Neonatal emergencies

Dr. Miada Mahmoud Rady

Hypoglycemia in newborn

• Definition : blood glucose level of less than 45 mg/dL in

full-term or preterm newborns.

• It result from imbalance between glucose supply and

utilization due to :

1. Inadequate intake or storage.

2. Increased glucose utilization.

Etiology • Disorders related to

decreased glycogen

stores:

1. Small for gestational age

2. Prematurity

3. Postmaturity

• Increased use of glucose

• Newborn of a diabetic

mother:

1. Large for gestational age

2. Hypoxia

3. Hyperthermia

4. Sepsis

Clinical presentation

• Most newborns are asymptomatic until glucose level

falls below 20 mg/dL., then it may result in seizures.

Any case of seizers in newborn glucose test is

crucial.

Clinical presentation

Nonspecific :

1. Poor sucking or feeding.

2. Irritability

3. Irregular respiration.

4. Cyanosis

5. Apnea

6. Eye rolling

Specific:

1. Vomiting.

2. Twitching

3. Tremers

4. Tachycardia

5. Tachypnea

6. Seizers

7. Coma

Assessment

1. Obtain baseline vital signs and oxygen saturation readings.

2. Provide as necessary ( Additional oxygen ,Assisted ventilation ,

Blood pressure support and IV access

3. If the blood glucose level is less than 40 mg/dL:

• An IV bolus of 10% dextrose solution (2 mL/kg) can be given.

• Recheck blood glucose level in about 30 minutes.

• Dextrose IV administration may need to be followed by a 10%

dextrose infusion at 60 to 100 mL/kg/d.

Diaphragmatic hernia

• Definition : An abnormal opening in the diaphragm that

causes herniaition of the abdominal contents into chest

cavity.

• Mortality may be as high as 50%.

• Causes the heart and mediastinum to shift to the

contralateral side of the hernia

Signs and Symptoms

1. Respiratory distress.

2. Heart sounds shifted to the right.

3. Decreased breath sounds on the left.

4. Bowel sounds heard in the chest.

5. Scaphoid abdomen.

Child may be asymptomatic or suffering from sever

distress.

Assessment and Management

1. Resuscitate on 100% oxygen.

2. if PPV is necessary, place an ET tube, and deliver a peak

ventilatory pressure of 25 mm Hg or less.

3. Place an orogastric tube, and provide intermittent suctioning to

minimize distention. ( caused by PPV)

4. Monitor heart rate continuously during transport.

5. Definitive treatment is surgical correction, so transport to a

facility with a neonatal intensive care and pediatric surgery.

Premature and low birth weight infants

• Premature newborns : newborns delivered before 37

weeks of gestation.

• Low birth weight : newborns weighing less than 5½ lb

(2,500 g)

Causes of prematurity

1. Idiopathic ( commonest ).

2. maternal conditions associated with preterm labor and

delivery as :

I. Maternal infection (UTI) and Chorioamnionitis .

II. Placental insufficiency .

III. Preeclampsia and eclampsia.

IV. Polyhydraminos .

Complication of prematurity

1. Respiratory distress syndrome

2. Respiratory suppression and apnea

3. Hypothermia

4. Sepsis

5. Intraventricular hemorrhage.

6. Increased mortality

Causes and predisposing factors of low birth weight

I. The most common etiology is prematurity.

II. Predisposing factors include:

• Genetic factors

• Infection

• Cervical incompetence

• Abruption

• Multiple gestations (twins, triplets)

• Previous delivery of a premature infant

Complication

• Morbidity and mortality are related to degree of

prematurity.

A. Those who are delivered after 28 weeks of

gestation and receive cardiovascular support

survive long term.

B. Those born at 24 weeks of gestation have high

morbidity and mortality.

Assessment of

prematurity

The degree of prematurity is determined by :

1. Physical features:

Maturity of skin

Size of infant

Degree of respiratory distress

2. Information from family about gestational dating:

Last menstrual period

Estimated due date

Ultrasound dating

3. Information related to maternal or fetal complications

Management

• To optimize survival for a newborn delivered

prematurely in the field:

1. Provide Cardiorespiratory support.

2. Provide a thermoneutral environment.

3. Use only minimum pressure necessary to move chest

when providing PPV because the risk of retinopathy of

prematurity, worsened by long-term oxygen exposure.

Seizures In The Newborn

• Most characteristic sign of neurologic disease in the

newborn and is usually related to an underlying

abnormality.

Causes of seizers in newborn

• In the first 3 days of delivery are usually caused by:

1. Hypoxic ischemic encephalopathy

2. Hypoglycemia.

3. Other metabolic disturbances e.g. disturbances in

calcium , proteins , ammonia and other electrolytes .

• Seizures that begin 3 days or longer after birth are

likely from :

1. Intracranial infections (meningitis).

2. Intracranial hemorrhage.

3. Development defects.

4. Epilepsy.

Types and signs of seizers

1. Subtle seizure : (eye deviation , blinking , sucking ,

pedaling leg movement and apnea).

2. Tonic seizers : (Tonic limb extension OR arms flexion

and leg extension )

3. Focal colonic seizers : localized jerking

4. Myoclonic seizers : flexion jerks of upper or lower

extremities.

Complication of seizers

1. Seizures may interfere with:

• Cardiopulmonary function

• Feeding

• Metabolic function

1. Prolonged seizures may cause brain injury.

Differential diagnosis

• The following are often mistaken for seizures in the

newborn:

1. Normal movements when a newborn is drowsy or

asleep

2. Jitteriness

3. Gastroesophageal reflux and choking episodes

Management

1. Obtain baseline vital signs and oxygen saturation readings.

2. Provide additional oxygen, assisted ventilation, blood pressure

evaluation, and IV access as necessary.

3. f blood glucose level is less than 40 mg/dL, give an IV bolus of

10% dextrose solution and recheck in 30 minutes.

4. Monitor respiratory status and oxygen saturation carefully.

5. Maintain normal body temperature.