Neonatal Emergencies

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Neonatal Emergencies

• Marvin S. Cohen MD
• UTMB

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Human Misery The Harvest Woman

• Paul Gauguin
• 1889

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TRACHEO-ESOPHAGEAL FISTULA (TEF)

• 1 in 3000 births
• VATER
• Vertebral/ (VSD)
• Anus- imperforate
• Tracheoesophageal Fistula
• Esophageal Atresia
• Radial and Renal

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TEFsymptoms

• Excessive secretions
• Inability to pass feeding tube
• Polyhydramnios
• Presence of air in bowel on KUB
• Respiratory distress and recurrent aspiration

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TEF

• Positive pressure ventilation after stomach has
  been vented or very judiciously
• Place ET tube below fistula and above carina and
  tape securely
• Beware of dehydration and aspiration
• Extubation only if baby is very stable

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A Neonatal Emergency
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Congenital Diaphragmatic Hernia CDH

• 1 5000 births 25 have cardiac abnormalities
• Ipsilateral lung hypoplasia
• Diaphragmatic defect Bochdalek left or foramen of
  Morgagni
• Bowel sounds in chest
• Pulmonary Hypertension

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Congenital Diaphragmatic Hernia

• Large intraoperative fluid losses
• Pneumothorax on contra lateral side is frequent
  due to barotrauma rapid low tidal volume
  ventilation
• Avoid N2O
• Outcome depends on underlying lung maturation

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PATENT DUCTUS ARTERIOSUS PDA
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PATENT DUCTUS ARTERIOSUS PDA

• Usually left to right shunt -gt CHF but reduced
  systemic blood volume due to Rx
• Problem of prematurity
• Preductal SaO2 Right Upper Extremity
• Hoarseness is complication of Rt. recurrent
  laryngeal nerve damage.
• Chylothorax due to injury to thoracic duct

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Omphalocele
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Omphalocele

• Early in utero - 10th week
• Covering membrane
• High frequency of other defects

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Gastroschisis
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Gastroschisis
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Gastroschisis

• No membrane
• High fluid loss
• Defect in abdominal wall probably ischemic

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Omphalocele and Gastroschisis

• Hypothermia
• Fluid shifts
• Blood loss
• Acidosis
• Hypotension Hypovolemia

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Omphalocele and Gastroschisis

• Awake intubation vs. rapid sequence
• Good IV access a must. Large volumes required
• Increased intra abdominal pressure leads to
  respiratory compromise, poor organ perfusion can
  be expected on abdominal closure
• Good paralysis a necessity
• Baby to remain intubated

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A 2nd Neonatal Emergency
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NECROTIZING ENTEROCOLITIS (NEC)

• 5 15 of babies. Usually lt1500 gm
• Mortality up to 50
• Presenting as sepsis and acidosis
• Huge amounts of fluids (Albumin) because of
  massive third space losses and blood are needed
• Beware of hypothermia
• Get out of dodge quick!

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Pyloric Stenosis

• 3rd to 4th week of life male gt female
• Projectile vomiting without bile
• Medical not surgical emergency.
• Hypo-Na, Hypo-Cl ,Hypo-K -metabolic alkalosis
• Severe dehydration can cause metabolic acidosis

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Pyloric Stenosis

• After medical stabilization
• Good urine output 1 2 ml/kg/hr
• Normal electrolytes
• Awake or rapid sequence intubation
• Empty stomach first
• Short procedure
• Mivacron/rocuronium

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Meningo-Myelocoele
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Meningo-Myelocoele

• Position with a donut ring in supine position
  for intubation. Lateral position may be
  necessary.
• Accompanying hydrocephalus due to Arnold Chiari
  malformation
• CSF losses need to be replaced with NS
• Blood loss may be large

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The End