Gastroesophageal reflux viCentral nervous system abnormalities viiMetabolic

Gastroesophageal reflux vicentral nervous system

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v.Gastroesophageal reflux vi.Central nervous system abnormalities vii.Metabolic disorders f.Pathophysiology depends on the underlying etiology. g.Newborns need respiratory support to minimize hypoxic brain damage and other organ damage. 2.Assessment and management a.Assessment includes: i.Careful history to find etiologic risk factors ii.Performing a physical exam focusing on: (a)Neurologic signs (b)Signs and symptoms of infection b.Differentiate between: i.Primary apnea (a)After a relatively short period of hypoxia, may have a period of rapid breathing followed by apnea and bradycardia (b)Drying and stimulation may cause resumption of breathing and pulse rate improvement. ii.Secondary apnea (a)If hypoxia continues during primary apnea, the newborn will gasp and go into the secondary phase. (b)PPV by bag-mask device is then necessary. B.Bradycardia 1.Most frequently occurs in newborns because of inadequate ventilation a.Often responds to effective PPV b.Other causes include: i.Hypothyroidism
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ii.Acidosis iii.Congenital atrioventricular block in newborns whose mothers have lupus iv.Prolonged suctioning or attempts at intubation v.Vagal stimulation from an inadequately secured ET tube or orogastric tube c.Morbidity and mortality are determined by underlying cause and how quickly it is corrected. 2.Assessment and management a.Heart rate is assessed by auscultation or palpating base of umbilical cord. b.If heart rate is less than 100 beats/min, provide PPV. c.Assess airway patency. d.If less than 60 beats/min in spite of effective bag-mask ventilation: i.Begin chest compressions per NRP guidelines. e.If less than 60 beats/min after 30 seconds of effective ventilation and 30 seconds of chest compression: i.Administer epinephrine. (a)Recommended concentration: 1:10,000 (b)Recommended IV dose: 0.1 to 0.2 mL/kg of 1:10,000, administered rapidly, followed with a normal saline flush (c)Recommended ET tube dose (if IV line not established): 0.3 to 1 mL/kg of 1:10,000 ii.Repeat dose every 3 to 5 minutes for persistent bradycardia. C.Pneumothorax evacuation 1.Pneumothorax can occur if: a.Infant inhales meconium at birth b.Lung is weakened by infection c.PPV is needed. 2.Signs of significant pneumothorax: a.Severe respiratory distress unresponsive to PPV b.Unilateral decreased breath sounds c.Shift of heart sounds if pneumothorax on left side 3.Assessment and management a.Clean area with alcohol around second intercostals space, midclavicular line b.Prepare equipment: i.22-g butterfly needle attached to extension tubing ii.Three-way stopcock iii.20-mL syringe c.Palpate upper edge of second rib, and insert needle above it. i.At the same time, a second provider pulls back on the syringe. ii.Slowly advance the needle until air is recovered. d.If syringe fills with air: i.Turn stopcock off to newborn.
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