Neonatology
Resus
HIE
Birth injuries
Prematurity complications
Hypotonia
Respiratory distress
Shock/cyanosis
Jaundice
Changes
Circulatory
- Opening of airways and fall in pulmonary resistance
- Increased pulmonary venous return closing FO
- Increase ppO2 closing DA
- Cutting umbilical cord to increase systemic resistance
Physiological jaundice: breakdown fHb and liver & kidneys taking over placenta.
Apparent on D2-3, peaks D5-7, fades by D10.
Pre-term peak may be later and resolve over more time.
Newborn liver has low conjugating ability (UGT) increased unconjugated bilirubin.
Dehydration (breast milk problems) can make worse as reduced output via urine.
, Resuscitation
Birth: dry baby, remove wet towels, cover and start clock.
Hypothermia can lower O2, increase metabolic acidosis, lead to hypoglycaemia and
inhibit surfactant production.
Within 30s: assess tone, breathing (40-60), heart rate (120-150)
Within 60s: if not breathing neutral position, 5 inflation breaths
Start SpO2 +/- ECG
?Suction of meconium in liqour
Reassess: if no increase in HR look for chest movement
If not moving: repeat inflation
If moving: if HR slow (<60), give compressions (100/min) with 3 compressions to
each breath
Drugs: give via umbilical venous catheter, IO or ETT
Bicarbonate, Adrenaline, Dextrose
Once stable, move to NICU and consider ventilation +/- abx (especially if PPROM).
If uncompromised delayed cord clamping for 1 minute
If meconium stained assess before suction (don’t do blind suction)
If preterm plastic wrap, heater, less air pressure
Shock
Signs
Weak & fast pulse 180bpm+
Capillary refill 3s+
Extremities cold
Provide warmth, ABC (neutral position, start O2 if <90%, correct hypoglycaemia).
Establish IV access and give normal saline 20ml/kg over 1 hour (10 min + Vit K if
bleeding)
Treat for sepsis
Hypovolemic – dehydration (poor feeding/sunken fontanelle), bleeding (birth trauma)
Septic – Sepsis (GBS, HSV, may have had PROM/chorioamnioitis)
Cardiogenic - SVT, hypoplastic left heart, severe aortic coarctation (murmurs, delayed
femoral pulse)
Lung – congenital diaphragmatic hernia
Metabolic – propionic acidaemia, methylmalonic acidaemia
Endocrine - panhypopituitarism
,
Resus
HIE
Birth injuries
Prematurity complications
Hypotonia
Respiratory distress
Shock/cyanosis
Jaundice
Changes
Circulatory
- Opening of airways and fall in pulmonary resistance
- Increased pulmonary venous return closing FO
- Increase ppO2 closing DA
- Cutting umbilical cord to increase systemic resistance
Physiological jaundice: breakdown fHb and liver & kidneys taking over placenta.
Apparent on D2-3, peaks D5-7, fades by D10.
Pre-term peak may be later and resolve over more time.
Newborn liver has low conjugating ability (UGT) increased unconjugated bilirubin.
Dehydration (breast milk problems) can make worse as reduced output via urine.
, Resuscitation
Birth: dry baby, remove wet towels, cover and start clock.
Hypothermia can lower O2, increase metabolic acidosis, lead to hypoglycaemia and
inhibit surfactant production.
Within 30s: assess tone, breathing (40-60), heart rate (120-150)
Within 60s: if not breathing neutral position, 5 inflation breaths
Start SpO2 +/- ECG
?Suction of meconium in liqour
Reassess: if no increase in HR look for chest movement
If not moving: repeat inflation
If moving: if HR slow (<60), give compressions (100/min) with 3 compressions to
each breath
Drugs: give via umbilical venous catheter, IO or ETT
Bicarbonate, Adrenaline, Dextrose
Once stable, move to NICU and consider ventilation +/- abx (especially if PPROM).
If uncompromised delayed cord clamping for 1 minute
If meconium stained assess before suction (don’t do blind suction)
If preterm plastic wrap, heater, less air pressure
Shock
Signs
Weak & fast pulse 180bpm+
Capillary refill 3s+
Extremities cold
Provide warmth, ABC (neutral position, start O2 if <90%, correct hypoglycaemia).
Establish IV access and give normal saline 20ml/kg over 1 hour (10 min + Vit K if
bleeding)
Treat for sepsis
Hypovolemic – dehydration (poor feeding/sunken fontanelle), bleeding (birth trauma)
Septic – Sepsis (GBS, HSV, may have had PROM/chorioamnioitis)
Cardiogenic - SVT, hypoplastic left heart, severe aortic coarctation (murmurs, delayed
femoral pulse)
Lung – congenital diaphragmatic hernia
Metabolic – propionic acidaemia, methylmalonic acidaemia
Endocrine - panhypopituitarism
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