neonatal emergencies dr ruben bromiker department of neonatology shaare zedek medical center
TRANSCRIPT
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
• 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
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.)
Response to Asphyxia1ary Apnea 2ary ApneaGasping
I10 min
I5 min
Brain Damage
Biochemical Changes Secondary to Birth Process
stage pH pO2 pC02 BE lactate
Fetus Prior to labor
7.37 25-40 40 -2 1.5
End of
labor
7.25 0-20 55 -5 2.4
Neonate 10m post birth
7.30 50 40 -10 4.0
1 hr post
birth
7.35 70 35 -5 2.0
Pre and Post Natal Pulmonary Circulation
Neonatal Respiratory Emergencies
Persistent Fetal Circulation (PPHN)
PneumothoraxTension vs Non tension
AspirationMeconium
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%O100%O22
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