NEONATAL EMERGENCIES Marc G Weiss, MD Division of Neonatology
Introduction <ul><li>Definitions </li></ul><ul><li>Normals – neonate vs peds vs adults </li></ul>
Delivery Room <ul><li>Physiology </li></ul><ul><li>Risk factors </li></ul><ul><li>Resuscitation basics </li></ul>
RESPIRATORY SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>tachypnea </li></ul></ul></ul><ul><ul><ul><li>nasa...
Retractions
RESPIRATORY SYSTEM <ul><li>Evaluation </li></ul><ul><ul><ul><li>CXR </li></ul></ul></ul><ul><ul><ul><li>ABG </li></ul></ul...
REPSPIRATORY SYTEM <ul><li>Conditions – anatomic approach </li></ul><ul><ul><ul><li>Alveolar </li></ul></ul></ul><ul><ul><...
Hyaline Membrane Disease
Meconium Aspiration Syndrome
Transient Tachypnea of the Newborn
Cystic Adenomatoid Malformation
RESPIRATORY SYSTEM <ul><ul><ul><li>Space-occupying </li></ul></ul></ul><ul><ul><ul><ul><li>Air Leak </li></ul></ul></ul></...
Pneumothorax
Pneumomediastinum
Pneumopericardium
Chylothorax
Congenital Diaphragmatic Hernia
RESPIRATORY SYSTEM <ul><ul><ul><li>Extra-pulmonary </li></ul></ul></ul><ul><ul><ul><ul><li>Sepsis/meningitis </li></ul></u...
CARDIOVASCULAR SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>cyanosis – central vs acrocyanosis </li></ul></...
CARDIOVASCULAR SYSTEM <ul><li>Evaluation </li></ul><ul><ul><ul><li>CXR </li></ul></ul></ul><ul><ul><ul><li>EKG </li></ul><...
Newborn EKG Axis + I - I + aVF - aVF
CARDIOVASCULAR SYSTEM <ul><li>Conditions  </li></ul><ul><ul><ul><li>Acyanotic lesions </li></ul></ul></ul><ul><ul><ul><ul>...
VSD
Coarctation of the Aorta
CHF – Coarctation with VSD
Hypoplastic Left Heart Syndrome
CARDIOVASCULAR SYSTEM <ul><li>Conditions  </li></ul><ul><ul><ul><li>Cyanotic lesions </li></ul></ul></ul><ul><ul><ul><ul><...
Transposition of the Great Arteries
Tetralogy of Fallot
GASTRO-INTESTINAL SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>polyhydramnios </li></ul></ul></ul><ul><ul><...
GASTRO-INTESTINAL SYSTEM <ul><li>Conditions </li></ul><ul><ul><li>Congenital malformations </li></ul></ul><ul><ul><ul><li>...
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 <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>seizures </li></ul></ul></ul><ul><ul><ul><li>l...
Men never win
CENTRAL NERVOUS SYSTEM <ul><li>Evaluation </li></ul><ul><ul><li>LP </li></ul></ul><ul><ul><li>EEG </li></ul></ul><ul><ul><...
CENTRAL NERVOUS SYSTEM <ul><li>Conditions </li></ul><ul><ul><ul><li>Hypoxic-Ischemic Encephalopathy (HIE) </li></ul></ul><...
HEMATOLOGIC <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>Pallor </li></ul></ul></ul><ul><ul><ul><li>Shock </li></u...
HEMATOLOGIC <ul><li>Conditions </li></ul><ul><ul><li>Acute Blood loss </li></ul></ul><ul><ul><ul><li>Placenta previa </li>...
HEMATOLOGIC <ul><li>Conditions </li></ul><ul><ul><li>Chronic Blood loss </li></ul></ul><ul><ul><ul><li>Maternal-fetal  </l...
HEMATOLOGIC <ul><li>Conditions </li></ul><ul><ul><li>Thrombocytopenia </li></ul></ul><ul><ul><li>Polycythemia </li></ul></...
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Neonatal Emergencies

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Neonatal Emergencies

  1. 1. NEONATAL EMERGENCIES Marc G Weiss, MD Division of Neonatology
  2. 2. Introduction <ul><li>Definitions </li></ul><ul><li>Normals – neonate vs peds vs adults </li></ul>
  3. 3. Delivery Room <ul><li>Physiology </li></ul><ul><li>Risk factors </li></ul><ul><li>Resuscitation basics </li></ul>
  4. 4. RESPIRATORY SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>tachypnea </li></ul></ul></ul><ul><ul><ul><li>nasal flaring </li></ul></ul></ul><ul><ul><ul><li>grunting </li></ul></ul></ul><ul><ul><ul><li>retractions </li></ul></ul></ul><ul><ul><ul><li>apnea </li></ul></ul></ul>
  5. 5. Retractions
  6. 6. RESPIRATORY SYSTEM <ul><li>Evaluation </li></ul><ul><ul><ul><li>CXR </li></ul></ul></ul><ul><ul><ul><li>ABG </li></ul></ul></ul><ul><ul><ul><li>CBG </li></ul></ul></ul><ul><ul><ul><li>Pulse oximetry </li></ul></ul></ul>
  7. 7. REPSPIRATORY SYTEM <ul><li>Conditions – anatomic approach </li></ul><ul><ul><ul><li>Alveolar </li></ul></ul></ul><ul><ul><ul><ul><li>Hyaline Membrane Disease (HMD) or Respiratory Distress Syndrome (RDS) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pneumonia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Meconium Aspiration Syndrome (MAS) </li></ul></ul></ul></ul><ul><ul><ul><li>Parenchymal </li></ul></ul></ul><ul><ul><ul><ul><li>Transient Tachypnea of the Newborn (TTN) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cystic Adenomatoid Malformation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Congenital Lobar Emphysema </li></ul></ul></ul></ul>
  8. 8. Hyaline Membrane Disease
  9. 9. Meconium Aspiration Syndrome
  10. 10. Transient Tachypnea of the Newborn
  11. 11. Cystic Adenomatoid Malformation
  12. 12. RESPIRATORY SYSTEM <ul><ul><ul><li>Space-occupying </li></ul></ul></ul><ul><ul><ul><ul><li>Air Leak </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Effusion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Congenital Diaphragmatic Hernia </li></ul></ul></ul></ul><ul><ul><ul><li>Airway </li></ul></ul></ul><ul><ul><ul><ul><li>Laryngomalacia/tracheomalacia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tracheal web </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vocal cord paralysis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Choanal atresia </li></ul></ul></ul></ul>
  13. 13. Pneumothorax
  14. 14. Pneumomediastinum
  15. 15. Pneumopericardium
  16. 16. Chylothorax
  17. 17. Congenital Diaphragmatic Hernia
  18. 18. RESPIRATORY SYSTEM <ul><ul><ul><li>Extra-pulmonary </li></ul></ul></ul><ul><ul><ul><ul><li>Sepsis/meningitis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Congenital Heart Disease </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hypothermia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Metabolic error </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Abdominal distention </li></ul></ul></ul></ul>
  19. 19. CARDIOVASCULAR SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>cyanosis – central vs acrocyanosis </li></ul></ul></ul><ul><ul><ul><li>tachycardia </li></ul></ul></ul><ul><ul><ul><li>tachypnea </li></ul></ul></ul><ul><ul><ul><li>murmur </li></ul></ul></ul><ul><ul><ul><li>gallop </li></ul></ul></ul><ul><ul><ul><li>pulses </li></ul></ul></ul>
  20. 20. CARDIOVASCULAR SYSTEM <ul><li>Evaluation </li></ul><ul><ul><ul><li>CXR </li></ul></ul></ul><ul><ul><ul><li>EKG </li></ul></ul></ul><ul><ul><ul><li>ABG – hyperoxia test </li></ul></ul></ul><ul><ul><ul><li>Echo </li></ul></ul></ul><ul><ul><ul><li>Cath </li></ul></ul></ul>
  21. 21. Newborn EKG Axis + I - I + aVF - aVF
  22. 22. CARDIOVASCULAR SYSTEM <ul><li>Conditions </li></ul><ul><ul><ul><li>Acyanotic lesions </li></ul></ul></ul><ul><ul><ul><ul><li>PDA </li></ul></ul></ul></ul><ul><ul><ul><ul><li>VSD </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Coarctation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>HLHS </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ASD </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cardiomyopathy </li></ul></ul></ul></ul>
  23. 23. VSD
  24. 24. Coarctation of the Aorta
  25. 25. CHF – Coarctation with VSD
  26. 26. Hypoplastic Left Heart Syndrome
  27. 27. CARDIOVASCULAR SYSTEM <ul><li>Conditions </li></ul><ul><ul><ul><li>Cyanotic lesions </li></ul></ul></ul><ul><ul><ul><ul><li>Transposition of the Great Arteries (TGA) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tetralogy of Fallot (TOF) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tricuspid Atresia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Truncus Arteriosus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Total Anomalous Pulmonary Venous Return (TAPVR) </li></ul></ul></ul></ul>
  28. 28. Transposition of the Great Arteries
  29. 29. Tetralogy of Fallot
  30. 30. GASTRO-INTESTINAL SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>polyhydramnios </li></ul></ul></ul><ul><ul><ul><li>distention </li></ul></ul></ul><ul><ul><ul><li>failure to stool </li></ul></ul></ul><ul><ul><ul><li>vomiting </li></ul></ul></ul><ul><li>Evaluation </li></ul><ul><ul><ul><li>Abdominal films </li></ul></ul></ul><ul><ul><ul><li>Contrast studies </li></ul></ul></ul><ul><ul><ul><li>US </li></ul></ul></ul>
  31. 31. GASTRO-INTESTINAL SYSTEM <ul><li>Conditions </li></ul><ul><ul><li>Congenital malformations </li></ul></ul><ul><ul><ul><li>Tracheal-Esophageal Fistula (TEF) </li></ul></ul></ul><ul><ul><ul><li>Duodenal atresia </li></ul></ul></ul><ul><ul><ul><li>Intestinal atresias </li></ul></ul></ul><ul><ul><ul><li>Omphalocele </li></ul></ul></ul><ul><ul><ul><li>Gastroschisis </li></ul></ul></ul><ul><ul><li>Necrotizing Enterocolitis (NEC) </li></ul></ul>
  32. 32. Tracheal-Esophageal Fistula
  33. 33. Double Bubble
  34. 34. Duodenal Atresia
  35. 35. Intestinal atresia
  36. 36. Ileal Atresia
  37. 37. Omphalocele
  38. 38. Gastroschisis
  39. 39. NEC - pneumotosis
  40. 40. Pneumotosis intestinalis
  41. 41. Portal Venous Gas
  42. 42. NEC - perforation
  43. 43. CENTRAL NERVOUS SYSTEM <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>seizures </li></ul></ul></ul><ul><ul><ul><li>lethargy </li></ul></ul></ul><ul><ul><ul><li>irritability/tremors </li></ul></ul></ul><ul><ul><ul><li>hypotonia </li></ul></ul></ul>
  44. 44. Men never win
  45. 45. CENTRAL NERVOUS SYSTEM <ul><li>Evaluation </li></ul><ul><ul><li>LP </li></ul></ul><ul><ul><li>EEG </li></ul></ul><ul><ul><li>US </li></ul></ul><ul><ul><li>CT/MRI </li></ul></ul>
  46. 46. CENTRAL NERVOUS SYSTEM <ul><li>Conditions </li></ul><ul><ul><ul><li>Hypoxic-Ischemic Encephalopathy (HIE) </li></ul></ul></ul><ul><ul><ul><li>Intra-cranial Hemorrhage </li></ul></ul></ul><ul><ul><ul><li>Drug withdrawal </li></ul></ul></ul><ul><ul><ul><li>Malformations </li></ul></ul></ul><ul><ul><ul><li>Meningitis </li></ul></ul></ul>
  47. 47. HEMATOLOGIC <ul><li>Signs and Symptoms </li></ul><ul><ul><ul><li>Pallor </li></ul></ul></ul><ul><ul><ul><li>Shock </li></ul></ul></ul><ul><ul><ul><li>Early Jaundice </li></ul></ul></ul><ul><ul><ul><li>Petechiae </li></ul></ul></ul>
  48. 48. HEMATOLOGIC <ul><li>Conditions </li></ul><ul><ul><li>Acute Blood loss </li></ul></ul><ul><ul><ul><li>Placenta previa </li></ul></ul></ul><ul><ul><ul><li>Abrutio placentae </li></ul></ul></ul><ul><ul><ul><li>Velamentous cord insertion </li></ul></ul></ul><ul><ul><ul><li>Cord accident </li></ul></ul></ul><ul><ul><ul><li>Organ rupture </li></ul></ul></ul>
  49. 49. HEMATOLOGIC <ul><li>Conditions </li></ul><ul><ul><li>Chronic Blood loss </li></ul></ul><ul><ul><ul><li>Maternal-fetal </li></ul></ul></ul><ul><ul><ul><li>Twin-twin transfusion </li></ul></ul></ul><ul><ul><ul><li>Hemolytic anemias – immune, non-immune </li></ul></ul></ul>
  50. 50. HEMATOLOGIC <ul><li>Conditions </li></ul><ul><ul><li>Thrombocytopenia </li></ul></ul><ul><ul><li>Polycythemia </li></ul></ul><ul><ul><li>Hemorrhagic Disease of the Newborn </li></ul></ul>
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