Neonatal

• Resus
• Seizzure
• Apnoea
• Sepsis
• Bleeding
Case 1

Tell me D.Ds for Apnoea in new born?

Absent breathing

Respi
1. Miconium aspiration
2. T - Oeaso fistular
Cardiac
1. TGA
2. TOF
3. Tricuspid atrexia
GI
1. Hiatus hernia

Pt brings a neonate with Apnoea

What will you do
=pt unstable
?i would put neonate on emergency bed
And assess TTCC

• Tone
• Term
• Cry
• Colour
= No cry / shallow breathing
Term baby
Tone reduced
Colour pale
?i will call for help and Start counting
Keep baby's head in neutral possition
Then keep pt Warm( room temperature )
Keep pt dry
Suckout secretions
And stimulate by rubbing the back of the chest

After 30 seconds
Then i would connect pt to pulse O2
Connect to monitor if neonatal size of BP cufd , probs available
Give PPV
ECG leads connect and monitor

If still after 1 minute

If HR < 100

Insert oropharyngeal tube

And start bag valve mask veltilation

• Mask should not cover eyes or chin

• Give 3: 1chest compressions
• Chest compressions - encircle chest by two hands and compress by
thumbs the lower sternum depth is 1/3 of chest)

• Rate is 90 chest compressions / min

Ask about Brief Hx
 • Term
Check after 1minute

• If HR <60 consider
• Andrenalin 0.01mg stat
• Or Hypovolumia ( correct by 10ml/kg bolus over 20min)
• Of CXR to exclude penumothorax
• Consider antibiotics too
After 20mins of resus still no spontanous breathing / still HR <60 stop resus.

Case 2

Tell me the causes for N.seizzure ?

2. Hypoxia
3. Hypoglycemia
4. N.sepsis or meningitis
5. Birth injuries to brain
6. Intracranila haemorrhage spontanous

Pt brings neonate with seizzure

Unstable
?i would keep pt on emergency bed and call for help
Then i would assess
Pt
 • Tone - yrrr... tonic clonic moments 😕 how to assess
• Term yes
• Cry - what a silly Q ti ask from a fitting newborn 🤬🤬
• Colour - pale
• Keep neonate head in neutral possition
• Suck out secretions
• Dry
• Warm
• Connect to Pulse O2 meter and cardiac monitor
• Give 100% O2 via a
• Start timing ask from the mother how long?

Assess breathing

C - insert a umbilical venous catheter

Take blood for

• CFC , CRP
• BS
Hypoglycemia
(<40mg/dl)
Give 10% Dextrose 2ml/kg

• Ca
 • Hypocalcemia
Give 10% ca gluconate 2ml/kg IV slow while caediac monitor

• ABG
• Blood culture
If it is not jitteriness ( physiological )

• No abnormal eye moments

• Cease jitteriness which apply passive flexion
• Stimulus sensitive
• Not jerky
Take bried Hx
1. FHx
2. Maternal Hx DM
Medications
Hyper parathyroid
Antenatal infection
Forcep delivery
APGAR
Brief Ex

• N reflexes
1. Pupil
2. Retinal haemorrhage
3. Scalp injuries
4. Rashes
5. AF
6. Hepatosplenomegaly ( TORCH)

Give Iv Phenobarbitol 20mg/kg over 20mins ( fit more than

5min)
Call N ICU anasthesiologist

5mins

Repeat IV Phenobarbitol 10mg/kg/dose ( max 40)

If anesthesia late
Give IV Phenytoin 20mg/kg/dose
Contact Neonatal consultant
Transver