Download Neonatal Emergencies

Neonatal Emergencies
Dr Ruben Bromiker
Department of Neonatology
Shaare Zedek Medical Center
Neonatal Emergencies
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Respiratory
Cardiovascular
Neurological
Metabolic
Infectious
Gastrointestinal
Psychosocial
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)
Oxygen Dissociation Curve
Fetal
Circulation
Placental-Fetal Circulation
Response to Asphyxia
1ary Apnea
Gasping
I
5 min
Figure 3. Primary apnea is responsive to tactile stimulation; however, secondary apnea does not. Primary
apnea may occur in utero, thus apnea present after birth may be either primary or secondary. Because it is
clinically difficult to distinguish between the two in the delivery room, positive-pressure ventilation is
indicated if brief stimulation does not result in spontaneous respirations. (Kattwinkel J (ed). Textbook of
Neonatal Resuscitation, 4th Edition. American Heart Association, American Academy of Pediatrics. Elk Grove
Village, IL. 2000, p. 1-7. Copyright American Academy of Pediatrics. Used with permission.)
2ary Apnea
Brain Damage
I
10 min
Biochemical Changes
Secondary to Birth Process
Fetus
Neonate
stage
pH
pO2
Prior to
labor
7.37
End of
labor
10m post
birth
1 hr post
birth
pC02
BE
lactate
25-40 40
-2
1.5
7.25
0-20
55
-5
2.4
7.30
50
40
-10
4.0
7.35
70
35
-5
2.0
Pre and Post Natal Pulmonary Circulation
Neonatal Respiratory
Emergencies
Persistent Fetal Circulation (PPHN)
Pneumothorax
Tension vs Non tension
Aspiration
Meconium
Blood
Amniotic Fluid
Tension Pneumothorax
Neonatal Cardiovascular
Emergencies
• Arrhythmia Heart Block ( HR <60-70)
SVT
• Ductal Dependant Cyanotic Heart
Disease (transposition,
severe pulmonic stenosis)
Hyperoxia-Hyperventilation Test
100%O2
Supraventricular tachycardia
Neonatal
Metabolic/Hematologic
Emergencies
• Hypoglycemia
– Glucose <35 (Maternal diabetes )
• Acidosis pH <7.0
• Unexpected Anemia
– Hct < 25-30 (cause Fetal-Mat hem)
Neonatal Gastrointestinal
Emergencies
• Diaphragmatic Hernia
• Esophogeal Atresia
• Perforation (ischemic)
– Gastric
– Small bowel
• Intestinal Obstruction
• Malrotation-Volvulus
Diaphragmatic Hernia
Neonatal Infectious Emergencies
(secondary to maternal “disease”)
• Group B streptococcus (Rx ampicillin)
• Hepatitis B (Rx Hyperimmune globulin)
• Varicella (Rx ZIG)
Neonatal Neurologic
Emergencies
• Seizures
• Intracranial Hemorrhage
– Posterior fossa
– IVH/PVH
• Trauma
• Drug withdrawal
Neonatal Psychosocial
Emergencies
• Maternal
Attachment
Neonatal Psychosocial
Emergencies
• Breast
feeding