The Collapsed Neonate

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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.