial PO2
4) Supporting Adequate Cardiac
Output
       STEPS FOR EFFECTIVE
          RESUSCITATION
   Preparation:pediatric team should be
    present
    a)identify high risk deliveries : fetal
    distress,fetal disease or serious conditions
    like meconium,prematurity,post- maturity abnormal
    fetal wt.,major anomalies,hydrops,multiple
    gestation, cord prolapse,abruptio placentae.


    Labor &delivery conditions: like
    APH.,abnormal presentation,difficult labor
NO PEDIATRIC TEAM
REQUIRED:PERSONNEL FOR EVALUATION
   neonatal conditions :unexpected
congenital anomalies,respiatory
distress,unanticipated neonatal
depression.

Maternal conditions:
signs of maternal infection
maternal illness
e.g.DM,isoimmunization,PET,renal,
endocrine, pulmonary,or cardiac
disease.
NESSESARY EQUIPMENT
1.    Radiant warmer
2.    Oxygen source
3.    Self inflating bag with reservoir or anesthesia bag
4.    Face mask with appropriate size
5.    Suction
6.    Stethoscope
7.    Emergency box: laryngoscope, batteries ET.
      Tubes,drugs:epinephrin(1:10000),NaHco3 4.2%,
      Naloxon, albumin, and NaCL 0.9%
8.    Umbilical catheterization tray
9.    Syringes, needles, t-connectors, and stopcocks
10.   Transport incubator with batteries
11.   Pulse oximetry
Begin a process of
evaluation,decision,and action.
                                         Place on warm
                                          table
                                         Dry &discard the
                                          wet linens+extra
    evaluation           decision       warming
                                         Positioning
                                         Suction the mouth,
                 action                  oropharynx, and
                                          nares (avoid deep
                                          pharyngeal suction
EVALUATION&ACTION

  Evaluate for:
 color: cyanosed ------oxygen

 Respiratory distress: signs?

 Indications of bag and mask
   ventilation: apnea, HR< 100
 Rate, press, technique

 indication for intubation, ET size &
   suction catheter sizes.
TUBE SIZE

Wt.of infant   ETsize    Suction
                        catheter
                            size
 <1000 gm        2.5       5-6 fr

1000 -2000         3           6
        gm
    2000 –        3.5          8
  3000 gm
 >3000 gm          4           8
CHEST COMPRESSIONS

   Indications: if after 15-30 sec of
    +ve press ventilation 100% O2 &
    HR<60 / 60-80 bpm & not ↑

   Technique : 1 finger breadth
    below nipple line, using 2 fingers
    compress 1-2 cm 90\ min ratio 3:1
    cc to vent.
Medications used for
resuscitation
   Indications:
   Bradycardia with HR < 80 BPM
    despite adequate ventilation with
    100% O2 and chest compression for
    mini. Of 30 sec or HR=0
   Epinephrine
   Volume expanders
   Naloxone hydrochloride
   NaHCO3
Dosage Chart

Epinephrine 0.1~0.3     1:10,000
            ml/kg
Volume      10 ml/kg    NS./albumin
expander                ,RL./BLD
NaHCO3      2mEq/kg     0.5 mEq/ml


Naloxone     0.1mg/kg     1mg/ml or
Hydrochlori-              0.4 mg/ml
de
Special resuscitation efforts

   Meconium present at delivary




   Diaphragmatic hernia
APGAR SCORE

   DEFINITION: an assessment of the
    newborn’s physical condition
    immediately after birth ; involve
    HR,respiratory effort,color, muscle
    tone & reflex.
   Devised in 1952 by VERGINIA
    APGAR the American anasthatologist
   The score range from 1-10
   Calculated at 1&5 min. & if <7 to be
    repeated every 5 min.up to 20 min.
Apgar scoring system
         sign            0              1            2

          HR        absent    < 100 bpm      > 100bpm

 Resp.effort        absent          Slow/ Good crying
                                irregular
Muscle tone            limp         Some       Active
                                flexion of     motion
                                      the
                              extremities
       Reflex           No       grimace       Cough/
   irritability   response                     sneeze
        color     Blue/pale          Pink      All pink
                                body,blue
                               extremities
   Definition of dysmaturity

1. Characteristic of faulty embryologic
    development, often leading to structura
    and/or functional abnormalities.

2. Relating to or characteristic of an infant
    whose birth weight is inappropriately lo
    for its gestational age
Premature vs. Dysmature
   > 20wks.&< 37 weeks         postmaturity
   Incomplete organ             syndrome: a
    system development           syndrome due to
   thin shiny                   placental insufficiency
    skin,extended arms           that causes chronic
    and legs,little              stress and hypoxia,
    subcutanous fat,spase        seen in fetuses and
    hair few palmar and          neonates in postterm
    sole creases,poorly          pregnancies,
    developed ear                characterized by
    cartilage ,genitalia         decreased
    boys few rugae               subcutaneous fat, skin
    undescended testicles-       desquamation, and
    girls gaping labia           long fingernails, often
    prominent clitoris           with yellow meconium
                                 staining of the nails,
                                 skin, and vernix.
    The Premature infant

   The premature infant is quickly
    transferred from the warm fluid
    medium of the liquor amnii with its
    practically constant temperature
    to the variable circumstances of
    an extrauterine life; he/she loses
    the preparatory transition-time of
    the third trimester of intrauterine
    existence .
Problems of prematurity
   Thermoregulation
   Respiratory distress
   Apnea
   Sepsis
    poor sucking& swallowing reflex
   Neurologic
   Cvs
   Hematologic
   Nutritional
   Gastrointestinal
   Metabolic
   Renal
   Immunologic
   opthalmologic
Management of premature
infants
   Thermal regulation
   O2 therapy & assissted ventilation
   PDA
   Fluid& electrolite management
   Nutrition
   Hyperbilirubinemia
   Infection
   immunization
Management of infants of
diabetic mothers
   Evaluation: before delivery : size,
    pulmonary maturity, obvious
    anomalies
   After delivery: Apgar score, physical
    examination for major congenital
    anomalies
   In the nursery: continuous evaluation
    repeat the examination, monitor blood
    glucose, hematocrit, calcium &
    bilirubin levels.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:16
posted:7/27/2012
language:
pages:22