Contents Chapter Topic Page Neonatology Respiratory Cardiology

More documents

Recommendations

Info

- Assess the gestational age with Dubowitz or Ballard score when stable (see end of chapter for score). - Monitor temp, HR, RR, BP and SaO2. E. Immediate Care for Symptomatic babies Investigations are necessary as indicated and include: Blood gases. Blood glucose (dextrostix). Full blood count with differential WBC and IT ratio (if possible) Blood culture. CXR (if respiratory signs and symptoms are present) a) Start on 10% dextrose drip. b) Correct anaemia. c) Correct hypotension (keep MAP > gestational age in weeks) Correct Hypovolaemia: Give 10 ml/kg over 20-30 minutes i) Normal saline ii) Albumin 5% (If a 25% solution, use 2 - 4 ml/kg diluted to 20 ml/kg with 0.9 % NaCl.) iii) Fresh blood if anaemic. d) Start inotrope infusion if hypotension persists after volume correction. e) Start antibiotics after taking cultures e.g. Penicillin and Gentamycin f) Start iv aminophylline in premature babies < 34 weeks if not mechanically ventilated g) Maintain SaO2 at 90-95% and PaO2 at 50 –80 mmHg F. General Measures for all Premature infant and SGA 1. Monitor vitals signs (i.e. colour, temperature, apex beat and respiratory rate) for all babies. Observe for signs of respiratory distress (i.e. cyanosis, grunting, tachypnoea, nasal flaring, chest recession and apnoea). In VLBW and ill babies pulse oximetry and blood pressure monitoring are necessary. 2. Check Dextrostix (see Hypoglycaemia protocol for schedule). 3. Keep warm (Asymptomatic premature babies can be dressed up even while still in incubator) 4. Feeding (See <strong>Chapter</strong> 8 and 9) 5. Provide parental counselling and allow free parental access. 6. Infection control : observe strict hand washing practices 7. Immunisation: a. Hep B vaccine is given at birth if infant is stable and BW is >1.8 kg. Otherwise give when weight reaches 1.8 kg or just before discharge. b. BCG on discharge if infant has reached at least 1.8 kg and term gestation. Otherwise ensure that BCG is given at a later date. c. For long stayers other immunisation should generally follow the schedule according to chronological rather than corrected age. In the presence of acute illnesses immunisation is usually deferred.
8. Supplements: a. At birth : Vitamin K IM (0.5 mg for BW= 2.5 kg) b. Starting on Day 8 of life if enteral feed volume is more than 2mls/hr , and infant is not on parenteral nutrition with added vitamins: Multivitamin 0.5 mls OD ( to be continued for till fully established weaning diet) Folic acid 0.1 mg OD. c. Starting on Day 30 of life: Elemental Iron 2-3 mg/kg/day – to be continued for 3-4 months (Dose of ferrous fumerate needed 3 x 2 mg/kg/day.) G. ICU care and Criteria for Replacement Transfusion in Neonates See relevant chapter. H. Discharge Cranial Ultrasound for premature babies ≤ 30 weeks recommended at: a. within 72 hours b. around day 7 to look for IVH c. around day 28 to look for PVL d. as clinically indicated ROP screening at 34 - 36 weeks’ gestation or at 4-6 weeks of age is recommended for a. all babies < 32 weeks gestation at birth or birth weight
Page 1 and 2: Contents Chapter Topic Page 1 Norma
Page 3 and 4: Dermatology 67 Atopic Dermatitis…
Page 5 and 6: Dato’ Dr. Lim Nyok Ling Consultan
Page 7 and 8: ISSN 1823-3856 Printed by: Perniaga
Page 9 and 10: Foreword One of the maxims of scien
Page 11 and 12: B. Anthropometric Measurements a) H
Page 13 and 14: Immunisation 1. Immunisation schedu
Page 15 and 16: 2 General Notes 2.1 Many vaccines (
Page 17 and 18: 3.5.6 Rubella - Contraindicated in
Page 19 and 20: 4.8 Rubella May have rash, fever,
Page 21 and 22: 5.5 Close contacts of immuno-defici
Page 23 and 24: Developmental Assessment Developmen
Page 25 and 26: Hearing Assessment Warning signs fo
Page 27 and 28: Global Developmental Delay History
Page 29 and 30: Developmental Milestones Table AGE
Page 31 and 32: AGE Gross Motor Vision & Fine Motor
Page 33 and 34: Principles of Transport of the Sick
Page 35 and 36: 3.1 Airway Management Establish a p
Page 37 and 38: 3.7 Environment Neutral Thermal Env
Page 39 and 40: 7. Special Surgical Conditions 7.1
Page 41 and 42: • Ventilation - Most of the babie
Page 43 and 44: Neonatal Resuscitation High Risk De
Page 45 and 46: • Drugs are available (and prepar
Page 47 and 48: Meconium stained liquor: Meconium i
Page 49 and 50: Summary: Use of medications during
Page 51: Definition Premature infant: < 37 w
Page 55 and 56: Enteral Feeding in Neonates 1. Intr
Page 57 and 58: 32 weeks Well babies Start milk imm
Page 59 and 60: Total Parenteral Nutrition for Neon
Page 61 and 62: Clearance is usually monitored by m
Page 63 and 64: Daily weight Meticulous care of th
Page 65 and 66: Monitor BUSE and correct any imbala
Page 67 and 68: C. UAC and UVC care UAC position Le
Page 69 and 70: HIGH FREQUENCY OSCILLATORY VENTILAT
Page 71 and 72: 6. Infants must be monitored closel
Page 73 and 74: pH , PaCO2, PaO2, HCO3 - , Bases Ex
Page 75 and 76: Q. Name a likely diagnosis A. RDS 3
Page 77 and 78: A. Definition Birth Asphyxia There
Page 79 and 80: E. Management I. Good intrapartum c
Page 81 and 82: c. All doctors managing such infant
Page 83 and 84: Etiology Determination of etiology
Page 85 and 86: FLOW CHART: MANAGEMENT OF NEONATAL
Page 87 and 88: 2. Klauss & Fanaroff: Care of The H
Page 89 and 90: D. Asymptomatic Hypoglycaemia Feed
Page 91 and 92: NEONATAL JAUNDICE What is jaundice?
Page 93 and 94: Physical examination • General co
Page 95 and 96: Once the baby is on phototherapy, v
Page 97 and 98: Reference: extracted from MOH publi
Page 99 and 100: - 1ml of 4.2% NaHCO3 given for ever
Page 101 and 102: a. If unconjugated hyperbilirubinae
Page 103 and 104:
APNOEA IN THE NEWBORN Definition :
Page 105 and 106:
History NEONATAL SEPSIS Septic Neon
Page 107:
Antibiotic choice will depend on pr
show all

Contents Chapter Topic Page Neonatology Respiratory Cardiology

Create successful ePaper yourself

Delete template?

Save as template?