ij

-,.,IJ,,/, .... NEOPOCKIEI

Early Essential • lmmodlato and thorough ~ • Non-soparatlan of tho
Newborn Care drying er" mothor and baby for
• Early akin to akin contact ,_. early broaatfoeding
• Proporly llmod
clam ping cord initiation
_ :.:.;:;._ _ _ _ __ i V .,.,
[ Newborn Classification
, ••••••••••••••••••••••• •, ••••••••••••• • : Largo for Gootallonol : > 90th porc:ontllo I
H:::
:~a~~d:~n:~u~;~0; ; ~0:~h~~t:::: i
: Based On Aao of Goatotlon 11 Batod On Woight : '•
11 A91S [Link] ••• ~ ••••••• ,. •• • ~
•.. • .......... •:·~ • .......... • ....1r • • • • • • '\ • • • • • • 1 , • • • • • • • ' I0th to 90th :
: Epxtromoly : < 28 wooka : : Low ~irth : < 2500 : : Appropriate (AGA) : orcentllo 1
1 rotorm • 11 Woight 1 9,L • 1'. ■ • • • • • ~
-:.~:r·y· ;;:t~;~· ·:. ·;~ ~: ~~~k~. ·;2 ·:~ ...... ..... ·}: .. ·s~~tt (SGAi •• :
~ ~ 10;h· P-OrCO!'~lo i 0 0

11I • • • • · • • • • • • • • •:·' • • • • • • • • • • • • • • • • •,U1Vory LBW 1I < I000 9 , ,

I r • • • • • • • • • • '9 • • , ., • • • • • • •
• A,ymmotric: HC,. ,1
Modorotoly • 32 t 3 , k IL • • • • • • J • ••••• J • h I I wt (
.i p : o .. woo 1 11 t I 1
11 Exromoy1< 1, Symmetric: wt, c, 1 norma ,La
1,
rotorm
1............... •~................... W • 1000 g,, <10th EarlyOn11t 11 <lOh t, to 11
J. 1
,L.~t~ .~r"!!~".1 •• ~~~ !9 .~~ .6J.~
Torm
;,i,;~~~•.: •
: 37 to 42 wook, :
~ .L~ • • • -'.:-:.:.: .~..7.:.~..:............ ~........................:...........[Link]... ....... (
LAlnglh pcm:onllloa 1

:···P~;j io·r~ ·•·:• ·•·~• 42. ~~~k; •·' •: ~- I 1111 I

...l.!,, • • ._.__. a, • • • •~ • • • • •~ .. .. -.■,-.,.I G2
-
~

I APGAR SCORE I E- ,,, I/

.... ,_ ~!! -
_....~ i-- t;-2!
~
~·· ················~····
I 0 1 i I
~
47 / ,
y
V
.....
: AeU41tg
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: :: V
i..,
... 11_11

b7r-f·
~

I (1111Ud£f.o11£) I "it 44 I/ ~ -'

-
I • I ll. 43 /
[2[- V- / -
: Putce Ab11nt < 100 bpm , > lOO : Ii!~ ·'
/ /_
,
"I bpm J'"°i .!
' 40 1/ J

: GlllmAu, No Grimace, Cough/ : I : V

./ 1 ,
J ro1pon10 · Snooze, i_j 37 /
,
I A I 311
, I'
1
pp'411MU, Bl uo/Pa Ic, Acrocyono111· Pink 36 / ~
1 ((!ofo.,.) I
1 34
~ ~ ~ ,-,- .· '

1 Strong
[Link].llo11, Ab,ont Slow, 1 32 ·: Teim -
~ ••• - • - •• - ••• - '~'!IU'lsr••• Sr.1• .: 1 _J_~
.I • '
30 °' I __( I ,1 cl
- ·, - - - - - - - - - - - - - -...- -. ~ 35 3G 31 :la :,a 40 41 42 43
24 25 2G 21 2120 30 31 32 33

I Normal Vi tat Signs I /. . . . .. Wol"iii".iircc·rWi~~~.~-9~.1~~!!~/..........................

- r· · H;~ri ii~,;-.,.. iiot~ 160 ii;;· ·:- 1 :: 0

II p
t···········J··············, !

=
I
4a<JO
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r- i- !L
~ ••T!'!'l?f!.'!'tu~••• •• ••3J:.5.t~ .3l.§.G. •• : I
10
5li

so
3400
3200
3000 /
., ...
,,
~-
125
.. 2800 I/ V
i4S ... 2000
• 2,00
I __ , I/
V
i--
1"'1·
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i:k~_=-.-=_~=_-=_-=_⇒~-~_:___
j /
J 2200 ,.
/
2000
1000
,, /

V
j /
...
'.

1000 I ,. I./
~: :- :~
~:-::~~~A~i,~-~:~-:~:~
::~ -: :=
~ =--_=-:3 -~:~~
- := 1400
..... ~

....
V ,- V

25
IIIOO
1000
... .... I-' ,.... 1:c
I'• ·· '

000
20

eo
1118
-. -,hou-!50::--,.--80'1':---":::7~0----=ao
o' --c':10:---:20'-:·-Pot-!30:-- ta1-"°~•{III
1

PANAROPII
000
400
0 al 1<>
•= 1•• I '
,v

24 H 26 27 28 :IV 30 31 32 33 34 35 34 $7 39 l9 40 41 ca 43
Got1nlloni1J !!9!! .l~t11>
.,
1'.'11'1,.;.
:1. 'I~- I :!:

>31"11 ,,,,,,,,,w,1w~1~o·u'NtYO';cw1:e·pevc•,~;m;a""'"''",..,,,,.,,,,,,,,,,
75 38
i
E 10 /j· "" 55
r
I 60
37
38
- ~

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i0·-·· i ~ ::- ~-
I

I
>3h \ 35
...
GS
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1 45 .
h ~--k 34
33 c-Ll, t-
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i-
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32
31 -,-
30
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I
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t"'
.,.
/
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., p
,,.
I<-' i- 10
,... ...
I 1
1/
29 I .... '/ v~
S5
.II r;o j
M
30
28 ,- t - ,-
27 - ,,. ~v I?
r---~ '. -' _;
V/

~
. I,;

J 45 ! 25 28
25
I-.,..
, '71 _.,
24 - i-- v 1.-1
I-'
1•·1->-

P~tfm '
23
40 20 Term,-
I a :I 4 6
22
0
I ' J I I I .1 I I
2• 25 2j) 27 28 21130 31 3233 34 35 3113736 39 40 41 42 '3
Day Ol ldl
0.11a11ona1 age (week)
U I I H U U I U U U U I U U U I I I U l l f l U U l l f l f U I U l f l l fU IIIUU11111nu • n 1 u u u 1 u u11 1
 NRPh Algorithm
A. Ant1ngtol coumellng
B. T■om brleflng (Coll for h1lp If high rl1k) HR ln6 ..c■ x 10
1.-- ----c. Equipment chock ------
.. .. .. ... . . . . . ..
D• Room Temperature check

•0•••h I. lmm1digf1 thorough II. Skin to akin contact

~ Blrl ➔ drying & quick Ill. Properly llmod cord clomping
IV. Non separation of mothor &
baby
NO_. V. Early exclu1lve broo1tfeedinA
YES
Ing or llmpf :
_,_,-·.- --- ---·
0 •
Kangar oo CGre
NO

1. Cglf for holp

2. Change wet lln ■ n Lactatic,n Support
• 3, Clgmp & cul tho cord Preductal 5pO2 Target
- 4. Trgn1fer to wormer
5. Position airway
6 . Clegr aecrotlont If
~ - 1 min• 60%-65 %
2 min • 65%•70 %
3 min • 70%-75 %
--
.• 4 min • 75%·80 %
5 min • 80%-85 %
10 min• 85%-95 %
8, Sp02 monitoring

NO StaT
Pott resusdfolion coro
Tron1port
Team debrio6ng

Ventilation corrective YES

1tep1
a. Po1ltion & cloar airway
10. Intubate if needed
b. Sp02 monitoring
- ...!== ===r-== =:!....- --1,. Supplomontal 02 as
noedod
NO- , - -- === =i.r.=-=..:..:_
:.. :_:...:!..c11, 7 ET• 00
Blade Sbo
• o,[Link] preterm
-.111111•• -• •0 • proform
• 1 • torm
CORRECTIVE STEPS PPV : Breatho, 2, 3
_ 10. Intubate If not olregdy ____ _ • M-cak Roadju1tmont CC: 1 & 2 & 3 & breathe
done • R•opo1ltlon Airway
_
11 . Coordingtod PPV &
ch11t compronlont
12 100% 02
13, Contldor UVC lnHrllon
1----- • • 5-uctlon mouth & noso
0-pon mouth
• P•ronuro lncroa11
Chott Compre stiom:
2 lhumb or 2 Rngor
l11chniquo, 1/3 of chiut
• A•lrway altornatlvo diameter, ;3: 1

Weight ff tube Depth of

(kg) 1lu lnHrtlon (c,n
(mm) from upper llpl
NO
< 28 < 1.0 2.5 6-7
28 - 34 1.0-2.0 3.0 7-8

34 - 38 2.0 • 3.0 3,5

14. IV Epln,phrlno
15. Con1ld1r hypgvol1mla
•---t 16. Con1ld1r pnoumothoralll >38 > 3.0 3.5 • ,4,0 9 . 10
• Doptli of ln 10rtlon (cm) • o+weight In kg or
Noto 5optum fo Tra9u1 +1
Medications used During or Following Newborn Resu scitat ion
• • • • • • • • •,. • • • • • • • • • • r • • • • • • ••• • • • • •.- • •
1 M.,,..I(! 10 i • • • • •,.. • • • • • • .. •'
1 "'" AT N 1 011o19ii / [Link] I I 1Tol&tlVVolunl£I p I
I Co11Ufdwlll11, 1 Wt Og) 1 I ) , waultoM •
L••• ••••• •~•• ••••• •••L ••••• ••~• ••••~
"! Ep~ : IV (UVC preferred : : :
•••~ •••J ••••• •••~
: Glvo ropidly 1
1 IWh•n HR rtmoln1 460 ,route) 0.1 to 0,3 ml/kg
• dtJptt, 301tc of onllltd I Higher IV do111 not 11
1 1 1 0.1 • 0.3 1 Ro ogt ovory 3 1
"'I vtnlllollon fl by 601H 1 1 2 1 0.2 • 0.6 1 p If HR'.
I ol coo1dlnot1d 1 1: 10,000 1 1 1lo 5 ml11ut11
I rocommond1d I I 3 0.3 . 0.9 I <60 with ch11t
• comprtolon 6 1 Endotrochoal 0.5 lo 1 1 4
I vtnldotlon)
1 1 0.4 • 1,2 I compreulon1
I ml/kg 1 1 I I
• • • • • • • • • • ,_ • • • • • • • • • • ~ • • • • • • ••• • • •
• ·1 1 ,
• ... • • • • • • • ,. • • • • •d•f• •
, 1 lndlcato or
I V,fwiv, E,q,aiw.u I , 1
I 1
1 1 10 , hock
1 lulotlu C!itg,ldlot.4. I1 I I
2
I I ., to
1 (Nwiw.A aftM) M 10 ml/kg IV 1 1 1 20 1 Glvo ovor
1 1 1 1 10 minutes
: Blood, • 3 30
1 1 40 1 Roalllll o~or
4 1
• I I I
····· ····· -··- ····· ··-·· ··-·· --·· ··-·· ---- ---
I I I
I
I
• each bolu1
•• • •• • •
• .-1
ps- ---- ---- ---, 1,
---- ---~ -=- or- ,,i...

DOPAMINE
• Usual DoH: 2 to 20 mcg/kg/mlnule c:ontlnuou1 IV infusion, Renal Dose: 2 lo 5 mc:g/kg/
minute
• Cardiolonlc Do1e: 5 to 15 mtg/kg/minute, Preuor Dose: >20 mcg/kg/minule
e Begin al a low do11 and titrate by monitoring effect•

Formula:
Weight x 6 x d11lrad dp11 !mcg/[Link] • mg/100 ml D5w Divide by 4 (since
De1lred rate (ml/hr) syringes aro 25 mL only) "'

t Sample Computatlon1
Dopamine available preparation; 200 mg/5 ml - 40 mg/ml
D11ired Rate: 0.5 to 1ml/hr
then by 40 (available
prep of Dopamin e)

., Weight: 2.9 kg
2.9 kg x 6 x 5 rn,g{kg/mjn • 174 mg + .4 + 40 • 1.1 ml
0.6 ml/hr
To order1
Dopamine 40 mg/ml, 1.1 ml + 05W or NSS lo make 25 ml solution lo run al 0.5 ml/hr
If Premixed Dopamine 1, avallablo, UH tho following factor,:
200mg/250 ml: 13.3; 400 mg/250 ml: 26.6
Wllgbt x do11• ml/ hour • (2.9 kg x 5 mcg/kg/mln) + 13.3 • 1.1 ml/ hour
Factor

DOBUTAMINE
• Usual DoJO: 2 lo 25 mc:g/kg/mlnulo contlnuou, IV Infusion
• Available preparation: 250 mg/ 20 ml - 12.5 mg/ml, 250 mg/5ml -somg/m l
• Samo formula 01 Dopamine Drip, but divide to 12,5 mg/mL or 50 ln1tead of 40
• If Prombted Dobutamlne 11 available , use tho following factor,: •
• 500 mg/250 ml (half strength) : 16.6; 250 mg/250 ml (full strength) : 33.2

.1 EPINEPHRINE •
ii
• Start al 0.1 mcg/kg/mlnuto ond adjust to d11lred rosponH, too maximum of 1 mcg/kg/
1• I minute
i• • Available Preparation: 1: 1000 (1mg/ ml)
la • Formulas Weight x 0,6 • mg of Eplnophrlno In 100 ml D5W
• 1 ml/hr dollvor, 0,1 mcg/kg /mln of Epinephrine
• Epinephrine 1:1000, _ mg lo be diluted In D5W to moko 100 ml, to be given al _ml/hr
• NebuHzatlon (altornatlvo to racomtc epinephrine): [Link]/kg of 1: 1000 aolutton diluted
in 3 •
ml NSS.

NOREPINEPHRINE
• Start of 0.2 to 0.5 mcg/kg/mln; tltrolo every 30 mlnute1 to target &P
e U1ual lnfutlon rate: 0.2 to 2 mcg/ kg/mln
,,
• Available Preporotlon:4mg/mL, .4 mg/250ml DSW, 16 mg/250 mlDSW
r • Recommended conc;ontrotlon of 16 to 100 mcg/ml

FENTANYL
• Analgo,la: i-
• Slngle/inlermlttenl dote: 0.5 to 3 mcg/kg/doso SIVP (every 2-4 hour,)
e Contlnuou, lnfu1lan: O.S to 2 mcg/kg/hr
11 • Sedation:
11 • Single/intermittent dote: 0.5 to .4 mcg/kg/do1e SIVP (every 2-A hours)
• Contlnuou1 lnfualon: 1 ta 5 mcg/kg/hr
• For continuou1 lnfualon: DIiute too concentration of 10 mcg/mL
• For Intermittent lnfu1lon: Administer over 15 lo 30 minulos al concentration of 10 mcg/mL
• Available proparatlon: 2,5,10, 20 mL ampule with cone of 50 mcg/mL
• Add 1 ml of 50 mc;g/ml to 4 ml of NSS to make 10 mcg/ml aolution ,_
'I
MIDAZOLAM Recommended concontratlon1 SIVP I to Smg/ml
e Sodatlpn : 0.05 to 0.16 mg/kg every 2 to ,4 hour,contlnuou1 lnfv1lon1 o.s mg/mL
• Continuous IV infualon: 0.01 to 0,06 mg/kg per hour (10 to 60 mcg/kg/hr)
• Antlconvulaant: Loading D011: 0.15 mg/kg IV ff by Maintenance dose: 0.06 to 0.4
mg/
kg/hr (1 to 7 mcg/kg/mln)

SODIUM IICARBONATI
• Cardiac Arrott: (not routinely uaed)I 1 to 2 mEq/kg/lV/10 ,lowly; DIiute 1 mEq/ml (8.4%
.. II c:onc) 1: 1 with SW ond lnfu11 al a rate of no gr,aler than 10 mEq/mln
e Melabollc ocidosl1:
• HC03 noedod (mlq)• Weight x 0.30 x baae deAclt or 0.5 x wt x (24 • aerum HC03)
e Dilute lo a max concenlratlan of 0.5 mEq/mL In dexlro1e or 1terll1 water. Give
half of
calculated via SIVP over 30 mlnutoa, thtn half via lnfualon at a rote of 1 mEq/kg/hr.

~--------------------------------.,-
ii
II e Repoat ABG afttr 2 hour, of corrtctlon.
 OB Pear ls
~- ----- ----- --,--SBP
-----
>/• ----- -----
140 mmHg -----
or DBP -----
>/•90mmHg----- ----- ----- ----- --,
on >1 occa1ion 4 houn apart;
.J. Geitatlonal HTN•:. _______ • _. __ f.l}~'!. ~q ~~'.~9s;, tl.~~l,!'!,n~ ~_. •. _. ___ . ___ ~
1

•
1
SBP >/• 140 mmHg or DBP >/•90mmHg on >1 occa1ion; BEFORE 20
I
: Chronic HTN wlu :
I AOG / PERSISTS BEYOND 12 wk1 po1partum (·) protelnurla
1 :
►~--- -----
MIid -----I•---- ----- -----or----- ----- ----- ----- ----- -----
, SBP >/• 140 mmHg DBP >/•90mmHg on >l occa1ion1AFTER 20 wlu -----
AOG:1
...: Preeclamp1la 1 (+) protelnuria >300 mg/24hn or +2 dip1tick or UPCr >/•0.3
'

~•
t ••• -• -• - ••••• '-BP.>. i6oii10~ Pr~~ein:~i~
severe I
;;;iuh;. ~;;
:;-di;1;;;k~o1ig:;i~ ~400 ~i:i~;, i
Crea >[Link]/dl, Pit <100,000, t AST/ALT (>211) tLDH, Persistent
, Preeclamp1la I . 1 ,I
, . . .
• I headache1/vl1ual d11turbonces, Pen11ten l ep1ga1tric pain, IUGR, Pulmo edema :,
}-·····-···--·,··--·-·---····-·-·---·---·--------·-··-------··-·~
... I Featvre1 of preeclamp1la PLUS NEW ONSET tonic-clonic, local, or multiloca
: Edampl a I l •
Hlzures In the abHnce of other conditions :
L:::: ::::: ;:::i: ::::: ::;:: ::::: ::::: ::::; ::::: ;:::; ;:::: :::;: ;::~
r:- 75gOG
t-~:·~~t~:~~I.~~. I _F~~ !'{:9..2.'!!il.d!,.[Link].H.~~~TTat24
1 to28w111ks: ,
?L: ]~~ Ti!L~L~ !':'~.H.~~R_: ?{-:.~6'}."!.9/~~ j
►~ - - - ':?~!"! _D_~ - •• ; •• - - - !~~ ?{-. g~ '!'ald!,. ~B_S.>J:.[Link] _m.Ju'~~ _H_b!'
7
1~?!: ~~5J:. -. -- ~
: ptl CBrlG I Premeal1: 70 • 100 mg/dl, 1 HR PP< 140 mg/dL, 2 HR PP: < 120 mg/dL
., mon to ng :
::::: ::::: ::::: ::::: ::::: ::::: ::::: ::::: ::::: ::::: ::::: ,
:
::::: ::::~
1 Modera te: AFI >/• 5 lo</• 8cm; Severe: AFI <5cm :
• 1
I 1 Volume of less than 200 or 500 ml •
• OIi h d I I Cau1es: Chromo1omal abnormalitiea, GU anomalies, IUGR, I
.J ~ go Y ramn °1
1 lntrautorine fetal
demise, Postmaturlty, PROM, Uteraplacental insufficiency, ACE and
; I Prostaglandln 1ynthetase inhibitors, Chronic abruption, Placenta
l crowdin g,
; I Twin twin tran1fu1lon, Placental Infarction, Idiopathic
· ········································ ,
: 1 ·······-·--·--·····-·•- ·◄
AFI >/ " 25 cm :
: Volume of greater than 2000 ml
1 :
..-,I Polyhydramnio• 1 Causes: chromosomal abnormalities, GI/Cran
iolacial/Pulmonary/Cardlac 1
i I anomalles/$keletal dysplasla, fetal hydrops, anemia, neuromu I
I scular dlsorderJ, ,
•, 1 neoplosias, macro1omia, DM, twin twin transfusion, Idiopathic I

·-··· ···-· ······ ······ ··--· ······ ····- ··-·· •~¥ -·-··---·--······-~
r••••••·•••••••••••••••••••••
••••••~---------------
,
~ Antenatal Steroids for >/=24 wks AOG within Johnso
: n's Rule for btimated fetal wt
• 1 days of poHible delivery • fundic height in cm • n (12 if engaged, JI if
L-••• ••••• •••~• ••••• ••••• ••••• ••••• J
: Betamethasone: 12 mg not) x k (155)
'••••• ••••• •••r• ••••• once dally for 2 doses :
••••• ••••• ••••• ~ eg. FH 28 cm, not engaged ., 28cm . 11 11
!Dexamethasone: !
6 mg every 12 hours for 4 dom 155 .. 2635 grams
..••. ••... •.•
n ~······· ···~ ····· ····· ·--- s --------I
Feta l Heart Rate Cate gorie----
r•••• ••••• 1•••• ••••• ••••~ •~••• ••••• • • ••••~
•••••• •••••• ••@• •••••• • ~
:
1 Baseline Rate: 11(). 160 bpm, Moderate Baseline FHR variability, Pro11nt/[Link] :
: [Link] I I Accelerations, Abtonl Late/Variable Deceleratlon1, Present/AbHnl Early
:
~ ••••• •••• J ••••• ••••• ••••• ••••• •• • \?l!CJLeraJlp~s•••••
••••• ••••• ••••• ••• !
: CaugO'lg II ' All tracings not Included in Category I or Ill
····· !
:,.,.,,_,.·····Ill'
·····Ab11nt
·····baH1llno
····-variabili
·····ty····· ·····t··~·
plus Recurroo late ····· ~··· ····· ····· ··~
OecolerationJ, Recurrent Variable
: ~M y :
I DeceloraHon11 Bradycardia; Slnu1oidal Pattern
j··················~~~b·;ii~~~i~~·~·~~~·~;;~;~··················j :

CONCERNS AmR SUCCESSFUL INDICATIONS FOR TRANSPORT

RESUSCITATION • Prematurity/IUGR
•Temperature Instability •vLBW
• Signs of continuing R11plralory Dltlren • AOG < 32 weeks
• Signs of Shock • Need for ventllatory support
• Hypoglycomia • Respiratory failure
• Need for Transport • congenital Heart Disoato
• Congenital Anomalies
• Severo Jaundice, SelzurH
• Need for surgery, exchange tran1fu1ion
and other procedures not available

Physiologic Changes in the Newborn

• Phytiologlc; Weight Lon• not more than 10 %
of BW, occura on 2nd day recovered by 10th • Transilional stools
day (term), or I.4th day (prelerm) • lnanition fever , l 11 week d/t
• Physiologic Jaundice • occurs on 2nd-3rd day, dehydration
• Physiologic de1quamation of the 1kln for
peaks at 4th-5th day, disappears on 7th day
(Term), 14th day (Pretorm) not more than 1 week
• Vasomotor ln1tablllty • Falling off of the cord
• P11udomentH • due to maternal estrogen • Physiologic anemia • at 2 lo 3 month11
• Witch Milk • due to maternal estrogen permluiblo level 80 m
-l
1
Umbilical Artery & Vein Catheterization
!"..1¥' ............................................................, :··•..·7tt•··................................................... l
j !j
-
i •LOW LINE UAC; lip
.
._.L:-
i• & 24
L of catheter above
r· aortic bifurcation bet
!5 12 .!!. L3 and L5; UA length
..J::'
,. l BW In kg +7
• JI
,)
ji 10 . ,,
,, ~~ 20 ,
,
High fi
:
I
•HIQH LINE UAC; lip
,i ,, I: ! ,' - no !' of catheter above
iJ ,,,,' ;I " 111 ,,,/ (T&-TII) I diophragm bet T6
Li ~ L
i
.J]
-
8·

,,
,,,'
,,''Olainll,n I! l
'!
µ;
§ 12
,'
,,,
/ ~epnroqm

-
i.
:
and T9; UA length:
(3 x BW) + 9

Low lln• ~ •~:lip jxn of IVC

!? ,/ I i i' / 11.3-l.4) ! and R atrium; UV
p e· ,/ j: ! 8 j length (0.5 x High
-tJ ,,'
~ OilurGll!IOn
orao,11
j.,
[
UAC J+ l

L!: • ,o 11 . " 15 18
4_.____._____.______,
10 14 ,a
j/&. ~ -
r~
L...........~ ~ .~ .1.~~!~!........ .........~~.:~!;,:;;)!~;,;!;.;t~~:.................l ,,. -1
1. Determine length of catheter. Prepare and drape UC and akin using sterile technique.
2. Flush catheter with sterile NSS.
3. Cut through the cord horizontally 1.5 to 2 cm from the skin. Identify vein or arteries.
.4. Use one tip of curved forceps to dilate veuel.
• 5. Grasp catheter 1cm from Its tip wilh toothleas forceps and insert to lumen of vessel.
6. Aim tip toward the feet and advance catheter to desired distance.
i 7. Confirm radiographically.
8. Secure catheter with suture through tho cord.

ti Anthropometrics ! Routine Newborn Care

WEIGHT GAIN BCG VACCINATION : 0.05 ml/ID
'<2 kg: >15 9 /kg/ day HEPATITIS B VACCINATION: 0.5 mg/lM
'>2kg: >20g/k9/day • Give 0.5mg/1M of Hblg if Hb1Ag (+) within 12 hours
HEAD CIRCUMFERENCE • not later than 7 days If mother's atatus initially unknown
'0.5 to 1 cm/ week VITAMIN K: infants> 1500 g : 1mg/lM within 6hn after birth
LENGTH • 15009 or Ion : 0.5 mg/lM within 6hrs after birth
'Average: 0.7 to 1 cm/wk ERYTHROMYCIN OINTMENT:lcm strip OU
'Torm:0.69 to 0.75cm/wk EXPANDED NEWBORN SCREENING
'Preterm: 0.8 to lcm/wk CCHD SCREENING
HEARING SCREENING : prior to discharge/ within 1 month,
Weaning from . • If(+} : Diagnosis at 3 mos. Intervention must be done w/in 6 mos.

r
"
. . .Incubator
.____
'Dotroo111 by 0.5 to I from the temperature every I
!Discontinue pulse oximeterL
lo 2 houn to reo,h 29.5 C (diopor plus cloth11). on full cup feeding, weight 1.8 to 2 kg, 3 to 5
'Woon when reo,hod 1.6 kg, >34 wk, w/ conslst,nt . da)'I off theophyllino, 34 weeks old i-
wt goln (15-20g/kg/doy), ,toble, lncubotor temp 32 If no longer oxygen requiring
C or Ion ovor previous 24h

I Criteria for Discharge l

'Uncomplicated antepartum, intrapartum, postpartum courses for both mother and newborn
•vaglnal delivery, 1ingleton, completed 37 week, AGA
'Normal, stable VS during the preceding 12 houri (RR< 60/min, CR 100-160/min, Temp ...
36.5-37.4C properly clothed in an open crib)
,. • Urinated and paned at 11011 I 11001
• Documented proper latch, mllk transfer, 1wollowin9, Infant satiety, absence of nipple discomfort
.
.. 'Normal PE
• No evidence of ,ignilicant laundice in tho I 11 24 houri of life .
• Educability and ability of the parent1 to care for their chlld
• Mu1t follow up within tho next 48 houri

~
~

Heat Loss in the Newborns I

···················-------------,---------------,
~ ••• t,tvl,pol,111. ••• 1 ••• P»sti1Jt.iq11, ••• 1 ••••• ,vvw•••••---------------~
,. ••• J11•1t'<wiPA •• ~
I""! [Link] I From baby to cold I Infant lie, In cold linen/ 1 replace wet linen w/ :,_
1 11, 1 1urfaco in contact with I wet diaper I new dry linen '
•···············1·······························
,
·············
From baby to
···i
111 room temp bet ,
I oir conditioned rooms; 1
I'"': Coiwedlon, 1
1urroundlng air current/ 1 proximity to airvent 1 25-28C ; use :
~ ••••••••••••••• 1••• ~ ••••••.•• • •• 1••••••••••••••• J4--~----J···· ··J
~ EvopD/IGU4n, I Heat lau when water I Infants skin/head I dry thoroughly; discard :...
~ ••••••••••••••• I •• • """•Jo r,i,w ••• J •••• r,,t""'ira »11\. ••• J ••••• wetJioeri. •••• ~
I I Heat tran1fer betwHn I I move away from cold :
.: [Link]. I 1olld 1urfoc1t not in I cold wl ndow,/walli I window1/wall1, use ,..
~ ••••. - • - - .• -· •• a. - ... ,,. •'- ........... - -- - -- --- .• - .• 1.1 • .,~ - ..... -'4• -~--!
 L.___c;;.;r~i;;.;t;.;;i;...c_a_l_C_o_n..;;g_e:n:i:t:al::":e:a:rt:::D:i:se_a_s_e_s_c_r_e
e_n _1_·n_g___ ___,I ,,
__J Initial Screen
- 't'

\t
<90% In the R hand /
loot - 90-9.4% in the R hand &
fool or > 3% difference
1
repeat after 1 hour 1
- >/• 95% in the R hand/
foot & </• 3% difference ➔, ..
II
I
l
1•
I+
<90% in the R hand /
foat
- 90-94% in the R hand &
foot or > 3% difference

•repeat after 1 houri

>/• 95% in the R hand/
fool & </• 3% difference
~"

,.
I
i .L
• '
<90% in the R hand /
foot - 90-9.4% In the R hand &
foot or > 3% difference - >/• 95% in the R hand/
fool & </s 3% difference
.., '

r,1 FAIL
PASS
~ • Target Diseases: Hypoplaslic left hea rt syndrome, pulmon
ary alresia, TOF, TAPVR, TGA, Tricuspid
alresia, Truncus arteriosus

Newborn Scre enin g

1

~ • Sick, Preterm, LBW I~ sample Co)lect immediately after 24

hours of life I,
• Samples taken < 24h from birth : repeal screening al 2 weeks
of age
,. • If on NPO 21U! sample Repeal after 24 hours of feeding J,d
Sa mple Re peal al 28th day of life
• If with feeding 2nd sample Repeal at 28th day of life
• If for BT collect regardless of age foll ow BT protocol
• • FFP recollect after 48 hours and after 14 days
I • pRBC or FWB recollect after 48 hours, after 14 days, alter 120 days

Cran ial Ultr asound

~ • BW < 1500 grams, Gestational Age </• 32 weeks
•ht : 3to7d ays
• • 2nd : 28 lo 30 days or before discharge

ROP Screening
• BW < / .. 1500 grams, Ge1talionol Age </• 32 weeu
• Ge1talionol age 32-36 ween with the ff Risk fadors
• S- Sep1is (Severe)
• T· PRBC Transflnion within 1st 10 days of life d/1 anemia
• (). Oxygen use esp. without oxygen blender
• p. Prematurity with an unstable dinical course placing the infant
al high rilk as anened by the attending
pedlatriclon/neonatolagi1I
• Premature < 28 weeks: 31 weekl AOG or prior to discharge whichev
er camel earlier
• Premature 28 wu and above : 20 day, postnatal age or prior
lo discharge whichever comes earlier
$UGQESTED SCHEDUL£ FOR fOLLOW•UP OPHTHALMOLOGIC
EXAMINATION IN
RETINDPATHY Of PREMATURITY MANAGEMENT
slWHk 1-2Wnkl 2Wnks Type I ROP
2-3WHks
Zone 1, staae J a, 2 RDP Zone II, staae 2 ROP
(Zone I (Any stage ROP w/ •
Zont II: Sfllll l ROP Zone Ill: st11e I
Zone II: sla&t 3 ROP plus/ Stage 9 ROP w/o
or 2 ROP
Zone I lmmalure Postetlor zune Zone II: no ROP, lmma• Zone Ill. plus), Zone II (Stage 2/3
v1scul1rlzaUon. no RDP II: Immature lure vascularf1J1llon racmsina ROP ROP w/plus)) : •
VUCIJltrlzahon Peripheral Retinal Ablation
Immature retina wnas Zone I: Ulll(IUivoc:.elly Zont II: uncqulwcally should be con1idered, Anti-
Into posttrior zone II near rearenln1 ROP re21111ina ROP
D011nd1ry of mne I VEGF Ix may be as effective
Suspected pmonco of for Zone I diseases .
■urnslw posleflor ROP HARRIET LANE
NIil£, 1111- ol pllll di ..... In .... , .. nlndJCllff (II, ( Type2 ROP
plflplllfol 1bl1llon ,.,.., llun -•tlan 1,
-•If (Zone I (Stage 1/2 ROP w/o
plus), Zone II (Stag• 3 ROP •
Severity
w/o plus)):
Stage I: a flat demarcation lln• d1>t dlffe rentlatH vuculor from •vascula
retina r 1 -,,.-_-.,-.-.,J..~.•..•..""-S!!!!.,e1111r:ia: l:ex:o:m:i..n""o:l.i~o..n11.,l!!•!!!!•""~d
I•
Sca,o l: elevated ridge betw«n the vucular and avascular
retina with or LOCATION
wn:hout , mall tufu of flbrova1culor proUfer~tlon ("popcom")
"" Ione h poiterior retina within O 60° ,
Stll• l: neovaoc ular vessel• growing •long d1• rids• Into
the vitreous circle centered on the optic nerve
Scaa• -4: partial retinal d•uchment
Ione lb from zone 1 to a 360°
-4A: utrofov eal
- circle encompaising th• nasal ora ~,
-48: lnclud1n1 fovta

9
Stai• S: coul retlnol dotachm enc, usually wllh funnel conflgur..1on Ione Uh remaining temporal ee.,.
0
peripheral retina
Ptu, dlauH: arteriolar cortuoal cy and venou1 engorgement In the
po1terlor pole, a algn of progren l•• dlaeaae
•
•
.,("""\ '
fl:_•~
j
•~l't'ep&~lt.1~t;d;l1iioa;:;,1~a·; .d;,;1:i;l1;tlo;n~•n~diiitili
di.,,-0011 of plua dlaeue oliirtiiiuii o1iilty;;;;;;;thiitiitiiJliroiiil
lniii1uiiff\iiciiil•illniitllo
foilir11i;tiii
h•. .iiii;;;;I • - - - - - - - -"\
11 _ .
 ,...----------=e-re-a-s7t-::M:-:-:i:":"t':""k----------,! I
• - --------·----- -- -------,------------ -;i.._.__,. ....... 1 oz a 30 ml
t·•·•!!'!'P!'~~.'!'~I! • • • • 1 •~ !.u!h~
, Room Temperature > 25 C I
- !'! • • ~
1 our ,•
Brea1tmllk: 20kcal/oz -o.67
:-.. • - • • • • • • • • • • • • • • • • 1• • • • • - • • • • • ..:Z. Preterm enriched mUk: 22 kcal/oz -0.73
I
1 Room Temperature < 25 C 4 hours HMF: 24 kcal/oz - 0.8;
L-•••••••••••••••••l•••••••••••A,
: Refrigerator 4 C 1 8 days : >start when TfR at 60ml/kg/day, in infants
•r • • • • • • • • • • • •• • ••••••••••••••••
1 rI SW < 1500
• freezer 1 door 2 weeks g .
L ••••••••••••• - •• - • t••••••••••• A >may d/c al 180ml/kg/day and 1800 g
~ Freezer 2 door J 3 months :_r..............•. •.... 1 ••••••• •• f
• • • • • • • • • • • • • • • • • • • 1• • • • • • • • • • • ~ 1 Slmllac HMF J acket '
• Deep Freuer • 20C 6 months A " . . . . . . . . . . . . . . . . - - •• - • I - - ..P,. • - • • - •
~ : : : : : :,: : : : : : : : : ;: : : : : : : : : : : : : : , : Addltlonalcalorie1 de1lred I Breastmilk :,
•• Nutrient Per Liter ; -• • • • • • • • • • • • • • • • • • • • • • I • • • • • • • • '" •
' : • 2 (Cal'A ozl 50 ml 1•
' Energy Cal 680 , • .. • • • • • • • • • ' • • :,. • • • • • • I • • • • • • • • •
-:
•
Volum;, ml 1000 :- i. ····. fJf~lf~ ~:l_. •···.I. _J-j.'11L. • • i·
' : , eg. Dilute 1 1achet of HMF in 25 ml of EBM & •
_; Protein, S 10.48 :_: give 15 ml every 2 hour,. ~
• % of total calories 6 ' : BM 20 kcof/oz + .4kcal/oz • 24 kcal/oz ,
: 39.05 : : 16 ml x (24 kcal/30ml) • 12 kcal every 2hr, :
,J, fat, S 1-: BUT if using 50 ml dilution: ,_
: % of total calories 52 : : BM 20kcal/oz + 2kcal/oz • 22kcal/30ml ,
,.: Unoleic odd, mg 374 I :--!. .....
J§rvl~ i7.21'ECJJl3.0,tn,R ': JQ•.f§~~L •• • }
!' Carbohydrate, g 72 :' GOOD ATIACHMENT
J % of total calories .42 }- • mouth wide open
• lower lip turned outward with a furrow
Water, g 898 below it
•: Minerals •• • chin touching or almost touching the breast

-
I
: Calcium, mg (mEq) 279(13.9) • • more of the areola visible above the baby',
..., Phosphorus, mg (mEq) 1.43 (.4.6)
' top lip than below the lower lip
I
!•
-~ GOOD POSITIONING
I
Magnesium, mg 34.7
• baby's body should be straight, not bent or "
Iron, mg 0.27 '
I
twisted

-·
I

I
I

'
I
Zinc, mg
Manganese, mcg
1.22
7 ·''-
I
• baby should face the breast
• baby's body should be dose lo the mother
• entire body, not just head & neck should be
•

Copper, mcg 252

r. I Molybdenum, mcg - ',
supported

... I
Iodine, mcg 109 EFFECTIVE MILK TRANSFER
'
I
Selenium, mcg 15
• baby tokes slow, deep sucks, sometimes w/
...•'
I
Sodium, mg (mEq) 177 (7.7) I
pauses for a short time
• you can see/ hear baby swallowing
I
• Potassium, mg (mEq) 531 (13.6) I • baby's cheeks are full and not drawn
;.: 422 (11 .9)
'-'
I
inward during a feed
I
I
Chloride, mg (mEq)
:i
... I

I
Vitamins
Vitamin A, IU 2252
10 STEPS to SUCCESSFUL
BREASTFEEDING
I
I • Have a written breastfeeding policy
~ • Vitamin D, IU 20 • Train all health care staff
I
I Vitamin E, IU 4.1 • Inform all pregnant women about benefits
_,
I
Vitamin K, mcg 2
and management of BF
• Help mothers initiate Bf within 1 hour of
:'
I

.. -'
I
I Thiamine (B 1), mcg 211 birth
I
RiboAavin (B2) mcg 347 • Show mothers how to BF
I
• Give infants no food/drink other than BM,
Vitamin B6, mcg 20.4 i unlen indicated
~ Vitamin B12, mcg 0.48 : • Practice rooming in
I :
: Niacin, mcg 1503 , • Encourage BF on demand
,..,: Folic acid (Folacin), mcg 48
:-
,
• Give no pocifier1/artilicial nipple$ > 4t:•
• foster the establishment of ~F support
: Potothenio acid, mcg 1803 ! groups
....: Biotin, mcg 4.1
'i
Electrolyte Content of Body Fluids
Vitamin C (ascorbic .41 '
1

~
'

: Choline, mg 95 :
r' Auld Source
Soclurn
(mmol/l)
Potassium
(mmol/L)
Chlortde •
(mmoVL)
l,.! Inositol, mg 149.7 :_ Storrech 20-80 6-20 100-160 •
I I
I ~~~~~ SIMI Intestine
I lI 100-140 5-16 00-120
~ To~~~ ~ Bis 120-140 6-16 90-120 •
I : Nudeotide fortification, : lleostomy 45-135 3-16 20-120
~ Renal Solute Load, 97.6 I- Oianheal stool 10-00 10-80 10-110
I :• O1mololity, mO1m/kg 286 :
• ---Al-low-a•b•1•.•o•G•n-lo•••••e,••,•m•l•/~•-/d•o•y- -
1 9
H O1111olarity, mO1m/l - ~ Rep/oce with PIRS
·-------------------------------·
Tran1itlon From OGT to Oral Feedi;,9: At 32-34 wb AOG, 1how1 1uckin9 behovior, not nHdin9 MV,
feedin9 ot 140.160 ml/k9/doy divided into 8 meal1, stable w/ no bradycardici or d111citurotipns
r TPN Computation
1. Total Volume • TFR x Wt C1"91 Start al D5 ~ ample Orders
' 2. NaCl: (given x wt) / 2.5 >11.~1 D10 PN to be prepo,.d by pharmocy under
' KCI: (given x wt) /2 laminar Aow a, loflowa:
3. Clkg1 AA al
I 4. 10% Ca gluconate: (given x wt)/ 100 050W
U59/lcg/day D!SW
5.
6.
Aminoacid: (given x wt x 100) / 6
Intralipid: (given x wt x 100) /20
► lkg: 3.5 - 4 sf
kg/day
NaCl
KCI
1/ \ '
7. D50W: {ldextro1ity x TV) - (5 (TV - electrolyte111}/45 I00-4 Ca 9luconale ..,,(D>:.

'
8.
9.
D5W: TV - electrolytes - D50W
Total Caloric Intake:
6o/. Arnlnoaleryl
----
:

A. CHO: (dextro1ity x rate x 24 x 4) / 100 ~otal 1ml) • . •

i
•I 6. CHON : aminoacids x wt x 4 o lnfuae only (TV~l) ml lo run at (TV~l/
C. Fats: 9 x wt 2Ahrs)- "'l/hr
lntralipid 20%, Aaplrate __ ml lo be be
D. Add all then divide by wt to get kcal/kg/day Infused al a role of (ll{'Uhra)_rnl/hr.
i
10. Glucose Infusion Rate: (Rate x Dexlro1ity x 0.167) / wt (NV
Term: 4~ Prelerm: A-8, MAX:15)
11. To check: D• ((D5x5) + (D50x50))/TV
12. Elecs Reqt per kg/day: Na(2-4 mEq Term, 3- 5 mEq Preterm
' ), K(1-3mEq), Ca (200..400 mg),
AA(2 • 49/kg), IL (1-39)
13. Rate of Increase (ROI) : ((preaenl ml feeding x frequency)
' · (previous ml foeding x freq)) +6W
1.4. Calories lo maintain wt: Term 60-80, Preterm 80.100
15. Calories lo gain wt : Term 80.100, Preterm 120.150
' 16. Trophic feeding• 10 -20 ml/kg/day; Full feed1 : Term (100
ml/kg/day)Preterm (150 ml/kg/day)
17. Discontinue TPN· if oral feedinn ~I 100 -I/kn• Di•continue
!VF if full feeds
' -
STANDARDS OF NEWBORN CARI
- '
.
Feeding Advancement
: Birth Weigh t (g) I Initial Rate (ml/k g/day )
.
I Valume Increa se (ml/
.
:
"'I~- - - - - - - - - - - - J_ - - - - - - - - • - • - - - - - - -l -k_~!'!
I < 1000 10 I I
!'Y.. !~ ~~~~'J. l- FANAROFF:
.. r--·-·-----· -,·------10.
··--·
1001 · 1250
r••••••••••••1•••••••••••
10
20 ····· ··,-- ---- ·-·-·
10 ---· -i,_..
I
VLBW : Advant e by
:
• • • • • • • • t • • • • • • • • • • • • ••••• 20-30 ml/kg/day
1251- 1500 1 20-30
._ r···1501
····· ·····I ···· ···· ····
• 1800
1
30 ····· ·····
10-15
····· ····· ····I•
ELBW: 15-25ml/kg/
day
r----
'
----- ---,-----
1801 • 25~0 _ _____-----
I 15
-•- -- -- --,----------------,r
1 _ ?0 • 40 _ _ 15. 20 :
- e Initial
1

volume should be adminillered for al least 24 hour, prior

to advancement.
. e Once feeding volume reached 80 ml/kg/day infant,
q2-3 hours.
<12509 should be considered for intervals
..
e Once reached 100 ml/kg/day, consider advancing
lo 22 kcol/0% or 2.4 kcal/0% <15009.
• e Consider advancing mare rapidly if tolerated>
l00ml/kg/day but not exceed increments of 15 ml/ ~
kg q12h in <15009. Recommended volume goal is 1.40-16
0 ml/kg/day.
e 32 weeks • non nutritive wc:king, 34 weeks/ 1.3 kg
• fractionated feeding
Blood Tran sfus ion
& Iron Supplementation
r-------------,---•----------,r-- ------,--------~ Sample Order:
-:
:
A

,' -----
I Estimated Blood : :
ge I Volume (ml/kg ) : : Blood
1 Volume
1 (ml/kg )
f
: Reserve I u pRBC, -
-----
Premat ---1-----90-----
ure Infant • 105-•--yr - • - - - - - - 1 - - - - - - - - 1•
~ - - - - - - - - - • - - - 4- - - • - - - - - • - • - -: :
, Term Newborn 1 82 • 86
1
pR8C I 10. 20 :
u, - - - - - - - - I - - - • - - - - ,.
properly typed &
crassmatched, wa,hed &
irradiated. Once
-
"!°, -- - -1 -• ay1 7-d-----
1-
.a - - - -78
- -•-8
6-----:: Platele___
, ~ _____ t I _____ ___ ..~
10 . 20
available, transfuse
- ' " l of pRBC aver 4
1-

,--------•---- 1 hours. Decrease IVF ta

,.., 1 • 12 month1 I -------------~·
72. 78 1J FFP I 10 • 15 !,I half.
~--- ----- for Irradia
• Indica tion,----------ted----- -----·~--
Bloods Transfu ---------- -- ---~w/ BW < 1200g, Intrauterine
i,.

sion la a premature infant

transfusion, Known or su1pected congenital cellular immuno
dellcienty, Hematologic malignancies or solid ~
tumors, Significant immunasuppreHion related lo chemotherapy,
radiation or immunosuppressive [Link],
Transfusion of cellular blood component obtained from a blood
relative, Transfusion of an HlA matched or
platelet crau matched product, Granulocyte components 1
•
VOLUME UQUIR ED (ml)• [wt (kg) JC Blood volume JC {Hd
o..ired. Hd Observed)) + Hct of pRBC to be given (uaually
60-80'/4}
•··· ····~ ---· ····· ····· ····· ····- ··~• -···· ···· ·r··· ····· ·1··
~ Su99e ,ted Guldellne1 for RBC Replacemen
, • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •t ·,,: : Status at I Iron 1
··-· -· I
•
1 For aevere cardiopulmonary Be91n at :-

.~
I ,, birth I Required
: diACHe (requiring Mech Vent I Maintain Hct 40 • I I

45% : ~ - - - • - - - • - -lo - - - - - - - • - ·,
I

1...
:
-~-~o..:t5_ 69Zl __ _-~ __ •• ___ • ______ ~~:L
For moderate I Maintain Hct 30 • AO% :..,
~l- !:~~_-~ __ __ :~-
I
~:~~~
I --•---
~:n~h-•
-·
I

I
I
r • •cardio1
• • • 1ulmon
• • • - -arr -di11a1e ~
I
- - - - - • L - - - - - - - - - • - - • - 'II I, PRETE RM I 2 /k I 2
: For Major Surgery I Maintain Hct 30 • 35% : !
mg g monthS I
1 I
~ •••••••••••••••••••L•-••
: For infonll with Stable
I
• • • • • • • • • • ~4 • • • • • • • • • • r • • • .
••••••1••••• •
-,. I

I
I Maintain Hct > 20 • : : Vl8W <1500g I 2-4mg/kg 1 2 weeks
: Anemia I 25% : t I ! ____ -- _,
I
I
·-- ----- --- ----- -----
_____ _

Hypernatremic Dehydration ----

-- -- - -- - --

Mid: 1.46 • 149 mEq e Free water required: current weight x 4 x ( 10 -12 mEq)
Moderate: 150-160 mEq e IVF correction: (Free waler required + TFR) - TV of feeding
hven : >160 mEq with CNS
monlfe11ation1
e
e
Use D50.3 or D50..45 1alution
Rapid correction may lead to cerebral edema
~
J,. ________ ... _____ ... ____
1
1 Eort
• ~ .' u ""' Late 11
• •
Onset I la"te O 1et I ,,,8 ·'
~~=;:.~~~_~~~·.~~ ______.____._. ____3
- ,[Link]•on of "'eatin1112t
• • • • • ~ • ~ • • • -·~ • • •"' • • • • • ., . 1
t . --_Y_ - - - - J. - - - - ~ - - .... - ~~!8! ..:~ §,,!i! ,L~.f;i~u! 1•
1r • • • • • • • • • •

.. !~!!'.: z,to_ 1_o_d_o_r1_;J~•!e!~:_191~ !~~01~-

: Birth lo 7 days I 7 to 30 day, I > 30 days :~ ~~l!'!.c!.•~ §!l?.5\! J•• •••
<;u~r! !'l!QaJi;::e_ ";. 18- IJ.0.Yt1 • • • • ~
..J.r • • • • • •
• • 1 • • • • • • • • ,. • • " • • • ·11
M I Menin ilia
.e••••• I
• •••• • •• • ,.14•••
to 21 dav1 1
'"" M t I I olema I .
'J. • • • • ,.
• I
• • ;t • • • • • • • • - _,
1
? ema I G•nital Traci/ 1 Environment II Gram (·l' 1 21 days or 2 week, beyond l 11 negative ,1 •
11

• Genital Tract ,
Environme nt 11
,, Menin91h1 •• CSF cu Ilure whl chever Is Ionger 1
1 1 ,
~•- 1
- - • - - - - - - - - • - - - -- • - - - - • -~-!. - - - - - - - - - - .. - - -
- - - - - - - - - - - - - - - - - - - - - - _,_
.~valuation of of a,ymptomatlc Infant, <37 week, with risk •2018 Sepsis Guidelin es
adou for ,ep,ls
~ / 7 weeks AOG
Risk Factors Diagnostic Tests Low Risk for EOS
Antibiotics
• noninfedious obstetric
Ol rJOd [Link] uu, 011 birth - - - -
C..'11onoo1nml)1t1l1"l• WUC/Orll t C HP e ,oad ~pectrum indication, for prelerm birth
• cesarean delivery
• ab111nce of lobar, attempts to
Induce labor or any ROM
before delivery
>> no laboratory evaluation &
no empirical antibiotic tx OR do
blood culture & clinical
Ulood OJlturc pon1hvo monitoring
Lob dnl 11 abnormt,1 High Risk for EOS
• cervical incompetence
• prelerm labor, PROM
Conllllut ~ II mOlhtr OilCOlltlnut eotiblotlet lltld • chorioamnionliis/ IAI
rwcelYtd tfltiblollct durlr,g • acute or unexplained onset of
labotlll)ddt ll dlscl)arge Dy 48 - •
non-reassuring fetal status
Evaluation of of asymptomatic infants >/=37 weeks with risk » do blood culture & start
fadors for sepsis empiric antibiotics
Risk Factani Diagnostic Tests Antibiotic s >/•35 weeks AOG
• 3 approaches;

~-,, ➔ ■■+ Categorical algorith ms

• includes risk factor threshold

~
values lo identify at risk
1. ill appearing
2: mother w/ chorioamnioniti,
· Moaae•="' 3. mother w/GBS and received
~~~
••ti
inadequate IAP w/ ROM
>18 hours

■I~i■
Oliood cuHur• po:..iuvo
4. mother w/GBS w/
inadequate IAP but no other
~ ~
RF
• lob lest & antibiotics • 1 &2
Conlin. . en1iblollcl K molllet
,-lvtd onllblollet dunng
Dl§conunut -
clll°""'IJO lly 48 houra
and • lob lest • 3
labor and !Id• • Observe for> /m48 hrs • .4
Evaluation of of asymptomatic infant, >/=37 weeks with r~sk Multivariate risk
adors for sepsl, as5essm ent
(no chorioamnionitls) • individualized synthesis of
established RF and newborn
Risk Factors Diagnost ic Tests Antibiotic s clinical condition to estimate

➔ l'il►l ➔ ■MI
Pf>ROM <!:HJ h <Jr each infants risk
IAP md1t:.,1lct.l, liul
111,1,Juqu,,10•
Serial physical exam
• begin w/ the 1st 2
approaches to identify px at
Managem ent ( J risk then do serial monitoring
if develop sx of illness
~ ~

-·
L.'lb dulu 11bno,mol lntraamniotic Infection
-(+) amniotic Ruid Gram stain
~ and/ or culture or by placental
histopathalo9y
Blood CultuN

~ Suspecte d lntraamniotic
Blood cullutc nt.•g;:thvo Infection
lnf:mt r~m:11ne woll,
d1sch,1,uo by 40 htt
-maternal inlrapartum fever
(single >/a39 or 38-39 for >30
mins)
AAA
-w/ 1 or mare of the If:
IT RATIO: immature / total neulrophils malernal leukocytosis, purulent
cervical drainage, fetal
NV< 0.2 tachycardia
ANC: WBC x neutrophils x 1000
NV >1500 Diagno1l1:
1000 • 1500 µl. • mild neutropenia Blood/CSF culture
500 • 1000 µL. • moderat e neutropenia CBC & lnAammatory markers •
low sen,itivity
<500 11L. • severe neutropenia
<200 µL. • very severe neutropenia Treahnen t:
Amplclllin + Gentamidn;
URINE CULTURE:
Discontinue by 36-.48 hrs if
> 100, 000 du/ml• urine bag sterile culture unlo11 with
> 10,000 cfu/ ml- sterile c:atheterization evidence of site 1pecific
>1000 du/ml• bladder atpiration infection
]
 ------ ---:N -:-e-o _n_a -=-t-a7l--:-:H-y--pe-:-::rb::-1.:;-:.l;-:1.;-:.r=.u:-;:b:-:;i::n::e::m~i-=a
--i
I
--------;l \
Order: Sample
·
Photo thera py Start single blue light photolherapy. Cover eyes & genitals . WOF any signs
of dehydration "'

428

- 342

- i 15

-
257
li5
- 1 10 171

-~ -a
5
.,_
-·
~• • • •
...... 1----- -
Infants at lowor r1sk (~ 38 wk and well)
lnfanls at medium risk(~ 38 wk+ rtsk factors or 35-3 _ ~ 85
-
-
-
en wk. and well
0
- .,____ _

Blnh 24 h
Infants at higher risk (35-37 6/7 wk. + risk factors)
7
=: :,
- J-

0
48h 72h 96h 5 Days 6 Days 7 Days
Ago
• Use lotal btllrubln. Oo not subtract direct roacfing
or conjugate d biUrutrin.
• Riak toctore • lt,oimmun o homoty,Jc d lsoaaa, OSPD
daflefeney . &sphy,tla. algnfficant lethargy, temperab.
&epsl• . acldoals, or albumin < 3.0g/dL (if ~uured ) ne lnstablillty,
• For won Infante 35-37 en
wk can adjuat TSB lewl1 tor lntarwntio n aroond the
medium rt■k tine. tl 1:, an 011Cion to
lmorvono at loworTSB 1°"°'8 for Infante cloaarto 35\~
and ■t hlgharTS B lowl1 lorlhoso doso, to 37 fV7 w%..
• II 11 an opUon to provtdo convonllon DI phOtothor opy
In oo,pnat or Dl homo ol TSB tevots 2-3 motcn. (35--50mrn
below thoeo •hown but home ~tothGro ov ohould oU\..)
not bo usod In unv infant with ,lr;k factoro.

•Excha nge Transfusion - - - - - - - - - - - - - - -

----- - AAP -
ao - -• !. . I I I
__ tnfanta al lower I I I
risk (2: 38 wk and I I I I I I - ~ S1a

-
well) _ ~
1-- _ - - Infants at medium r1&k (2: 38 wk+ r1ak factors or
35-37 617 wk.. and well _ ~
i-- _ _ Infante nt higher risk (35-37 8/7 wk.+ risk factors)

... _

-
1,-

-· --- - -- - .
428

. .
20

,_
.,,,
_,.. ,
-· - 342
1
:1.1-

-
15

10 ....
e ..
-
- ,---- .,,,
,r_lh_.....__2..4_h_.....__4...6'-11- -'-- 7-2L..h_......_ _ 96
......_h_..__5_D_a1,.y_s_ ...._6_D,1.ays_...,1__7_D.1,ay
257

_ s~ 171 '
-,_

- ' • Tho dnGhod linoG for tho llrat 2A hour& lndlcoro uncortnlnt
Age

--
y duo to o wldo rango ol dlnlca.l ctrC1MnAlance!:,
and• range of re1ponsea to phot01nera py.
• tmmodlaJo CIXChDngo lmnatu&lo n ID rocommon
dod If lnlru\t &haw5 oJgna of ocuto b 1llrubin oncophDlo
(hypertonl a, •rchlng. relroc:olh. opl•lhOton os, fover, [Link]
aboYe thoee lines. Ngh p i\chod cry) or If TSB Is ~ mg/dL (SS~mo&IL.)
• Filak factor• - 1soimmun o homotyUe dlsoac.o, OSPO
lnstAbilcty, aep,afa. ocidoale. doflel'ency , aephyxJa. ■lgnlfieoinl lethargy, lompora tu,o
• Moasuro • orum albumin and ealc:utate 8/A ratio
(Se• lc,gond)
• Use [Link] bWtubin. Do not awbtract d'arad reacti
ng or conjugate d bilirubin
• U lnfant la wen and 35-37 0/7 wk (mecRan risk) can
lnc'1vlduauze TSB level& t o r • ~ [Link] on acwal
goGlDUono l ogo,

• Volume of blood for exchan ge (ml) • 80 ml x

~----l b=ind red 11-- --- 11
weight (kg) x 2
• Volume per aliquot fa r exchan ge (ml) • 80 x
- '11- - - --t_~ ~~-- J--- -•1---f
weight (kg) x 0 .05
f ~
P~eCoa nbate~ I
• # of exchang es'" Volume of blood for exchang e/ ~
Volume per aliquot
• Give 1-2 ml ol 10% Ca gluconot e by SIVP after 100 ml
ol exchang e blood
f
1
lnaimuuz ation H~
r Carimw.!~

Rh J- -r
• Check Bilirubin, CBC w/ pll, Eledrolyte, Glucose, ABO "f "f
Calcium levels
Preterms~FA~N~A~RO liood IJlllJP 01her ANoanol oc lcm I l,idi ~ ) I
~ FF~ ----- --•1 ---_ _;-- -J- ~ t

. CRITERIA FOR PATHOL OGIC

JAUNDI CE
CORRECTED RETIC CT (CRC)
• (% roliculocytes x Actual Hcl) +
..
• On,et within 1" 24 hours of Ille Normal Hcl
TSB ,;..,, >5 mg/dL/24 hrs % RETICULOCYTES • Tolal
~
TSB >12 mg/dl (term), 10.14 mg/dl Reliculocyle, +
(1000 RBC x 100)
(prelerm) RETICULOCYTE PRODUCTION

.• Perslll"s alter 2 nd week of file

Conjugat ed billrubln > 20%
INDEX1 Corrected Relic Ct
Molurallo n Time
+ NELSON
 --- --- --- -:: Ne:-:o::n::a-:ta:;l~H:::y:po:g:;l:y;
ce:;m~ii:a:- -- -- - 7
anagemen o os a a ucose omeos as1s m
.,
a e re erm
and Term SGA, IDM/LGA Infants
(llPTJ lnbrll! M- 36"-o nd SOll (,.._0.2A In~ llM-
LGA llaA _ (_,_,0- 12 IWl)J AAP
Symptomatic and <40 mg/dL - IV glucos e
ASYMPTOMATIC
Birth to 4 hour s of ag_e_ 4 to 24 hour s of age
INITIAL FEED WITHIN 1 hour Conunuo food s q 2·3 hours - - -
Screen glu cose 30 minutes ofler 1" feed Scrcon glu cose prior to each food
lnl<lal screen <25 mg/dl Screen <35 mg/dl
Feed and check In 1 hour Feed end check in 1 hour
<25 mgld l 25-40 mg/dl <35 mgl<tl 35-45m g/<IL
. l .
IV glucose Re!J V glUcose' IV glJcoso· l
Refeod/lV glucose·
M needed as needed
Targe t gluco se scree n .!:45
• Glucose dose = 200 mg/kg (doxtrose 10% at 2 rnlAg) and/or mg/d l prior to routin e feeds
IV lnfusloll at 5-8 mg/leg per min (8~100 mUkg per d). Actliew
pta•ma glUCO!e le\/81 of 40-50 rng/dL
.
Symptom• or hypoglycemia Include: lnilabilily, lremor9,
Jltterlnes,, exaggera led Moro reflex, high-pitched ay, seizures ,
floppiness. cyanoslS, apnea, poor feodlf11l. le!hargy,

TIMING OF HGT MONIT ORING (HOUR OF LIFE)

After glucose hos been normal for 2.4 hours and
' • SGA, LATE PRETERM: 1st, 3rd, 6th, 12th, 24th
enterol leedings hove been started , toper IV
• IDM, LGA: 1st, 3rd, 6th, 12th HOL
GIR by 1-2 mg/kg/m in every 4 to 8 hours as
, • Weight of </• 2.S or >/a3.S not mentioned above: tolerated. IV GIR connot be below .d-6mg/kg/
Spot Hgt min until feedings hove been started.

Hyperglycemia
• Blood glucose >125 mg/dL (Term) , >150 (prete
rm) or Plasma glucos e >150 mg/dL
• Causes : IV glucose , Drugs (Steroids, Theophylline), ELBW
infants, Sepsis, Stress, Neonatal DM
• Treatment: Decrease GIR (4 lo 6 mg/kg/ min). Feed
baby if general condition allows. Prepare
used drugs in normal saline or sterile waler instead of glucose
solutions. Insulin infusion if

I
blood glucose still > 180 mg/dL despite other adjustm
ents. Close monitoring of Hgt.

Maintenance Fluid (Water) Requirements during the

r ___ _ • _ ~ • ___ _ • l~
Firs t
_!tt_N!R~F
~o:~ _o! - ~e__ •••_____
BWJtw~fd, : l,uwil,F.e, WoteJL : T [Link] WateJLR,,[Link] &y Age. (ml/ Ilg/ d.)
• (glUUIU) • Lou j•••• ••••• •••.•••••• •••• ••....•...••••••.. .....• •..
• , (ml/ Ilg/ ~) : 3 • 7 l Day 8 - 30 :
,--- ---- ---------~----- ----- -----i-····· ······ ·---}-------------
Day 1 - 2 l Day
• < 750 : 100
--~------·---------.
: 100 · 200 : 120 · 200 : 120 . 180 •
1---- -- ----------~-------------- -,···· ······ ·-----r---------------~-- ------
• 750 . 1000 : 60 . 70
I

: ao . 150 : 100 .150

I
----- ---• I I

•····· ······ ······ ······ ······ ···J·· ······ ······ ······ ······ : 120 . 100 •
1001 - 1500 : 30 . 65 : 60 . 100 :
······ '····· ······ ·····•
ao.15 0 : 120 . 100
• > 1500 r 15 . 30 : 60 . so r 100. 150 : 120. 100 •
~- I -----~--

Factors affe ctin g Inse nsib le Water Loss in New --·------

---- . J
borns
p -.--• ..._.._- ____ .._. _... • ..._..._.._-.- -. __.._ , ---------.-
.. • · • -----• ---• ---• • · ---• • --• • · • •
· • • · • • ----• · • -•-- • --•-• • • • · • • · •
' Factor • .- l

L-••Level
:
-•--• --••--••I•
of Moturity •
••-•-••-•-Effect on Insensible Water Loss
•---------••----•--· '
•••----•••---~:__
Inversely proportional to BW and AOG
----- ----- ----- -,--- ----- ----- ----- ----- ----- ----- ----- -----
: Environmental •
: ~ -~
: temperature obove Increased In proportion lo increment in temperature
~ _ neutral thermal zone _ •I _____ _____ __ • _ • _____
~ ___ E~::;:~a~:r:y
____ • _____ • _____ ____ • ___
' l
~l
I
___ ; _. _ • Increased by up to 300% at redal temperature

High ambient/ inspired I Reduced by 30% if ambient or I

> 37.2 C ____ ~
1
respiratory vapor pressure equals skin ._
: humidity • or respiratory trod vapor pressure
·---- ----- ----- --1- ----- ----- ----- ----- ----- ----- ----- ----- :
!1 Skin breakd
b own (eg. • Increase d; 111agmtu
· de depen ds on
---J
extent o f Ies1on
· :__
~ --• ----~r~L ----- -! - - - - - - - - . - - - - - - - - - - - - - - - - - . - - - - - - - - ,
• Congen
' ( I ital skinh defects
1
Increased; magnit. ude depends on size
• fd f
-- -- ---- -~ j
, eg. orge omp a Ioce Ie ) • o e eds '
•
:---- ----- :
1 d' ----- --'-- ----- ----- ----- ----- ----- ----- ----- --·--
I Increas ed by obout 50% above values obtained in incubator setting --~
•, Ra ,ant warmer • . moderate relative
with . . y an d neutra I h •-
humidit t erma I env1ron
· ment ''
~--- ----- -----
Phototherapy ---·- ----- ----- ----- ----- ----- ----- ----- -----
I
Increased by up to 25% depending on technique ---~
r••····••••- •·•••I•• ••·· ·····
1

•·•· ··· ····· ····· ··•·- ····· ··· ···~~ •

: Double walled [Link] I
_ ___ ~______ . ______ _____ ._. _.,:...L•
Reduced b 10.30%
~ • ,?~ pl_?!tl_c ~!~t_s~•~~d__ ! _________ . __ . _____
I
 Respiratory Distress in the Newborn I
-------,--------
r·---------- i,~ia;;d clearance/ I
--------------~•----------------
Central Perihllor s!reoking,
,
Self limited (<72 hrs} :
I I nN 1
Resorption of_Ruid_ .,_ - - - - - ."!Y.P!'':.0 !'~01~'! - - - - - - J - - - - - - - - - - - - - - - . l<

i. ___
\ --•---•---- -p;;t;r; Surfactant I Ground gloss, reticulogronulor w/ I Steroid prior to delivery :
RDS__ _ _ _ __ P!'~~l?,n_tt ___ } _ojr_bJ~'!c.!i~11r~!!11. '[Link]'! _~\!tJ~".9!
I Coarse Irregular patchy mliltroles,
• /
'i -____
S_urf~S'~'!t____ -~
Pulmonary toilet 02 ,
1
Post term; Hypoxia I 1
1 Inc AP diameter, Flattened t"b" t· ·f 'd d' :
, ~I MAS vogoI stimulotion -II . on 1 10•1c_________
___ c!,•C;?P..h!~!l."! _. ___ • _ •I ______ I nee e
:,,
~- -•- -•- -- - - ~;e~di~; infe::;;;nj ,- - -s~:aky Densities, ConRuent I Ampicillin + :
,{ Pneumonia Passage thru Birth I opocilied areas, diffusely granular I Aminoglycoside ?
Canal I • '!!L .P!rlar2!!c;.hp9,:o£11. ___ • ! _... _... _. __ .. _.:
~----------- ---------------- -- . I
• ~'
I
Few pores of Kohn, :
1 100% O2/Nitrogen :,
I Uneven alveolar (+) tronsilluminolion test I washout technique '
!Pneumothorax I ventilation in RDS/ : Hyperlucency on affected side I Needle Aspiration/ ~
1~ MAS, Ov~rz~o1ous 1 1 Thoracostomy tube :
t 1
resusc1to1ton __ .I. _____ •• __ • __ ••• ___ ••• J. __ •••• _ • __ •• ___ ,
I
,1:.:·:.·:.:.-.:.·.:·.:·.:-:::·:.:-:.:·:.:.-~-.:-.:·;.:;.__-::---:-----~;"."'.'.=-=-=~-=~-::=--::;--;;:::--::;:-:::-::-----,1
, Persistent Pulmonary Hypertension of Newborn
•l ---------- ---;,,
-~'.1 .P_u_l_m_o_n_a_ry_D_i_se_a_s_e_.'llimproves, PO2 rises to> 100 mmHg)

''-~:~:::-)-+ ~~:::xia ~I Cardiac Disease I !still blue, PO2 rises to oniv 1~0 mmHg)
ti...___~~---·
t : = = = =[Link]°:¼,:F:i[Link] x:1~
0 -m- in_s_ _ --:• ------;;,~- -t.l___ ,P_H_N
__ _,.l___,
respiratory distress, (improves, PO2 rises to > 100 mmHg)
Hyperoxia .....,..,.._ _ _ ___
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .-..- - - -- -
cyonosis, labile hypoxia, '-Hyperventilation / --...I.
pole grayish hue of skin, ~es'/" ~ _ Cyanotic _
hypotension, single second 1----,,..,.,,.,.
6To°
~ Fr,,Jo!1"!~x.,,i""
o-m 1
- in_s_ _ _ __ _ _ _ _ _ _ __.._ __ _ 1
10 0 2 (little/no response)
Keep PaCO2 at 2~0 mmHg
• Avoid hypothermia , polycythemia/onemio, hypotension, overslimulation
• Supportive: Mechanical Ventilation, Surfactant, lnotropic Agents
• Pulmonary Vosodilotors: Inhaled Nitric Oxide, Prostacyclin, Sildenafil (LD: 0.4 mg/kg over 3 hrs
ff by continuous infusion of 1.6 mg/kg/day * avail as [Link]/ml IV soln, OR 0.5 to 1 mg/kg/dose
orally TID), Magnesium sulfate (25 to 50 mg/kg IV infusion over 30-60 minutes diluted lo
concentration of 100 • 200 mg/ml)
• Extrocorporeal Membrane Oxygenation (ECMO)

'1 cessation of breathing for greater than 15 to 20 seconds :-

: OR < 15 seconds if accompanied by oxygen desaturation and bradycordia :
I TX: CPAP, AMINOPHYLLINE, CAFFEINE I

---: ---------------
CENTRAL ---------------
I ---------------
OBSTRUCTIVE I ---------------
MIXED ---J~
:
~
r--------------
T I tt· f
------,---------
•
------------r--------------------~
I infant tries to breathe against an
o Ia cesso on o resp1ro1ory I obstructed
· respiratory effort '-
•
: effort with no evidence of I obstructed upper airway, 1 usually following a central :
_; obstruction, I resulting in chest wall motion I pause :_
, ___ ______ __ I _ ~i!h_o~~ ~o!~l_ai'!l~~:. ___ L _ __ __ _ _ _ _______ .!.
CPAP (Continuous Positive Airway Pressure)
I
• Compressed air: [ 100 - (desired FiO2) / 79] x 02 Row rote (o-8)
• 02 : Flow rote - Compressed air J
Mechanical Ventilation
Need for MV: pH <7.2, pCO2 >/=60mHg, pO2 </,.50 mmHg al 70-100%, CPAP 6-10 cmH20, persistent
_ apnea, ELBW <l000g, obstructive anomalies
fa
Parameters:
• Peak inspiratory pressure (PIP): usually < 20 cm H20, but up to 25 in prelerm, 30 in term

,. • lnspiratory times 0.35 to 0.4s (may be up to 0.6s)

• Rate: 40 lo 60 breaths/min (may be decreased to 20 breaths/min during weaning) • • ~
m
• • Positive end-expiratory pressure (PEEP): usually 4 to 6 cm H20, but may be as low as 3 or high as B -
cm H20 depending on underlying pathophysiology
•

• Fraction of inspired Oxygen (FIO2): 21 to 100% • a

i- • Flow rate: 6 ta 12 liters/min / '1111111111. i--
• Tidal volume: 4 to 6 ml /kg _.,
• Mean Airway Pressure (MAP): 10 to 12 cmH20
• MAP a (PIP-PEEP) x (Tl + (Ti+ Tel] + PEEP
~ "'1
"' l. -
• Oxygenation Index: (MAP x FIO2 x 100) + PoO2
• </=15 mild HR, 16 to 25 moderate HRF 26 ta 40 severe HRF >40 very severe HRF, (01>25 requires
iNO, 01>40 ECMO) ' '
 M9clla11ica1 \llelnti1.a:t:ion
[
Rate PIP PEEP IT Fi02
To t PaC02 ! NA ! NA NA
To PaC02 f NA t NA NA
t~~:___J__-------
. .~~:~tr. .:~:~~::. !-+-__:~
- :'-------'+- -I:-- -+--I:--- - t- - :N: - :t:A ---r-~I:--,J:
--___._=~--=----=-~~~;;;;;;;;=:;;;;;;;;;;;;;;:;:::.
Adequate
:;l Hypoventilation (may
Acute Deterioration of breath sounds need higher
Ventilated Infant w/ hand pressures) OR [
(Hypotension, Hypercopnea, "JI ventilation, px Partial Tube blockage
Bradycardia , Cyanosis) ,, imaroves (s uction/ ch ange tube) ,

Barotrauma • do OCR
[ 2 Clinician at bedside
Inadequate BS
px doesn' t Tube blockage/ I.
improve Malposition
(reposition/ change
tube) OR
Remove infant from
Medical complications
ventilator. Hand ventilate .__
(IVH,
_ _sepsis,
_ _ _shock)
_ _ __.!..
with anesthesia bag &
moving
manometer
Machine Failure
•Hoses disconnected .l
Pressure gauge
not moving •Nebulizer hood off ,•
•" ( ) STANDARDS OF NEWBORN CARE •Internal Machine
Q'f; ,________,I
malfunction rl
1 SUGGESTED METHODS FOR USING VOLUME CONTROLLED VENTILATION FANAROFF i
1 ---------~------------
S I
--------~----------~-
AC : d :
----------······------ ------·······---------~
: Woon by reducing volume os lolara lad bul conlinue in AC w/ 1•
• •• I I tarl In vo ume mo e, , • . .
, lmtia , Ad' I h h' , W . , conlrol role to assure normocopn1a & hdal volume at 3-4 ml/ kg. ,
,
Mo de , 1ull vo ume al I e mac ,na ,
, d . -4-6 L/k , eamng ,
, . h / h
Sw,lc lo SIMV PS w en contraI role "<30
, b hs/ •
real m,n. •
10 e1,var
1 : m g. : ! Load wilh melhylxanthine
1
---------~ --------------------~---------- ~-- ---------------~----- ~-- ----------.--------1
Time limit : Use flaw lo adjusl inspiralory: Weaning to: Decrease SIMV rate lo 10 • 20 brealhs/mm.
(A/cl !• 1,1me 1o o.2 Io O,4, seconds. :, extu ba t"10n !,
1
Decrease pressure support lo maintain Hdal volume al
_ ml/k .
I,
\•
3 ·4· - • • !Ra •• •• • •• · ·- · • • • • •• • 1.
.••..•.•.,•• . . . ·- . . ... -· . . . • · - · r· • • • . • •••• , ••• . • . •• ..... • ••• • ••
Target : pH 7.25. 7.4, pCO2 .40 . 60 : Trial of : Consider when pressure has been weaned lo provide al 3. 4 ml/ !.
, ABG : mmHg, pO2 50 • 80 mmHg : extubation : kg TY & baby breathing spontaneously al low rate SIMV j
L-----------~---, Arterial
~ ~:'wvobl
:...._A.~:.l~!r\~!'!:~~L ..
1 pH <4Sh !
7· 3 • 7.4 : :rl.:E
•·······>.~h. ... ;. .z,:i:;.a7.~ ... 37~ 1
& V~nous Blood Gas

1.d2!l
41.756
61 , ~0.10
727•0.07
7.2!aOJJ7
-=~, 3.8i29
4.8 •:12
[Link], U.J
Zl.3: 15.0
j~,
~~":;;» ~°:":'2'
[Link] 9Jl '
54.!l t 105
:..... f~.~~.....J....~~.:~....: 42 [Link]!i2 7ZltOJJ7 5.4.3..3 22.6: lo.O 572: 10.5
: p02 !roam ! 60-80 ; Pnma,y
Expected Compensation in
• a ,r) :
:·itcoa:·<·.iai.T ..i9·:;;···~ I
Raspindory
Alnllmairy
4Pco,
Comc,onsolll,n
dHCO,· Acid B(!'se Disorders
:•••••••.. > 48h j... 20. 26 ••.J [Link]--.. r t rmi Hg T 0.1 IT'EqlL FANAROFF
Aau ""-= I 0.25 rr£Q,\.
~ - Venous Cord Blood Gas "I
: Base EJues1 ; • ,4 lo + 4 : L 1 rmi Hg
• • • • • - - • • • • • - • • • • Onn:ocdood t lrrmf<g [Link],1-
Onn: a1ka1am ! 1 rm, Hg l 0.5 IT'Eq!L
- - -. (Mean +/• 2SD) ~
• • • • • • • • • • • • • • • • • • · , • • • • •• • • •• • • • • • • • 1
• pH : 7.25 to 7.45 I
Mllabollc dHCOj 6Pa>, •··· · · ···· ·· · · ·····l ··· · ····· · · · ··· ·· '
•- -- - - - - - - - • .
_ _._
_ _ _ _ _1_1_rra,,\.
......:___1_ 1_.2S
_ nm .=..... - - - -: ••••• PCO2 ..... :. 26.8 la 49.2 .;
_ Hg
Ablooit TI rra,,\. [Link] : • • •• •• P02 ... .. .i..17.2 ta 40.8 .:
1b HARRIET LANE - l1· . . . . HCO3· : 15.8 lo 24.2 I
~~ Anor!al blood [H '] (nmol/Uter) . . ... . ... ... .. : --- -- · - .... ..... . . . l
~ r 100 90 80 70 80 50 40 30 20 ~ !~s_e_?!~s_s j __ _o_i~ :8__J
r•••••••••••••• • •••
60 111 OB ~ Arteria l Cord Blood Gas •
I I
:········'Mean ~/· 25D) ....... :
52 - ; ....... PH ....... jJ.18 to 7.38 .:•
• pCO2 : 32 .2 lo 65.8 •
48
_ ., <'.:'

~
44 --J......P02. . ... . :. . 5.6 to 30 .a .. ~
g 40 :..... H~O.;l:,..... j.... !lJP..i 7.... ~
_ g 38 _ ; Base Excess i O lo .a '
,;;
0 .. ----------- -------,
L •• • •••• • '•• •• - - - - -'

- .. (,)
32
; Capillary Blood Gas :
~ 28
- •........ .!Mean+/• SD) ....... ,
~
ii
24 : pH i
7.395 (0.037) :
1-····· ·· ··-··· ···· ······· ····· ··· ·· ·,
20
..
~
:z 16
_ ,
, pCO2 : 38.7 (5.1) I
................ ; .. ·-··--··········· ...
: . .. . . pO2 .. ... :. .. . 45.3. (7.51.... ;
12
- .,' Lactate :' 2 _6 (0.7)
I1 ,
e :..l~m~•J.~l..:...................~
4 :.H9b (9/dLl.; ... 20.4 ( 11.61•••~
0 +-+-+--'.--+--+-+-+ -+--+-;-+-+-+--;- +-; - : Glucose j 69 ( l.4) :
:...(~~!~~)...:...................~
7.0 7,1 7.2 7.3 7.4 7.5 7.8 7.7 7.8 --> iCa (mmol/: 1,21 (0.07 ) ! ,
Arterial blood pH
: - • - L). - - _:•• - • - - • - • · '
 Prematurity
[
• Chronological age/Actual age/Postnatal age: time from octual day of birth
• Corrected Age: Chronological age - no. of weeks born before 40 weeks
• Post Menstrual Age: time between the 1" day of LMP and birth plus time alter birth

Bronchopulmonary Dysplasia
·----------,-----------··············1··························,
, < 32 weeks >/= 32 weeks '
L • • • • • • • • • • J • • • • • • • • • • • • • • • • • • • • • • • • • J • • • • • • • • • • • • • • • • • • • • • • • • • • ~-
: Time point of I 36 weeks PMA or discharge to home, I> 28 days but< 56 days postnatal age or,
1 assessment I whichever comes first I discharge to home, whichever comes first :
'-·-·······1········································-········-··
, Treatment with O}!:ygen >21 % for at least 28 days PLUS :
1
~------------------------------------i·-------------------------~
, 1 Breathing Room Air at 36 weeks PMA Breathing Room Air at 56 days postnatal '
I I
: MILD BPD or discharge, whichever comes first age or discharge, whichever comes first :
L •••••••••• J ••••••••••••••••••••••••• •····•••••·••••-••·•••••-·-1
: MODERATE I Need for< 30% 02 at 36 weeks PMA I Need for< 30% 02 at 56 days postnatal,
: BPD I or discharge, whichever comes first I age or discharge, whichever comes first :
·-·······-· ·······-·······-·····-·--1··-·-··············---·--·,
, l Need for>/= 30% 02 and /or PPV or Need for>/= 30% 02 and /or PPV or '
I
SEVERE BPD NCPAP at 36 weeks PMA or discharge, : NCPAP at 56 days postnatal age or •
1
whichever comes first discharge, whichever comes first :
••J J e •••••••••••• ••••••••• •••J•••····-• •••J •••• ~--~--- ~• ...._.
DART (Dexamethasone, A Randomized Trion Protocol for BPD
JO days
0.075mkdose q12h x 3 days, 0.05mkd q12hx 3 days, 0.025mkd q12h x 2 days, 0.01 mkd q12h x 2 days
.l..dayi
0.075mkdose q12h x 3 days, 0.05mkd q12hx 2 days, 0.025mkd q12h x 1 day, 0.01 mkd q12h x 1 day

Tomporatum gasb1c retention,

Instability, apnu, abdominal normal, or Intestinal NPO. antibiotic x 3
IA lUSPEctED bredyoardla, distention, emesta, dllatlon, mild lieus days
lethargy heme-poslllve stool
18SUSPECTEP same as above gro••iy bloody ~ol 1 same as above same as IA

umemabove+ [Link] dilation,

HA DEFINITE. absent bowel sounds, NPO, anbblotic x
same as above lleus, pneumatosis
MIU>[Link] wl 01 w/o abdominal 7-10 days
tenderness lntes1inalis
same as above, • aama as above, +absent
11em1N1TE, mild metobolic bowel aounds, definite same as IIA. + NPO, antibiotic x 14
tondemess. w/ or w/o
MODERATELY ILL acidosis, abdomlnal CIUUIIIII or ascftes days
thrombocytopenia
- -as-118,·+ -- --RLOman
- same --
NPO, antibiotic x 14
hypotonslon, same as above, +
days. fluid
I
RIA AOVANCE!i bredycerdla, sovore llgns al perttonltls,
same as IIA, + resuscitation,
SEVERELY ILL, apnea, combined mertc:ed tenderness,
asolles lnolJCpio support,

1'JJ-
INTACT BOWEL resplre1ory & abdominal
ventilator lherapy,
metabolic acidosis, dl•lontion parucentesis

1118APVANCEO,
_ .P.!£,J18lllr0P-'!!'!9~ - ------ --~-- --
SEVERELY IU., sameaallA aomeaa IIA
same as above + ••m••• IIA,+
PERR>RATEO pnoumoporttonaum surgary
BOWEL

~ Intraventricular Hemorrhage U Use of Supplements (VLBW)

r-----r-------------------------••r•-----,-----------------------~
' GRADE Description •, v·, D •oo 1000 · •
p - • - .... - ••• - ••• - •••• - ••••• - •••••• , I I I .. • IU I
• Grade I L Germinal Matrix Hemorrhage Fr • • • • • • •1• • • • • • • • • • • • • • • • • • • • • • • .,,
1
- • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ·• Calcium 120- 200 mg/kg/day (1st month) '
: Grade II I lntraventricular Hemorrhage without : ~ •••••• -I • •••••••••••••••••••••• ·:
r •••• • L ••.•••• [Link].<tilgti,oo • •••••• • :;,P~2•p~ 0!',!•J • • _6p; !-1,0_"l!i/~!i/~~.(! ~ T2~~) •• ;"
: Grade I lntraventricular Hemorrhage with ocute , , Vil E I Preterm : 6. 12 IU /kg/ day, Term: 3--4 ,
ca.o
Ill Ventricular dilation : ~ • • ,·ran 4. · i k-/d -• 2· ·
• • • ·• • ;-- mg g ay a~ wee·k·s ·• mos ~ 6-· ·
• - • - • .L - •• .t,lgtJill~>J>.D~.01ti,; y,u,1,r~l_p L •• _• :"' - • • • • - - • UANIS'JOO:S"s'" Of fillMbllN" Ula..

......
Polycythemia
• Peripheral blood Hematocrit >/=65%
~ •
•
Symptomatic or Hct >70% : do partial exchange transfusion with NSS
Asymptomatic, Hct 65-70%: increase Ruids, repeat Hct in 4 to 6 hours ,
• Monitor Hct and platelet level, serum glucose, Bilirubin, Calcium

Anemia
I I.I~
. • hemoglobin or hematocrit value that is more than two standard deviations below the mean for age
• Central Hematocrit < 40 %
,. • PHYSIOLOGIC ANEMIA
• TERM: manifests ol 8-12 wks, (hemoglobin, 11 g/dl) -
• PRETERM: manifests al approximately 6 wks (hemoglobin, 7-10 g/dl)
• ANEMIA OF PREMATURITY (1 to 3 months, <7. 10 g/dl): pallor, poor weight gain, decreased adivity,
lachypnea, tachycardia, ond feeding problems -
 Birth Asphyxia & HIE
• Metabolic acidosis with pH <7.0 {in umbilical cord or infant blood sample)
• Base Deficit -12
• APGAR score = five at 10 minutes with a continued need for resuscitation
• Presence of multiple organ-system failures
• Clinical evidence of encephalopathy: hypotonia, abnormal oculomotor or pupillary movements,
weak or absent suck, apnea, hyperpnea, or clinical seizures
• Neurologic findings cannot be attributed to other cause (inborn error of metabolism, a genetic
disorder, congenital neurolog ic disorder, medication effect) "·i ··,·\,-i,r,i ·,,.• ·,:1 '{J
Sarnat & Sarnat Staging of HIE
r••-------••••••·•••••••-••••-••~-•••••••••••-••~---••••••••••••~
\ ~tL::u......~- L.._--a
, : Stage 1 : Stage 2 : Stage 3 '
L-• • • - - • • • • • • • • • • • • • • • - ~ - - - - - - • • • • • - - • • • • • 1 • - - - - - • • • - • • • • • • • • • • • ~ • - • • • • • • • • • · • • · - - ·
-••·
1 Level of consciousness : Hyperalert : Lethargic/Obtunded : Stuporous :
ct1 ••••••••• -------------········-- ---------~----------- ----------"··--------- ----------.
Neuromuscular control : :
t----·······•····•···• ·r••········••···•··~ •-··--·•···•···•·····~: •
---·····-•··•·•··•··· 1
~~ •••••• Muscle tone •••••• ~ •••••• Normal •••••• ~ ••••• Mild Hyeotonia •••• ~ •••••••• Flaccid_ •••••• _i-
~ •••••••• PoshJre •••••••• ~ •• Mild distal Rex Ion •• ~ ••• Strong distal Rexion •• .;. Intermittent decerebrotion 1
: Stretch reRexes : Overacnve : Overactive : Decreased or absent :
_r ·········-········-···~ ··-···············~·-· ··················~··· ·······-·--··--···1
, Segmental Myoclonus : Present : Present : Absent •
•·············-··--··· ·~··················J ·········-·····-·--·-~ ······················
~. Complex/Priminve ReRex • ~ •••••••••••••••••• j ...........•......... J. .................... :
,.~••••••••• Suck ••••••••• ~ •••••••Weak •••••• ~ ••••• Weak/ Absent •••• ~ •••••••• Absent ••••••• :
,I Moro I I
I Strong ; low threshold •
wea k; .mcomp IeIe ; H'19h 1I Absent I

-4 ...................... ~ .................. ;....... Jlir~,bold••••••• ~ •••••••••••••••••• • •• :,

, Tonic neck : Slight : Strong : Absent
•··········-··-··-····
Autonomic Function
·~··················~ --············-······~ ··················-··•,
1 • • ,
~'··-···············---- ~--------·--··--·-·J - .................... ~ ..................... 1•
I p • '1 Md. . ,' M' . . ble, oft en unequa;I I
,' Vor,a
1
up, 1s : Y r1aS1s : ,os,s : 1
1 poor light reRex 1
····-·--····--·-······- •-···-··-··-·---·--1· ··-··----·---·--·--· ~-·-·-·--·----···-··-- •
"" Heart Rate ; Tachycardia : Bradycardia : Variable 1
~ ••••••••Seizures•••••••• ~ ••••••• None••••••• ]. Common; focaVmultifocal JUncommon; Decerebration;
I I I • I • I
•; EEG : Normal : Low voltage changing lo : Burst suppress,on lo 1 ~
!....... _____ ............ __ ~ ........ _... _.. _..... ~- ..... seizure adiviry' ...... ~ .... _. _ _isoeledric ....... :
: Duration : <24 hr if progresses; : 24 hrs to 14 days : Days lo weeks :
, ............................ .......................
1 otherwise normal
•
~ ......................... ......................... ,
~
1
~
• ,

• Outcome : Good : Variable : Death; Severe DeAcits •

~----------------~--------------~---------------J---------------~
I Twin to Twin Transfusion Syndrome
• occurs when vascular connections
.... stage --
Description (QUINTERO STAGING)
{arterial-to-venous, venous-lo-
-
I Polyhydramnios (DVP >8 cm) with
arterial, or arterial-0rterial) form oligohydramnios (DVP <2 cm) with bladders
between the umbilical cord present in both twins
vessels of both fetuses, resulting in
a bypass of maternal circulation
and an imbalance of umbilical
- II
Ill
Bladder not visible in the donor twin
Changes in umbmcal cord or ductus venosus
flow.
• Growth discordance of 20% or
- IV
end-diastolic flow; tricuspid regurgitation in
the recipient twin
Evidence of hydrops in either twin
more weight difference
• Hemoglobin difference of >5g/dl V Fetal death
FANAROF~

l __________B_i_r_t_h_I_n...;;j;...u_r_i_e_s_ _ _ _ _ _ _ _ _...Jl·
r...
r•••-------··•·•••·•••1••••••-----•-•••·•···~---••·······•••·•·•--1 1
,'

: CAPUT SUCCEDANEUM ; CEPHALHEMATOMA SUBGALEAL HEMORRHAGE ~ !

r• ••·················•••· ••••r .. ••• ................................. ... .............................. .... - .. ,
~

1
1 edemo over presen t'ing par t of th e :, subperioteal colledion of blood; : collection of blood beneath the
, • ,
, I t It .
sea p, ex erna o penos1eum , rupture of capillaries traversing from, aponeurosis; rupture of emissary
,, ai
1 , , ,
, : skull to periosleum : vein; may extend from eyes to nape
r·····-··············· .. -- ...... ....................... ....... , ........................... ........1,
1
crosses suture lines : does not cross suture lines : Arm Ructuant moss increasing in size 1
lI ...................... ...... •··••••··•··~·······•
I ······•·~·•··•········ ····•••······· lI _,
I
1 overlying skin with petechiae/ : scalp not discolored : complication: severe anemia & ,
: purpuro : complication: hyperbilirubinemia : hypovolemic shock :
J• .. • • • • • • • • • • • • • • • • • • • • ......... L • • • • • • • • • • • • • • • • • • • .. • • • • .. • • - ~ • • • • • • • • .. • • • • • • • • • • • • • • • • • •
l
1 . : . : volume replacement, blood 1
' resolves 1n 48 to 72 hours • resolves ,n 2 to 8 weeks ' d . Id . 1
1 : : pro ucts, surgrca romoge •
·---------------- ----------------- ----------------- ---------------·
r••••••-••••••••••••••••••••••••~-•-•••••••••••••~•-•••••••••••••\
: : MC is
FRAaURE OF THE greenstick type, but : kx, decreased movenienl : ConArmalory Xray '
: CLAVICLE occasionaly may be
: ; of affected arm, crepilus : Callus formation at 7-10 :
~, ••••••••••••••••••••• :. •••••••C.?!'[Link]~t.!'••••••• ~ ••••••'?'1 pp!P.,aJloJl•••••• ~ •••••••• _d_oy] •••••••••,
: : I . : arm adducted & internally : p . I I bil' • :
ERB DUCHENNE PALSY , upper arm para ym , d f d , arho mmo tzation
: : injury of CS, C6 : rotate '- orearm pro,nate ' : Good prognosis : ~
,, ••••••••••••••••••••• ~ •••••••••••••••••••• ;. ~!!s! ~~~~~ j~?!t~~? !ip). l ••••.•.••..••••.•••••:
I I , I
• '• lower a rm por a ly s1·s •I hand ,s paralyzed, grasp ,
I
1
. , KLUMPKE'S PARALYSIS•
• I • ,, 1

~
. . f C CB Tl reRex absent, Horner • Re 1ahve y poor prognom ,,.
m1ury o 7 i ' • •• ~
: •..••••••••.••...••..;.•..••••••.• : .• : .•••• ~ .. SJ!'~!'2'!'!\ !~I~'!". ~'?'!<!l.. ~ ...•.•......•........:
: TOTAL BRACHIAL : entire arm paralysis : Aoccid arm, all reAexes : :J
~ ....... !.~~rr........;....
[nj~ry. <2t ~~ .'?.1:1.... ~ -....... '2~!~n1 .••.•••. ~ •••.•••••.••••••••.• .:1
1 : d' h . I . : respiratory distress : Roal ttmo ,anogrophy . :
, , ,op ragma 11c para ys1s , I .
.! PHRENIC NERVE PALSY, I. f CJ t CS , CXR: e evallon a f off ecle d ,, d I
para ax c mowm•
n1
~• •
: : ovu s1on o o : hemldiophrogm : spontaneous complete recov■ ry : J
- - - - - - - - - - - - ____ J _______________ · - - - - - - - - - - - - - - - - ~ - - - - - - - - - - -- --- ·
I,--------~==-==~~~=--------
I Common Medications NEOFAX

':"' Amikadn: Dilute to a Rnol concentration of 2.5 to 10 mg/ml 1-

..! .-.~ .~~~.-l~~.l!~!l.~ ~
1
r .~~!~~!;fj~.C!\'!i.·.1 ~.-. ~~~;.l'!1~~ei:.~1.. _lnt;~C!~ ,~;'!i:si:.:..
: 0 lo 7 ! 18 • : 48 :
: </•29 : 8 lo 28 : 15 : . 36 ,
~ ··· ···············"·~·· ·····E.l.~;a9.. ....... ~ ......... l5••••••••• ~••••••••• .2.4 •••••••••
' 30 • 34 : 0 lo 7 : 18 : 36
r-
'
-fI · ••.••.•.••••••.•••• -:•' •••••.•.>/:".vII •••••••• ~' ••••••••• JC"· •••••••• ·!·' •••••••• A.4 ••••••••• Ij-
, >/•35 : ALL : 15 : 24 ,
~--~---~---------------------------------------------------------~
Ampicillin: Recommended concentration: 30,40,50,100 mg/ml
1

Usual: 25 to 50 mg/kg/dose by SIVP or

•

~ IM PMA (weeks) [Postnatal.(Days)} interval (Hours)

• Meningitic-(Baderial): FDA dosage
</m29 : Ota28 : 12
• >34 wks 28 days/less: 50 mkd q8 : > 28 : 8
• 34 wks/less:
• 7 days or less: 50 mkdose IV q12 30 • 36 r Ola 14 1 12
• > 14 • 8
• 8 to 28 days: 75 mkdose IV q12 ·------ ----t----------------~---------------
• Meningitic (GBS): Guideline dosage 37.44 :
0to7 : 12
• 7 days or less: 100 mkdose IV q8 : >7 : 8
············-,----------------,---------------
- • >7days: 75mkdose IV q6 >/=45 : ALL : 6

.
Aminophylline:
• Loading: 8 mg/kg IV infusion over 30-60 minutes
Recommended concentration:
1, 25 mg/ml
• Maintenance: 1.5 lo 3 mkdase IV every 8-12 hours
• Amphotericin: 2.5 to 5 mkdose every 24 hours IV infusion (at cone. of 1 lo 2 mg/ml) over 2 hours i-
Caffeine Citrate:
• Loading: 20 lo 25 mg/kg IV over 30 minutes
• Maintenance: 5 la 10 mg/kg slow push every 24 hours (started 24 hrs after LD)
• Nescafe 128 mg/2g sachet+ 25 ml SW to make 5 mg/ml solution. LD of 10 mkdose then
• 5 ~kdose q24 I
Off caffeine : 5-7 days opneo free off support or 33-34 wks PMA whichever comes first
Calcium gluconale: - - - - - - - - - - - - - - - - - - - - - - - - - ----1
• Initial: 100 - 200 mg/ kg/dose or 1-2ml/kg/ dose
I•
• Maintenance: 200-800 mg/kg/ day or 2-8 ml/kg/ day continuous IV x 3-5 days
Cefotoxime:
• Meningitis: Recommended concentration: r-
• 0 lo 7 days: 100 to 15 0 mkday IV divided q8 to 12 hours Push: 50 to 100 mg/ml,
• >7 days: 150 lo 200 mkday divided q6 to 8 hours Infusion: lO to 40 mg/ml i-

p - - - ·- - - - - - - - - ·- - - - - - ,- - - - - - - - - - - - - • - - - • - - - r . - - - - - - - - - • - .•• - - • - . ..
_____ ?~-~ l~4=!~sJ _____ ,1_ • __ _P_oJtn.a}~t [Link] • _ .. L _ •• _ • __ '!!Qi~e.!1. ___ _. _;
~
•'L ____ ___ t,~ ~!l~kJ _____ __ _I _ _ • _ ___ _":, Z~~is___ _____ ! ____ ~<?. !!1~~o.s~ !~ 9t2_h_ ___ .J
: ______ < 32 weeks ______ 1__ __ _ 7 dov; or older _____ 1 ____ 50 mkdose IV q§h ____ :
r I 1 1
_, 32 weeks / more · • 7 days or older ■ 50 mkdose IV q6h
Ce~azidime:
• Usual: 30 mg/ kg/ dose I
Reconstitute 500 mg vial w/ 10 mL SW ->50 mg/mL
1·
• Meningitic: Recommended concentration:
I
• 0 to 7 days: 100 lo 150 mg/ kg/ day every 8 lo 12 hours 1 to 50 mg/ml
• 8 to 28 days: 150 mg/ kg/ day every 8 hours
• ___ _P_o1tn_a_t~l lD_ay1t ____ •
_:. _____ !'~_'\ l~!!~sJ _____ -41- • _. _ • !'!.tM'!C!.I Jtt~!!tsJ _•.• ~
: </•29 I O lo 28 I 12 :
' I > 28 I 8 '
.., ~---------------------------------------------------------------J
! 30 . 36 0 lo 14
I
12
,-
,
I
I I >14 I 8 I

~- -------------------,---------------------,--------------------~
-, 37. 44 I O lo 7 I 12 ;-
1 >7 . 8 :
~--------------------.1---------------------1--------------------;
_, >/ a45 ALL I 8 •- 1

Colistin: Recommended concentration:

• • 2.5 lo 5 mg/ kg/day IV or IM in 2 to i divided doses 75mg/ml
Fluconazole: - Recommended concentration: 2mg/ml
• Prophylaxis (BW<l kg or 1.5kg): 3 10 ·6 mkdose IV or orally twice weekly for 6 weeks
• Loading: 12 lo 25 mg/kg, Maintenance: 6 to 12 mg/kg per dose
--- - - - - ·r - - - - - - - - - - ,. - -- .
~1!'1\klY<[Link]., P.s>[Link]>,szy1l ~J1Jt.,nq1Jtf.s>l'rv} Ftucona1olo Prophylaxis
<1000 g or <28 wk• AOG: start at 48-72h e-
i I < 29 weeks I 0 lo 14 1 48 r after birth twice weekly for 4- 6 week. or until
,----------L-----~J4 _____ J _____ Ji _____ ~ I
IV access not required
-{ 30 weeks and I 0 lo 7 I 48 \ 1000. 1500 g • if started for> 3 days of i..
· ' .. _ older __ _I _ :'J. __ I 2~_ _ ! antibiotics

, Furosemide Recommended concentration: 2 to 10mg/ml -

• Initial: 1 mg/kg IV, IM, or orally, may Increase to max of 2 mg/kg/dose IV or 6mkdose orally
• Prelerm: every 24 hours, Full Term: every 12 hours ~
• Full Term > 1month: every 6 lo 8 hours Recommended concentration:
Heparin: lD: 100 to 500 units/ml
• Patency CVC: 0.5u/kg/hr; Potency PVC: 0.5 lo 1 u/mL of IV Ruid continuous infusion:
• Thrombosis: 75 u/kg IV over 10 mlns ff by 28 u/kg per hour 10 to 500 units/ml
 IVIG
• 0.5 to l g/kg/dose IV; may repeat In 12 hours
Insulin;
• Continuous IV infusion: 0.01 to 0.1 unit/kg/hr; Intermittent dose: 0.1 to 0.2 unit/kg subQ every 6-12h
• Hyperkalemia: Regular insulin 0.1 to 0.2 u/kg/hr in combi w/ 0.5g/kg dextrose as infusion
Gentamicin : Recommended concentration: 2, 10mg/ml

~ .. !.~~ h"!'!.3~!)_ .. • . J'~~tn.a!':!I. (,!>_ay~l • 1 •• •D_0;.sJJ!.11..sJ!<SJl .. .a •• tn!t:"Y!l! i~'?'!r~l . ~

1
1 Oto 7 I 5 I 48 •
I 6 1
' </=29 1 8 to 28 I 4 I 3 ,
: I >t.= 29 I 4 ••• J•••••• • H ...... ~
~ • • • • • • · · • • • • • • • i • • • • • ·o t~ "i · · · · · i • · · · · • ·4~5 · · • 1 36 '
t... _. ~~: ~~ ..•.. :. _....>J: .0••• _ •• !.. __ ... ~ ....... !....... H •..••. ~
: ._. ____>/:35 • •----•-•- · ~ · ~ ALL--~- •.• -1~ ·-~- 4 ~-~~-- -J-.•-- - 24 _ · ·· ---• ,
Levetiracetam Recommended concentration: 5 to 15mg/ml
• Loading: 20 to 150 mkday divided to multiple smaller doses
• Maintenance: 41.7 mkday to 65 mkday ql2h
Meropenem: Recommended concentration: 1 to 20mg/ml
• NonCNS infection
• <32 weeks AOG and <14 days: 20 mg/kg ql2h; <32 weeks AOG and >14 days: 20
mg/kg q8h
• >32 weeks AOG and < 14 days: 20 mg/kg q8h; >32 weeks AOG and >14 days: 30
mg/kg q8h
• Meningitis
• <32 weeks AOG and< 14 days: 40 mkdose ql2h; <32 weeks AOG and >14days: q8h
• >32 weeks: q8h
Metronidazole: Recommended concentration: not to exceed 8 mg/ml

' .. J'.M~ .h."!!!.3~!l_ • _1 •• •L_!>!l~!nJJ. l?~~e. .. 1 • ~!l!'!.•~~C?'!C..eJ~'?s.e. .a • • tn!l?"Y!I! !~C?'!r~l • ~..

: 24 to 25 weeks I 15 mg/kg I 7.5 mg/kg I 24 :
r·············· l ··············1···············1····-······· . .. ,
26 to 27 weeks 15 mg/kg 10 mg/kg 24 •...
L - • • • • • • • • • • • • • • l • • • • • • • • • • • • • • • l • • • • • • • • • • • • • • - ~ • - • • • • • • • • • • • • -J
~-- 28to33weeks... • .... 15mg/kg· .... • .... 7.5mg/kg ____ • . . . . . . ) 2# .... ~
34 to 40 weeks 1 15 mg/kg 1 7.5 mg/kg 1 8 ,,.
L•••••••••••••••l•••••••••••••••t•••••••••••••••t•••••••••••••••J
: ____ > 40 weeks ___ !_ -•-- 15 ~gfkg .• ___ •.L __ _ 7.5 mg/kg ____ 1. •---• • f --·•·•·· ... :
Paracetamol: Recommended concentration: 10mg/ml
• 15 mkdose every 6 hou rs pox 3 days (PDA closure)
• Fever/pain: j
• IV : 32 wks/ more: 12.5 mkdose q6 u"pto MAX 50 mkday I
•Oral: < 32 wks: 12 to 15 mkdose ql2 prn, > 32 wks: 20 to 25 mkd then 12 to 15 mkd q8
prn, Term: 20 to 25 mkd then 12 lo 15 mkd q6 prn
Phenobarbital: Recommended concentration: 10, 65 mg/ml
• Loading: 20 mg/kg IV give additional of l0mg/kg q20-30 mins up to total dose of 40 mg/kg ,.
• Maintenance: 3 lo 5 mg/kg/ day in 1 to 2 divided doses 12 hours after loading dose
,Phenytoin:
• Loading: 15 to 20 mg/kg IV infusion al 50 mg/ml concentration al 15-20 mins (1 mg/kg/min)
• Maintenance: 4 lo 8 mg/kg every 24 hours IV slow push or orally (up to 8 mg/kg per dose
every 8 to 12 hours after 1 week of age)
Piperacillin: 50 to 100 mg/kg/dose IV Reconstitute 2 g vial w/ JO mL SW ->200 mg/mL->
2.5mL + 7.5 mL SW-> 50 mg/mL
~ ••... ~~ l".!!!'5sL ..•• ,1 • • • • •P_0 ,t'!.a. ~ _ .tAY, . _.. I- •• _ ••'! !'~C!. • • !>!:'~5 ......~
: < 29 I Oto 28 I 12 !
'

,
I
I

I
I
> 28
~---------------------------------------------------------------
' 30 to 36 O lo 14
> 14
1

I
8
12 ... '
:
,
8
~············•···•···l•·•··•····•·••·•••··•r·····••···-••••·•·•·~-
' 37 to 44 1 Oto 7 1 12 ,
~····················~·········1.t .........•..........~6 ......... ~
n
!
> a45
Salbutamol:
ALL

• Bronchodilation: 0.1 lo 0 ,5 mg/kg/dose every 2 lo 6 hours via nebulizalion

1-

I • Hyperkalemia: Preterm: 0.4 mg/dose every 2 hours via nebulizotion

Surfactant: 4 ml/kg/dose lntratracheal divided Into 4 quarter dose aliquots

• • Prophylaxis: 111 dose ASAP afte r birth with up to 3 doses in I 11 48 hrs not more frequently than
every 12 hours
• Rescue: up to 4 doses in 1•1 48 hours not more frequently every 6 hours
Vancomycln: 10 lo 15 m k dose IV ever 6 to 18 hours over 60 to 120 minutes
r ... -~..........--~-~ . -. ~~
Reconstitute I g vial w/ 20 mL SW ->50 mg/ml-> Dilute lurther to make 5 mg/ml .,
~ ..... PtM. [Link]" ..... ~· ... .P.o,[Link] .a.v, .... • .... J11t,c'(q l:IP!t't •••• ~
1
< 29 1 0 to 14 I 18 :
~ •••••••••••••••••••• J ••••••••• ~J~ .......•. l ••••••••• Ji ......... ~-
! 3 0 lo 36 I Oto 14 I 12 :
., I >14 I 9 b,
·---------------------------------------------------------------1
• 37 t 44 I 0 to 7 I 12 :
! o I 7 > I 8 ••
·--------------------1-----------------·-··t····~-------------·-~
~ •••••••• -::_l_•j.§ •••••••• ............I\.L~ ••••• ·•••• 1 ••••••••• • 6•••••••••. ~
 Laboratory Reference Values HARRIET LANE
. -• · · · ~: · · · · · · · ·. .....
Labs
• • • • • • • • • • • • • • • • •
· N~!'!';1.......
al Values
• IP • • •
"
• , • • • • • • • • • • • •t
... .. . .. .. .... ... . .. .... .. .Indite s : 26-30 wla :
... ....... .;.... . .. . ...... i •• · · .. · • Term
.. •··• ... .. .. . .,
........ .... :....p;~·,~.:i:.;:3.25 mg/dl or 1.1 - 8.9 mmol/l H..~~~.l.1!~~~!..:....1.1.:1.~~ ..
BUN . ; .. .. .. .1.~..~•.1.~ .~ i'
: Term: 2•19m g/dl?.r.?:?1:?!1.1~~1..1~ .... ...
:: He!(%) : 3.4.9-41.5
.C... ;l;i~~· j· ....:::::~ii:9:~~i~( i??.-~.~.~~<?1/.~l......... .~:·
.. .r!'.~ .. ... . ,.... .
Sodium :
130-145 mE11/l
..[Link] . . T·1·[Link]
.. .. .. .. .7 . .. . .. . ... .. .... . ..
1i e·. 2 r.... ..
:
....... .... . ....... . ..... . ...... , ....... . .... ....
J• MCHC
.42-51 ...... .
·9e:io·e .. .. . .. t
...... .
1...... . _. .. . ~ .. .. ... .. .. .. _.:l-6.~ Eq/l, : :
Tenn: 3.7•5.9 mEq/l !! ( /dl RBC} : 30.6-3 •
. ~.~t~~~I~~ . ~~:;:;:\·.2:ii ~~/dl·~; ·i.ssi1s~~~iiL...·::··R;tt~~·I~~·
( ·
·t~·
7.9 :
t ······:······i········ ·ii·· ·······~
30-33 •
Tt0 0I · 76 10.4 /dlor 19-2 6mm ol/l ....... ..... Y....;.. ....... ..
: 0-10 days: • • · mg
· · .. WBC :
... ; ... ... ... .. .. .. ... .... ,
Calcium j .1.~ .~?ts. ~. ~.~.~.~~'.~~:.~: !\~~( ~: ~r. : •
, ... . .... ... :. 0-0.5 mg/dl
!:~.~.~-?: ..r. (xlOJ/ ml) \ 2.7 • .4 ..4 \ 9-30 !•
CRP .: ....... ... . ... ~ .. ..... . ...... : . .. ... . .. .. .. ... .....
i········, .. ;.. .. .. ....... . ... ....... .. .. .... .. .. .. .... .. .... . ....
: </032 weeks (7-1.4 days) 0 • 3.53 ng/ml Platelet : 180-327 :
I!' -• . ... _. _• • _. _.., ...._.._..__,._~ - .... ~ _.
290
.~
•
..._. _. _. _. ..._. _. ~..- . ,,
j </c32 weeks (1.4-30days) 0 • 1.66 ng/ml LUMBAR PUNCTURE
: </=32 weeks (30-60 days) 0.06 • 1.7 ng/ml
• Prepare the If materials:
• # 1 gauge 26 needle, #.4 sterile test tubes, # 1 •
', IProcalci•
33-36 weeks (7-1.4 days) 0 · 0.53 ng/ml
33-36 weeks (1 .4-30 days) 0 • 0.56 ng/ml
sterile drape, # I sterile cotton, # I betadine
• Please secure consent. NPO ,4 hours prior.
tonin 33-36 weeks (30-60 days) 0.01 • 0.21 ng/ml
Hgt prior the procedure
• Request for the following: Test tube # 1 cell
>/• 37 weeks (7-1.4 days) 0.05 • 0.5.4 ng/ml
count, differential count, TT#2 CSF glucose
>/• 37 weeks (1.4-30 days) 0.06 · 0.9 ng/ml
& protein, TT#3 Culture & sensitivity, TT#.4
. >/• 37 weeks (30-60 days) 0 • 0.53 ng/ml
------~-----------------·-·..:.:. : -~-~-~-~-~·-- --- --- --- --- --- Save specimen

I ~---
f'nllam ...... (47 [Link] linnlr fads f

FANAROFF Al ~Day a >7Day s

. n•t48 n•88 n•82
Al
n•170 n•130
>1°"19
n•40
CSF WBC, CIIOs/µ1.
Al lnfllnta
Mlldi sl~ 311-81 3 (1-7) 3 (1-4) 311-61 3(1~ 2 (1-4)
ll!ill pal'Cll'dm 18 18 12 26 23 32
Ardlb kJllc- unup
ll!ill plllCll1ill 11 17 10 32 31 63
CSF Protein, mg/di.
Al Infants
Medi ll'I~ 104 (70-131) 118 (ln-1381 93 t8'1-122l 74 (54-111) 7818)-100, 57 (42-77)
ll!illp aadia 2IX3 213 2IX3 137 137 159
~
ll!illpara:r,Se 111!i 1fl6 138 138 136 284
CSF Glucoso, mg/dl
Al Infants
Mecf lll~
61h pirarii9
4Q (42-82)

33
631 ~
33
47 (40-58)
33
61 (44-57)
36
50 (44-68) 62(4S-8dl .
• 36 38
AnUb lollc-u noxp
5lhPlf!lll& 33 33 36 33 33 33
·i Neonata l Radi ology
I·
NORMAL CHEST XRAY
• lung fields appear ,ymmetrlcally aerated , costophrenic
angles are clear
• diaphragm I, at the level of the posterior arc of 8th
rib posteriorly & 6th rib anterlorly
• cardlo thoraclc ratio should be < 0.6
• increased pulmonary vascularily I, not always appare
nt in the CXR Rim. Reduced pulmonary blood Aow is
easier to detect and Indicates serious cyanoHc
CHO.
• Thymic shadow may show classic "sall sign" or may
have undulant/ smooth borders on upper medlastinum
ENDOTRACHEAL TUBE •
• ET tip should be positioned halfway between the medial
ends of the clavicles & the carina (1 • 2 cm above
carlna, T3-T.4)
UMBILICAL ARTERIAL CATHETER
• Should lie In the lower aorta (ot level of l3. l..4) or
above diaphragm (higher than T12; between T6 & T9)
• catheter turns downward & then upward (upward turn
Is the point al which the catheter passet through the
Internal Iliac artery)
UMBILICAL VENOUS CATHETER
• catheter tip should be at the !unction of the Inferior
vena cava & right atrium, prol1ctlng iust above the
diaphragm
INTERCOSTAL TUBE
• Insertion sites: anterior chest wall through the 2nd or
3rd ICS dlrectly lateral to mld clavlcular line, & the
lateral cheat wall through the .4th, 5th or 6th ICS directly
anterior lo the axillary line
• tube should be Inserted -3 cm Into the thoracic cavity
FEEDING TUBE & directed towards the apex of the lung

• tip of nasogastrlc/orogastrlc tube should be ldentlR

ed within the alomach or when nasolelunal feeding tube
used, within the lelunum Is •

..i--- -..~ ~~rfll jj'. a!'IN t1,tot1,1w1!a:!Mi :) Iii:\. References: Ne lson's, Fonoroff, Harrie t ..
0
~ ~ ~RPli;"STABCE~ STandcircli"or
•'
Newb orn Core, AAP Guidelines, Neonatal
...__ _ _ _ _Cote..fc.~[Link]._Guidi.- - - -
-1

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