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Critical Neonate

Critical Neonate. Rafat Mosalli MD. Objectives. Describe the algorithm for neonatal resuscitation and Delivery room management Approach to a infant with Respiratory distress Describe the etiology and effect of birth asphyxia Describe common birth injuries. Case 1 Scenario.

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Critical Neonate

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  1. Critical Neonate Rafat Mosalli MD

  2. Objectives • Describe the algorithm for neonatal resuscitation and Delivery room management • Approach to a infant with Respiratory distress • Describe the etiology and effect of birth asphyxia • Describe common birth injuries

  3. Case 1 Scenario • You are called to attend the delivery of a baby who is not born yet. • What should you do first

  4. Delivery Room Care: Resuscitation Detailed maternal hx, GA Preparation ( equipments and personals)

  5. Case 1 • Baby is 35 weeks delivered now, breathing fast ,irregular, Nasal flaring,blue in color and intercostal Retractions? • how you would approach this newborn? • What is your DD?

  6. Case 1:ABCD first • APGAR SCORE • Resuscitation (NRP) • ABCD • Postnatal resuscitation.

  7. (Or 21%-100%)

  8. Differential Diagnosis • RDS • TTN • Infection • MA

  9. Respiratory Distress Syndrome (RDS) • Surfactant Production? • Complications

  10. Risk Factors • Premature babies • Previous baby with RDS • Maternal diabetes • Hypothermia • Fetal Distress Asphyxia • Male sex • Caucasian race • Second twin • C/S with out labor

  11. Signs of Respiratory Distress • Grunting • Tachypnea (RR >60/m) • Nasal flaring, chest indrawing

  12. Apnea • Obstructive Apnea:No air flow but the chest wall movements continue • Central Apnea: Complete cessation of airflow and respiratory airflow and respiratory efforts with no chest wall movement • Mixed Apnea (Is the most frequent type)

  13. Cyanosis • Deoxygenated hemoglobin is 5 g/dl • Types? • ACROCYANOSIS: blue color of the hands and feet with pink color of the rest of the body, common in delivery room and is usually NORMAL

  14. Other Routine Delivery Room Care • Erythromycin eye drops? • Vitamin K IM?

  15. Case 2 • You are called to attend a delivery for baby with Meconuim liquor? • What you do first?

  16. Meconium/Suction Meconium in Amniotic Fluid Infant Active Infant Depressed Absent or decreased respirations, decreased muscle tone OR HR <100 bpm Observe No stimulation intubate and Suction Trachea Resuscitate PRN

  17. Depressed Meconium baby

  18. MAS

  19. MAS • Radiological appearance: 1-overexpanded lungs. 2-coarse air space infiltrates. 3-Wide spread consolidation. 4-+/-airleakage.

  20. MAS and HIE ! • The baby is born now and he is flat with Apgar score of ZERO? • How do you proceed?

  21. Meconium Aspiration Syndrome Complications: • Severe Resp. failure • HIE • PPHN(persistent pulmonary hypertension) • Pulmonary air leak

  22. Effect Of Asphyxia(HIE) • CNS • CVS • Pulmonary • Renal • Adrenal • GIT • Metabolic • Hematology

  23. Treatment • Resuscitation • Post resuscitation:  Depend on severity(stage3 is the worst) • Fluids restrictions • O2 and ventilation • Inotrops • Anti seizure medication

  24. Primary Pulmonary Hypertension of the Newborn (PPHN) • Severe hypoxemia, with out evidence of parenchymal lung or structural heart disease that also may cause right to left shunting. • Often seen in term or post-term infants who are asphyxiated or meconium stained fluid

  25. Case2 • You are called to assess the same baby with MAS because of worsning respiartory status and sudden desaturation ,bradycardia and hypotension? • What is your approach?

  26. Treatment

  27. Other Pulmonary Air Leaks • Pulmonary Interstitial Emphysema (PIE) • Pneumomediastinum • Subcutaneous Emphysema • Pneumopericardium

  28. Pneumonia

  29. Pneumonia • Early Vs Late. • Diagnosis is impossible from XR alone. • frank lobar consolidation as seen in adults and older children is rare • More commonly, there is coarse opacity of one or more regions of the lung parenchyma

  30. Transient Tachypnoea of the Newborn • Typically, respiratory symptoms resolve within the first 24-hours of life, but occasionally can persist longer. Typical radiologic features: • Increased central vascular markings Hyperaeration • Evidence of interstitial and pleural fluid • Prominent interlobar fissures

  31. We Talked about! • Algorithm for neonatal resuscitation and Delivery room management • Approach & DD of an infant with Respiratory distress • Effect of MAS and birth asphyxia

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