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NeonatalEmerg-1 - NeonatalEmergencies...

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Neonatal Emergencies Neonatal Emergencies (After Discharge) (After Discharge) Robert Englert, M.D. Dept Neonatology Bethesda Naval Hospital
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Most Interesting ED Chief Complaints Most Interesting ED Chief Complaints Drank the dog’s milk - from the dog’s  nipple Needs a circumcision because his tonsils  are so big Can’t find baby’s birthmark Piece of bologna string hanging from anus Baby is afraid of his hands
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Case Presentation Case Presentation 10 day old male presents to ED with 1 day history  poor feeding, lethargy and, over last 1-2 hours,  increasing work of breathing. Pre- and postnatal history are unremarkable.
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ABC’s of Neonatal Resuscitation ABC’s of Neonatal Resuscitation Airway Airway Airway
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Initial Management Initial Management IV access monitor oxygen
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Initial Management - Therapy Initial Management - Therapy Respiratory Support Volume Antibiotics
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Diagnostic Tests Diagnostic Tests ABG CBC Lytes Cultures Radiography
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Categories Categories Infectious Cardiac Endocrine
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Late-Onset Infections Late-Onset Infections Group B Streptococcus E. coli Listeria H. influenza, S. Pneumonia, N. meningitis Viral RSV, HSV, Enterovirus
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Group B Streptococcus Group B Streptococcus 1-3/1000 live births Up to 1/3 women colonized Early and late onset disease Antibiotics around delivery affect early  onset not late onset Late onset highly associated with  meningitis
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Listeria monocytogenes Listeria monocytogenes Early and late onset disease Early onset often associated with meconium  staining even in preterms Late onset disease is primarily meningitic
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Escherichia coli Escherichia coli K1 capsular antigen uniquely associated  with neonatal meningitis K1 related not only to invasive disease, but  to more severe outcomes Significant association with galactosemia  likely due to depressed PMN function  caused by elevated serum galactose levels Urosepsis/posterior urethral valves
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  • Fall '11
  • Dr.Aslam
  • Arterial blood gas, congenital adrenal hyperplasia, Supraventricular tachycardia, cardiac lesions, Neonatal Hyperthyroidism

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