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Neonatal Emergencies

Neonatal Emergencies. Dr Ruben Bromiker Department of Neonatology Shaare Zedek Medical Center. Neonatal Emergencies. Respiratory Cardiovascular Neurological Metabolic Infectious Gastrointestinal Psychosocial. Unique Characteristics of Newborn Emergencies.

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Neonatal Emergencies

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  1. Neonatal Emergencies Dr Ruben Bromiker Department of Neonatology Shaare Zedek Medical Center

  2. Neonatal Emergencies • Respiratory • Cardiovascular • Neurological • Metabolic • Infectious • Gastrointestinal • Psychosocial

  3. Unique Characteristics of Newborn Emergencies • Transition from fetal to neonatal circulation • Lower oxygen consumption • CNS (especially cerebral cortex) more resistant to hypoxemia • Normal birth is an “asphyxiating process” • Vascular reactivity of pulmonary vessels • Oxygen Dissociation Curve ( p 50 =16-18)

  4. Oxygen Dissociation Curve

  5. Fetal Circulation

  6. Placental-Fetal Circulation

  7. Response to Asphyxia Gasping 1ary Apnea 2ary Apnea Brain Damage I 5 min I 10 min

  8. Biochemical Changes Secondary to Birth Process

  9. Pre and Post Natal Pulmonary Circulation

  10. Neonatal Respiratory Emergencies Persistent Fetal Circulation (PPHN) Pneumothorax Tension vs Non tension Aspiration Meconium Blood Amniotic Fluid

  11. Tension Pneumothorax

  12. Neonatal Cardiovascular Emergencies • Arrhythmia Heart Block ( HR <60-70) SVT • Ductal Dependant Cyanotic Heart Disease (transposition, severe pulmonic stenosis)

  13. Hyperoxia-Hyperventilation Test 100%O2

  14. Supraventricular tachycardia

  15. Neonatal Metabolic/Hematologic Emergencies • Hypoglycemia • Glucose <35 (Maternal diabetes ) • Acidosis pH <7.0 • Unexpected Anemia • Hct < 25-30 (cause Fetal-Mat hem)

  16. Neonatal Gastrointestinal Emergencies • Diaphragmatic Hernia • Esophogeal Atresia • Perforation (ischemic) • Gastric • Small bowel • Intestinal Obstruction • Malrotation-Volvulus

  17. Diaphragmatic Hernia

  18. Neonatal Infectious Emergencies(secondary to maternal “disease”) • Group B streptococcus (Rx ampicillin) • Hepatitis B (Rx Hyperimmune globulin) • Varicella (Rx ZIG)

  19. Neonatal Neurologic Emergencies • Seizures • Intracranial Hemorrhage • Posterior fossa • IVH/PVH • Trauma • Drug withdrawal

  20. Neonatal Psychosocial Emergencies • Maternal Attachment

  21. Neonatal Psychosocial Emergencies • Breast feeding

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