Neonatal Resuscitation

2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines

DDx in infant suddenly gone off (day 10) with cyanosis

• PDA closing
• Group B Strep sepsis
• Critical aortic stenosis
• Coarctation

A few clinical notes

• SubXiphisternal impulse = dilated RV (at any age!)
• Hyperoxic test - <10% rise in O₂ saturations with 100% O₂ or PaO₂<150mmHg = Obstruction to pulmonary flow
• PCO₂ LOW in cardiac cause tachypnoea
• Pulmonary atresia or transposition, anomalous aorta, coarcatation, hypoplastic left heart, critical aortic stenosis all very well until duct closes at day 10 – sudden – present sudden onset LVF. - Need prostaglandin infusion
• If using PG must intubate as apnoea a side effect during transfer:
  • Alprostadil is kept in CUH Resusc. room fridge and is available from the neonatal unit in CUMH
  • Alprostadil / Prostin works very quickly
  • Usually response in 10-30 min become pink
  • PG side effects - apnoea, pyrexia, vasodilation, seizure like activity
• Trial prostaglandin in any doubt / cyanosed / underperfused

Back to Paediatric Resuscitation Algorithm

Recommendations for Irish services dealing with care of the critically ill children is available at www.aagbi.org/pdf/care_of_the_critically_ill_child.pdf (Local copy)