Neonatal cyanosis Flashcards Preview

Obstetrics and Gynaecology > Neonatal cyanosis > Flashcards

Flashcards in Neonatal cyanosis Deck (7)
1

History

1. Pregnancy
GDM
Oligohydramnios
Pregnancy HTN
Maternal age
2. Labour
PPROM
GBS +ve
Maternal fever
Preterm
LUSCS

2

Physical examination

1. Vital signs
Respiratory distress
Sepsis
2. Four limb BP
3. Murmurs

3

Investigations

1. ABG
2. FBE
3. BGL
4. UEC
5. BC, septic screen
6. Consider fluid boluses if hypoT and acidosis
7. ECHO
8. 02 sats->right and left
9. CXR
10. ECG

4

Hyperoxia test

1. 100% Fi02 in headbox for 10minutes
2. Monitor oxygen saturation, repeat ABG
3. 02 / stats + by 15%->pulmonary disease likely
4. P02 cardiac or PPHN likely

5

Management

1. Resuscitation
2. Intubation if ++distress
3. Two IV lines
4. Fluid boluses if needed
5. Investigations
6. IV antibiotics post cultures
7. Prostaglandin E1 infusion if duct dependent cardiac disease suspected
8. Consider ionotrope support to maintain BP
9. Refer to pediatric cardiac centre if required

6

Etiology

1. Primary pulmonary
TachyP, no right-left difference, +CO2, no metabolic acidosis, responds to +02
2. Cardiac
TachyP, deep slow breathing, right-left 02 difference (5-10%), normal or -ve CO2, severe metabolic acidosis, no sigN change to +02
3. PPHN
TachyP, grunting, recession, >10-15% difference right-left, normal/+CO2, +/- metabolic acidosis, +/- response to 02, evidence of right ventricular strain ECG
4. Sepsis
Resp distress (not if not primary lung pathology), no difference right-left, CO2 normal/+increased, +/- metabolic acidosis, moderate response to 02 (blunted due to low output)

7

Evidence of ductal dependent pulmonary circulation

1. Cyanosis
2. TachyP w/o respiratory distress
3. Adequate peripheral perfusion
4 TGA, pulmonary stenosis