SOME ASPECTS IN Neonatal Management

1. SOME ASPECTS IN Neonatal Management BY: RUBANA BAABBAD MD CONSULTANT NEONATOLOGIST

2. Contents: Resuscitation APGAR Score Management of Premature Infant Management of Infant Diabetic Mother Premature vs dysmature

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

4. Goals of Resuscitation: 1) Minimizing Immediate Heat Loss 2) Establishing Normal Respiration and Lung Expansion 3) Increasing Arterial PO2 4) Supporting Adequate Cardiac Output

5. STEPS FOR EFFECTIVE RESUSCITATION • Preparation:pediatric team should be present a)identify high risk deliveries : fetal distress,fetal disease or serious conditions likemeconium,prematurity,post- maturity abnormal fetal wt.,major anomalies,hydrops,multiple gestation, cord prolapse,abruptio placentae. Labor &delivery conditions: like APH.,abnormal presentation,difficult labor

6. NO PEDIATRIC TEAM REQUIRED:PERSONNEL FOR EVALUATIONneonatal conditions :unexpected congenital anomalies,respiatory distress,unanticipated neonatal depression.Maternal conditions:signs of maternal infectionmaternal illness e.g.DM,isoimmunization,PET,renal,endocrine, pulmonary,or cardiac disease.

7. NESSESARY EQUIPMENT • Radiant warmer • Oxygen source • Self inflating bag with reservoir or anesthesia bag • Face mask with appropriate size • Suction • Stethoscope • Emergency box: laryngoscope, batteries ET. Tubes,drugs:epinephrin(1:10000),NaHco3 4.2%, Naloxon, albumin, and NaCL 0.9% • Umbilical catheterization tray • Syringes, needles, t-connectors, and stopcocks • Transport incubator with batteries • Pulse oximetry

8. Begin a process of evaluation,decision,and action. • Place on warm table • Dry &discard the wet linens+extra warming • Positioning • Suction the mouth, oropharynx, and nares (avoid deep pharyngeal suction

9. EVALUATION&ACTION • Evaluate for: • color: cyanosed ------oxygen • Respiratory distress: signs? • Indications of bag and mask ventilation: apnea, HR< 100 • Rate, press, technique indication for intubation, ET size & suction catheter sizes.

10. TUBE SIZE

11. CHEST COMPRESSIONS • Indications: if after 15-30 sec of +ve press ventilation 100% O2 & HR<60 / 60-80 bpm & not ↑ • Technique : 1 finger breadth below nipple line, using 2 fingers compress 1-2 cm 90\ min ratio 3:1 cc to vent.

12. Medications used for resuscitation • Indications: • Bradycardia with HR < 80 BPM despite adequate ventilation with 100% O2 and chest compression for mini. Of 30 sec or HR=0 • Epinephrine • Volume expanders • Naloxone hydrochloride • NaHCO3

13. Dosage Chart

14. Special resuscitation efforts • Meconium present at delivary • Diaphragmatic hernia

15. APGAR SCORE • DEFINITION: an assessment of the newborn’s 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 1&5 min. & if <7 to be repeated every 5 min.up to 20 min.

16. Apgar scoring system

17. 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

18. > 20wks.&< 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. Premature vs. Dysmature

19. 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 .

20. Problems of prematurity • Thermoregulation • Respiratory distress • Apnea • Sepsis • poor sucking& swallowing reflex • Neurologic • Cvs • Hematologic • Nutritional • Gastrointestinal • Metabolic • Renal • Immunologic • opthalmologic

21. Management of premature infants • Thermal regulation • O2 therapy & assissted ventilation • PDA • Fluid& electrolite management • Nutrition • Hyperbilirubinemia • Infection • immunization

22. 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.