2. Neonatal Emergencies Dr Ruben Bromiker Department of Neonatology Shaare Zedek Medical Center

3. Neonatal Emergencies Respiratory Cardiovascular Neurological Metabolic Infectious Gastrointestinal Psychosocial

4. 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)

5. Oxygen Dissociation Curve

7. Fetal Circulation

8. Placental-Fetal Circulation

9. Response to ASPHYXIA— CNS resistance to asphyxia

10. 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, 4 th 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 Asphyxia 1 ary Apnea2 ary Apnea Gasping I 10 min I 5 min Brain Damage

11. Biochemical Changes Secondary to Birth Process stagepHpO 2 pC0 2 BElactate Fetus Prior to labor 7.3725-4040-21.5 End of labor 7.250-2055-52.4 Neonate 10m post birth 7.305040-104.0 1 hr post birth 7.357035-52.0

12. Pre and Post Natal Pulmonary Circulation

13. Neonatal Respiratory Emergencies Persistent Fetal Circulation (PPHN) Pneumothorax Tension vs Non tension Aspiration Meconium Blood Amniotic Fluid

14. Tension Pneumothorax

15. Neonatal Cardiovascular Emergencies Arrhythmia Heart Block ( HR <60-70) SVT Ductal Dependant Cyanotic Heart Disease (transposition, severe pulmonic stenosis)

17. Hyperoxia-Hyperventilation Test  100%O 2

18. Supraventricular tachycardia

20. Neonatal Metabolic/Hematologic Emergencies Hypoglycemia –Glucose <35 (Maternal diabetes ) Acidosis pH <7.0 Unexpected Anemia –Hct < 25-30 (cause Fetal-Mat hem)

21. Neonatal Gastrointestinal Emergencies Diaphragmatic Hernia Esophogeal Atresia Perforation (ischemic) –Gastric –Small bowel Intestinal Obstruction Malrotation-Volvulus

22. Diaphragmatic Hernia

23. Neonatal Infectious Emergencies (secondary to maternal “disease”) Group B streptococcus (Rx ampicillin) Hepatitis B (Rx Hyperimmune globulin) Varicella (Rx ZIG)

24. Neonatal Neurologic Emergencies Seizures Intracranial Hemorrhage –Posterior fossa –IVH/PVH Trauma Drug withdrawal

25. Neonatal Psychosocial Emergencies Maternal Attachment

26. Neonatal Psychosocial Emergencies Breast feeding