Oct 27, 2016
Trish Woods guides you through some clinical pearls in the intensive care management of neonates.
The complex physiology of the transitioning required in the journey from foetal life to neonatal presents many challenges and scary moments.
Many things can go wrong in the neonatal period as babies transition to life in the real world. Trish highlights her thoughts on the use of positive end expiratory pressure (PEEP), how deep to intubate, when to clamp the cord and the use of ultrasound.
When babies arrive early their lungs can be full of meconium or fluid. Due to this, Trish recommends using PEEP – without which there is distal airway collapse and fluid accumulation.
Aeration of the lungs is vital. To this end, how deep should intubation be aimed? The depth may not be overly important. This is because regional lung aeration triggers widespread, global increase in pulmonary blood flow.
There is little definitive evidence to guide clinicians on when to clamp the cord – early or late. Trish recommends considering the physiology of clamping the cord.
After clamping the cord there is a massive drop in cardiac output. Ventilatory support will turn this around – something to remember.
In a compromised baby, perhaps we should aim to clamp the cord sooner and then initiate ventilation.
Finally, Trish highlights the utility of ultrasound. Viewing the heart and lungs provides crucial information for the clinician.
Furthermore, Trish discusses actively looking for aeration, collapse, consolidation and pneumothorax in the lungs and thorax.
Overall, don’t forget the essentials. Trish reminds you to keep life sweet, warm, and tempting and help neonates to transition into the big world.
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