Upload
dang-thanh-tuan
View
3.177
Download
0
Embed Size (px)
Citation preview
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