Neonatology Book

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Neonatal Circulation Assessment

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  1. See Also
    1. Newborn Resuscitation
    2. Neonatal Airway Assessment
    3. Neonatal Breathing Assessment
    4. Neonatal Perfusion Assessment
    5. Neonatal Distress Causes
  2. Approach
    1. Heart Rate over 100
      1. Proceed to Neonatal Perfusion Assessment
    2. Heart Rate under 100
      1. Positive Pressure Ventilation with 100% Oxygen
      2. Ventilate for 15-30 seconds
      3. Re-evaluate Heart Rate
      4. Heart Rate under 60
        1. Positive Pressure Ventilation with 100% Oxygen
        2. Perform Chest Compressions
          1. Depress chest one third of AP chest diameter
        3. CPR Sequence
          1. Count: One and Two and Three and Breath
          2. Compress at rate of >90 beats per minute
          3. Breath at rate of 30 breaths per minute
        4. Consider Orogastric Tube to decompress stomach
        5. Consider Endotracheal Intubation
      5. Heart Rate under 100
        1. Positive Pressure Ventilation with 100% Oxygen
      6. Heart Rate over 100
        1. Go back to Neonatal Breathing Assessment
  3. Medications
    1. Indication
      1. Heart Rate under 60 after 30 seconds despite above
    2. Available Preparations
      1. Epinephrine (Use only 1:10,000 solution)
        1. Dose: (1:10,000) 0.1 to 0.3 ml/kg by IV or ET
        2. May repeat every 3-5 minutes for Heart Rate <60
      2. Pediatric Fluid Resuscitation
        1. Crystalloid (NS or LR) 10 ml/kg over 5-10 minutes
          1. Umbilical vein is most common site for delivery
          2. May repeat for a second dose
        2. Other fluids for Resuscitation
          1. Colloid Solution
          2. Blood Products
      3. Sodium Bicarbonate (Use only 4.2% solution)
        1. First treat acidosis by maximizing ventilation
        2. Consider bicarbonate if persistent acidosis by ABG
        3. Dose: 4 ml/kg (2 meq/kg of 4.2%) very slowly
        4. Administer by large vein (umbilical vein)
      4. Naloxone
        1. Dose: 0.1 mg/kg of 1.0 mg/ml IV, ET, IM or SQ
        2. First treat apnea with PPV
        3. Indications
          1. Respiratory depression despite PPV
            1. Apnea with normal Heart Rate and color
          2. Maternal Narcotic Analgesics within 4 hours
      5. Intravenous Dextrose
      6. Calcium Chloride
      7. Atropine
      8. Dopamine
  4. References
    1. Kattwinkel (2000) Neonatal Resuscitation, AAP-AHA

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