Neonatal Collapse

Neonatal Collapse

Previously well neonate who presents critically ill

DDx:

  • Sepsis
  • Cardiac lesion – ductal dependent or large shunt
  • Asphyxia
  • Metabolic – error of protein or fat metabolism presents when exposed to proteins in feeds or begins to catabolise own protein/fat

Assessment:

  • Major issues w/ pregnancy/birth (don’t worry about maternal GBS/HSV status b/c going to treat empirically)
  • Nml baby pink, warm, flexed active
  • Palpate PMI and liver edge

Management:

  • A – 
    • HFNC early and leave on during more advanced maneuvers (if don’t have age appropriate gear can use normal NC at 2 L/kg/min peri-intubation)
    • High risk for gastric insufflation w/ BVM
    • Early NGT to decompress stomach
    • PPV can also improve CO2 clearance and cardiac output
  • B – 
  • C – Prostaglandin for:
    • Left heart obstruction – can’t palpate femoral pulses
    • R heart obstruction pre-ductal (R hand) sat < 90%
    • Increase prosta until femorals are palpable or pre-duct sat >93%
    • Watch for hypotension, apnea, hypoglycemia

 

  • Metabolic support – stop feeds, start glucose regardless of etiology
  • Antibiotics – Broad spectrum B-lactam/cephalosporin early (consider giving yourself) plus:
    • Ampicillin for listeria
    • Gent for G (-)
    • Acyclovir for HSV