SOP 15: NCU

Shock in Newborns
- Serious and complex clinical syndrome caused by acute failure of
circulatory function
- Characterized by inadequate tissue and organ perfusion
- Different conditions can lead to shock (e.g. acute blood loss, fluid loss,
sepsis)

Clinical Presentation Investigations

• Pallor and mottling of the skin ✓ Full blood picture (FBP)
• Cold extremities, prolonged capillary ✓ RBG
refill time (> 3 sec) ✓ Blood group and cross
• Tachycardia – weak and fast pulse rate matching
• Tachypnoea – rapid shallow breathing ✓ Bleeding indices
• Extreme lethargy, irritability, or loss of ✓ Blood Urea Nitrogen
consciousness (BUN)
• Decreased urine output ✓ Septic screening

Management
• Follow ABC of resuscitation
• Give oxygen
• Establish IV or intraosseous access (use intraosseous if IV is not available
within very short time)
• Infuse Normal saline or Ringer’s lactate 10 ml/kg over 10 minutes and
repeat once after 20 minutes if signs of shock persist
• If blood glucose level is less than 2.6 mmol/l or not known:
→ Give bolus of Dextrose 10 %, 2 ml/kg IV stat, then start Dextrose 10 %
at maintenance volume appropriate for age and weight
• If there is obvious bleeding:
→ Control bleeding, give Vitamin K 2 mg IV stat
→ Immediately give blood transfusion (whole blood 20 ml/kg)
• Treat specific conditions, e.g. sepsis
• Keep the newborn warm

Immediate management and active

monitoring is crucial
MoHCDGEC (2019) National Guideline for Neonatal Care and Establishment of Neonatal Care Unit, p 82-83, 107-108