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