SOME ASPECTS IN Neonatal Management

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SOME ASPECTS IN Neonatal Management

• BY
• RUBANA BAABBAD MD
• CONSULTANT NEONATOLOGIST

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Contents

• Resuscitation
• APGAR Score
• Management of Premature Infant
• Management of Infant Diabetic Mother
• Premature vs dysmature

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Delivery Room Resuscitation

• ANTICIPATION RECOGNITION OF NEONATE IN
  DISTRESS
• Primary Apnea due to brief hypoxia
• Recovers with stimulation and oxygen supplement.
• Secondary Apneawith prolonged hypoxia.
• Requires assisted ventilation and oxygen.
• Assume all times that it is secondary and
  resuscitate immediately.

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Goals of Resuscitation

• 1) Minimizing Immediate Heat Loss
• 2) Establishing Normal Respiration and Lung
  Expansion
• 3) Increasing Arterial PO2
• 4) Supporting Adequate Cardiac Output

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STEPS FOR EFFECTIVE RESUSCITATION

• Preparationpediatric 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

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NO PEDIATRIC TEAM REQUIREDPERSONNEL FOR
EVALUATION neonatal conditions unexpected
congenital anomalies,respiatory
distress,unanticipated neonatal
depression.Maternal conditionssigns of
maternal infectionmaternal illness
e.g.DM,isoimmunization,PET,renal,endocrine,
pulmonary,or cardiac disease.
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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,drugsepinephrin(110000),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

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Begin a process of evaluation,decision,and action.

• Place on warm table
• Dry discard the wet linensextra warming
• Positioning
• Suction the mouth, oropharynx, and nares (avoid
  deep pharyngeal suction

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EVALUATIONACTION

• Evaluate for
• color cyanosed ------oxygen
• Respiratory distress signs?
• Indications of bag and mask ventilation apnea,
  HRlt 100
• Rate, press, technique
• indication for intubation, ET size suction
  catheter sizes.

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TUBE SIZE
Wt.of infant ETsize Suction catheter size
lt1000 gm 2.5 5-6 fr
1000 -2000 gm 3 6
2000 3000 gm 3.5 8
gt3000 gm 4 8
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CHEST COMPRESSIONS

• Indications if after 15-30 sec of ve press
  ventilation 100 O2 HRlt60 / 60-80 bpm not ?
• Technique 1 finger breadth below nipple line,
  using 2 fingers compress 1-2 cm 90\ min ratio 31
  cc to vent.

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Medications used for resuscitation

• Indications
• Bradycardia with HR lt 80 BPM despite adequate
  ventilation with 100 O2 and chest compression
  for mini. Of 30 sec or HR0
• Epinephrine
• Volume expanders
• Naloxone hydrochloride
• NaHCO3

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Dosage Chart
Epinephrine 0.10.3 ml/kg 110,000
Volume expander 10 ml/kg NS./albumin,RL./BLD
NaHCO3 2mEq/kg 0.5 mEq/ml
Naloxone Hydrochlori-de 0.1mg/kg 1mg/ml or 0.4 mg/ml
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Special resuscitation efforts

• Meconium present at delivary
• Diaphragmatic hernia

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APGAR SCORE

• DEFINITION an assessment of the newborns
  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 15 min. if lt7 to be repeated
  every 5 min.up to 20 min.

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Apgar scoring system
sign 0 1 2
HR absent lt 100 bpm gt 100bpm
Resp.effort absent Slow/ irregular Good crying
Muscle tone limp Some flexion of the extremities Active motion
Reflex irritability No response grimace Cough/ sneeze
color Blue/pale Pink body,blue extremities All pink
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Definition of dysmaturity

• 1. Characteristic of faulty embryologic
  development, often leading to structural and/or
  functional abnormalities.
• 2. Relating to or characteristic of an infant
  whose birth weight is inappropriately low for its
  gestational age

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Premature vs. Dysmature

• gt 20wks.lt 37 weeks
• Incomplete organ system development
• thin shiny skin,extended arms and legs,little
  subcutanous fat,spase hair few palmar and sole
  creases,poorly developed ear cartilage ,genitalia
  boys few rugae undescended testicles- girls
  gaping labia prominent clitoris

• postmaturity syndrome  a syndrome due to
  placental insufficiency that causes chronic
  stress and hypoxia, seen in fetuses and neonates
  in postterm pregnancies, characterized by
  decreased subcutaneous fat, skin desquamation,
  and long fingernails, often with yellow meconium
  staining of the nails, skin, and vernix.

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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 .

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Problems of prematurity

• Thermoregulation
• Respiratory distress
• Apnea
• Sepsis
• poor sucking swallowing reflex
• Neurologic
• Cvs
• Hematologic
• Nutritional
• Gastrointestinal
• Metabolic
• Renal
• Immunologic
• opthalmologic

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Management of premature infants

• Thermal regulation
• O2 therapy assissted ventilation
• PDA
• Fluid electrolite management
• Nutrition
• Hyperbilirubinemia
• Infection
• immunization

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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.