Neonatal Emergencies

NEONATAL EMERGENCIES

Marc G Weiss, MDDivision of Neonatology

Introduction

• Definitions• Normals – neonate vs peds vs

adults

Delivery Room

• Physiology• Risk factors• Resuscitation basics

RESPIRATORY SYSTEM

• Signs and Symptoms• tachypnea• nasal flaring• grunting• retractions• apnea

Retractions

RESPIRATORY SYSTEM

• Evaluation• CXR• ABG• CBG• Pulse oximetry

REPSPIRATORY SYTEM

• Conditions – anatomic approach• Alveolar

– Hyaline Membrane Disease (HMD) or Respiratory Distress Syndrome (RDS)

– Pneumonia– Meconium Aspiration Syndrome (MAS)

• Parenchymal– Transient Tachypnea of the Newborn (TTN)– Cystic Adenomatoid Malformation– Congenital Lobar Emphysema

Hyaline Membrane Disease

Meconium Aspiration Syndrome

Transient Tachypnea of the Newborn

Cystic Adenomatoid Malformation

RESPIRATORY SYSTEM

• Space-occupying– Air Leak– Effusion– Congenital Diaphragmatic Hernia

• Airway– Laryngomalacia/tracheomalacia– Tracheal web– Vocal cord paralysis– Choanal atresia

Pneumothorax

Pneumomediastinum

Pneumopericardium

Chylothorax

Congenital Diaphragmatic Hernia

RESPIRATORY SYSTEM

• Extra-pulmonary– Sepsis/meningitis– Congenital Heart Disease– Hypothermia– Metabolic error– Abdominal distention

CARDIOVASCULAR SYSTEM

• Signs and Symptoms• cyanosis – central vs acrocyanosis• tachycardia• tachypnea• murmur• gallop• pulses

CARDIOVASCULAR SYSTEM

• Evaluation• CXR• EKG• ABG – hyperoxia test• Echo• Cath

Newborn EKG Axis

+ I- I

+ aVF

- aVF

CARDIOVASCULAR SYSTEM

• Conditions • Acyanotic lesions

– PDA– VSD– Coarctation– HLHS– ASD– Cardiomyopathy

VSD

Coarctation of the Aorta

CHF – Coarctation with VSD

Hypoplastic Left Heart Syndrome

CARDIOVASCULAR SYSTEM

• Conditions

• Cyanotic lesions– Transposition of the Great Arteries (TGA)– Tetralogy of Fallot (TOF)– Tricuspid Atresia– Truncus Arteriosus– Total Anomalous Pulmonary Venous Return

(TAPVR)

Transposition of the Great Arteries

Tetralogy of Fallot

GASTRO-INTESTINAL SYSTEM

• Signs and Symptoms• polyhydramnios• distention• failure to stool• vomiting

• Evaluation• Abdominal films• Contrast studies• US

GASTRO-INTESTINAL SYSTEM

• Conditions– Congenital malformations

• Tracheal-Esophageal Fistula (TEF)• Duodenal atresia• Intestinal atresias• Omphalocele• Gastroschisis

– Necrotizing Enterocolitis (NEC)

Tracheal-Esophageal Fistula

Double Bubble

Duodenal Atresia

Intestinal atresia

Ileal Atresia

Omphalocele

Gastroschisis

NEC - pneumotosis

Pneumotosis intestinalis

Portal Venous Gas

NEC - perforation

CENTRAL NERVOUS SYSTEM

• Signs and Symptoms• seizures• lethargy• irritability/tremors• hypotonia

Men never win

CENTRAL NERVOUS SYSTEM

• Evaluation

– LP– EEG– US– CT/MRI

CENTRAL NERVOUS SYSTEM

• Conditions• Hypoxic-Ischemic Encephalopathy (HIE)• Intra-cranial Hemorrhage• Drug withdrawal• Malformations• Meningitis

HEMATOLOGIC

• Signs and Symptoms• Pallor• Shock• Early Jaundice• Petechiae

HEMATOLOGIC

• Conditions– Acute Blood loss

• Placenta previa• Abrutio placentae• Velamentous cord insertion• Cord accident• Organ rupture

HEMATOLOGIC

• Conditions– Chronic Blood loss

• Maternal-fetal • Twin-twin transfusion• Hemolytic anemias – immune, non-

immune

HEMATOLOGIC

• Conditions– Thrombocytopenia– Polycythemia– Hemorrhagic Disease of the Newborn