2. b/o jamuna nb /f/740gm CRN 201603276406
Tob 4;10pm dob 16/3/16
•
•NVD ,CIAB?,AUTO RICKSHAW DELIVERY,
• POG 25WEEK
G2P1L1
•RECEIVE IN GASPING
CONDITIONINTUBATED WITH ET TUBE NO
2 (BETTER TO PUT 2.5
3. ET tube sizes
Weight GA(weeks) Tube size(mm)
(internal diameter)
Below 1 kg 28 2.5
1-2 kg 28-34 3.0
2-3 kg 34-38 3.5
>3kg >38 3.5- 4.00
3
4. STARDED IV FLUID 40ML 12 HRLY 5%
D(>100ML/KG/DAY) BETTER TO START80-90
ML/KG/DAY BCZ PT SHOULD GIVEN RESTRICTED
FLUID BCZ OVER FLUID MAY LED TO OPENING OF
PDA,NEC,BROCHOPULMONARY DYSPLASIA
These PT have large insensible loss of fluid ,immature
skin barrier use of transparent plastic barrier
,application of coconut oil, use of double wall
incubator
5. Monitor temp
Inj vit K
Shifted to nursery
SURFACTENT
NEW BALLARD SCORING
RISK FACTOR IN MOTHER
SEPTIC SCREEN
CXR
6. RISK FACTOR FOR EONS
1. Low birth weight (<2500 grams) or prematurity
2. Febrile illness in the mother with evidence of bacterial infection within 2
weeks prior to
delivery.
3. Foul smelling and/or meconium stained liquor.
4. Rupture of membranes >24 hours.
5. Single unclean or > 3 sterile vaginal examination(s) during labor
6. Prolonged labor (sum of 1st and 2nd stage of labor > 24 hrs)
7. Perinatal asphyxia (Apgar score <4 at 1 minute)
Presence of foul smelling liquor or three of the above mentioned risk factors
warrant initiation of
antibiotic treatment. Infants with two risk factors should be investigated and
then treated accordingly
Source:aiims protocol of neonatology
8. Indication of SRT
RDS
OTHER WHERE SURFACTANT IS INACTIVATED
SUCH AS MAS,PNEUMONIA,PULMONARY
HAEMOORRHAE,CDH,ARDS
IN RDS IT IS GIVEN AS PROPHYLACTIC OR AS
RESCUE THERAPY
9.
10. PROPHYLACTICALLY : IN DELIVERY ROOM
WITHIN 15 MIN
EARLY RESCUE ;WITHIN 2 HR IF RDS DEVELOP
LATE RESCUE: >2 HR DONE IN OUTDOOR PT
REFFERED FROM OUTSIDE
12. PROCEDURE
EXPERIENCE PHYSICIAN(who can anticipate
,recognize ,t/t complication of surfactant)
WARM DO NOT SHAKEINTUBATE ASSES
BREATH SOUND-CONNECT TO PULSE
OXIMETER->INSERT FEEDING TUBE SUCH THAT
TIP PROJECT BEYOND ET TUBE->surfactant given as
bolus in four aliquots -> connect the infant to
ventilator, T piece, resuscitation bag till saturation and
heart rate stabilizes before administering next aliquot
No position change is required
Avoid suction at least 2 hr after administration
13. Septic screen
the sepsis screen consists of 5 items: C-reactive protein
(CRP), absolute
neutrophil count (ANC), immature to total neutrophil ratio
(ITR) and micro-erythrocyte
sedimentation rate (μ-ESR).TLC
• CRP: Quantitative CRP assayed by nephelometry is superior
to CRP by ELISA and semiquantitative
CRP by a latex agglutination kit. Cut-off value for
quantitative assay is 10 mg/L.
• ANC: It must be low count as per Manroe’s charts or
Mouzinho’s chart, depending on whether it is a term
baby or a preterm baby respectively .
14. • Immature /total neutrophil ≥0.2
• μ-ESR. Value ≥ 15mm in first hrs
TLC (TOTAL LEUKOCYTE COUNT) <5000/MM₃
Source:aiims protocol of neonatology
23. BABY PUT ON VENTILLATORY SUPPORT-
>SETTING WAS
PRVC MODE PEEP 5CM, TV 10,RATE 50,FIO2 80%
COMMENT ON VENTILLATORY SETTING
->IN TAXIM
INJ AMIKACIN SHOULD ALSO BE STARTED
@18MG/KG/DOSE EVERY 48 HR DOSE IS FOR
<29WEEK
24. VBG
Ph - 7.235 (acidosis)
pCO2 - 29.5 mm Hg, pO2 - 30.1 mm Hg
HCO3 - 12.2
->METABOLIC ACIDOSIS->I/V NS 7.5CC SLOWLY OVER ½
HR --.>IV AMIKACIN STARTED (DOSE IS NOT AS PER
AIIMS PROTOCOL @18 MG/KG/DOSE EVERY 48 HRLY
SAME CONDITION CONTINUE
BUT NO MONITORING OF SPO2 BCZ FIO2 increase to
90%, other setting same
25. Skin mottling is there I/V BOLUS 10ML/KG +DOPAMINE
@10MICROGRAM/KG/MIN,ET ALSO CHANGE
NNR,TONE,ACTIVITY-----NIL
RD STARTED RR 58,RETRACTION PRESENT,CFT
4SEC,SPO2 88% with fio2 100%
SIMV MODE STARTED PEEP 5,TV 10,FIO2 100%
DOWNY YA SILWERMAN SCORING SHOULD BE DONE
FOR ASSESSMENT OF RESPIRATORY DISTRESS
27. Started adrenaline infusion @.2 microgram /kg/hr
7am baby develop cardiac arrest chest
compression inj adr @.1ml/kg(1:10,000) iv twice
But second dose should be .2ml/kg
Cpr continue (TIME NOT MENTION)
7:25AM DECLARED DEATH