In this week's episode Dr Colin Gilhooley visited to discuss the approach to a collapsed neonate.
Colin breaks his approach down into 4 potential causes:
- Sepsis - the most common cause; must always cover for sepsis
- Triple antibiotic therapy - Cefotaxime, Gentamicin & Amoxicillin
- Ask about pregnancy risk factors - was it a difficult pregnancy or labour?
- Cardiology - murmur? Are the femoral pulses present?
- Check BP and O2 sats in all four limbs
- You can listen to our Paediatric Cardiology podcast here
- Think Prostin if duct dependent lesion
- Neurological/NAI - any history of hypoxia? Did the patient have Vitamin K at birth? Any focal neurology
- Shouldn't be bruising in the neonate - subconjunctival/petechial haemorrhage
- ?Chest wall bruising
- CT Head if evidence of harm and skeletal survey
- If no Vitamin K, drop in Hb, Focal neurology - CT Head
- Febrile seizures don't tend to happen in neonates
- Metabolic - any family history? Consanguinity in marriage?
- Inborn errors of metabolism - Disorders of fat, protein or sugar metabolism; production of dangerous by products
- Check Ammonia
- Give 10% Glucose
- Use the gas; check Hb and Hct. Glucose and Lactate could point to metabolic conditions
Here's our Take Visually graphic based on our podcast:
The RCEM Learning SAQ page on the Shocked Neonate can be found here.