)Short cases( ‫ مصطفى داوود‬.

‫د‬

RDS
 Tachypnea>60 breath per m.
 Ask about onset ddx ‫تحدد الـــــ‬
 DDX:
RES.,CARDIAC,GENERAL,SEPSIS,METABO
LIC(CF,KARTAGNER
SYNDROME.),CNS(FLOOPY,ASPHYXIA).

 1st day :HMD(1,2), TTN, Meconium aspiration,

congenital pneumonia, Diphramatic hernia.
 After some days: Congenital acquired
pneumonia ,bronchiolitis ,aspiration pneumonia .

 Symptoms: Tachypnea ,cough ,flaring nasal alai,

intercostal and subcostal retraction, cyanosis,
grunting.

 Ask about birth weight.

 Mode of delivery, tired ,cyanotic ,NICU.

 Maternal Hx DM , HTN,PROM ,

oligohydro(pulmonary hypoplasia).
  Assessment of GA

 Reflexes: moro ,rotting ,sucking ,walking,

steeping , tonic neck ,grasping ,parachute.
 FIVE:- Ear recoil + cartilage= 2w
-Nipplebilateral breast nodule >0,5cm= 2w
- Skin pink with no sub.fat=2w
- GenitaliaMale:pigmentation+descend=2w
Female:.majorcoverl.minor=2w
-Plantra:deep and cover ant.2/3=2w
-----------------------------------------------------------------------------------------------------------------

 DDX of big baby:

LGA
Infant of DM mother
Hyperinsulinemia

 Complication of DM mother on infant

-Hypocalcaemia ,hypoglycemia ,hypomagnesaemia ,
hyperbilirubinemia.
-Cardiac(septal hypertrophy)
-GIT(IO)
-RESPIRATORY(RDS)
-Polycythemia.
-Birth trauma
Mx of RDS

 ABC O2, sucker ,nutrition spport

 Supportive measure:

1- Incubator care in NICU and respiratory support

2-Temperature : goal core temperature = 36.5 – 37 C

3- Nutrition : IV fluids 10% glucose water 60ml/kg

first day and increasing everyday 15 -20 till we achieve
120ml
on the third day, change fluid to glucose saline and
20ml of KCL

4- if preterm give Surfactant

5- antibiotics cover gram positive and negative

(empirical)

6-Treat underlying cause

7-Blood culture
  Hypoglycemia: preterm<40
Term<50
Infancy<70
 Mx of hypoglycemia:
Asymptomatic: feeding, assessment
Symptomatic: dextrose 10% 2cc/kg bolus ,
after 15m not correctedbolus dose.

Mx of Seizure:
1-phenobarbital 20mg/kg, still give 10
2-phyntoin
3-diazepam
4-leveteracitem
5-B6

Exchange transfusion indication:

-TSB>25 mg/dl
-Any sign of kernicterus
-1ST day jaundice
-Bilirubin increase at level>5mg/dl/day.
-If total sr.bilirubin equal 10% of body weight.

Done by :Qudama Zain