Podcasts about Neonatal resuscitation

Content Warning: This episode contains discussions of neonatal resuscitation, which some listeners may find sensitive or distressing. In Episode 13 and the season 2 finale, Eoin and Duncan welcome Dr. Esther Godfrey, co-founder of the SuPPORT project, to share her personal experience of neonatal resuscitation with her own daughter Juno, along with the project's origins.  Together, they explore the role of effective communication with patients during neonatal resuscitation and how to compassionately provide support in such critical moments. References  European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth Understanding psychological traumatic birth experiences: A literature review The SuPPORT Project (Website) - Supporting Parents and Professionals through neOnatal Resuscitation in Theatre  SuPPORT Project abstract - International journal of obstetric anaesthesia Quick Reference Handbook for Obstetric Emergencies - Page 9 - Debrief RCOA Wellbeing Hub BMA Wellbeing Support

Send us a textIn this episode, Ben and Daphna are joined by Dr. Rinawati Rohsiswatmo from Universitas Indonesia in Jakarta to discuss the MixSafe project, a battery-powered T-piece resuscitator designed to address neonatal mortality in low-resource settings. Dr. Rohsiswatmo highlights the innovative solution to blending medical air and oxygen affordably, making it accessible for use in remote regions. She shares the challenges of implementation, training, and the transformative impact of MixSafe on neonatal transport and care in Indonesia. This conversation showcases the potential of cost-effective innovations for improving outcomes in low- and middle-income countries.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this episode of ACEP Nowcast, host Amy Faith Ho, MD, MPH, FACEP, interviews Matthew Turner, MD, and Stephen Sandelich, MD, about their recent article in ACEP Now on neonatal resuscitation. Read more on ACEPNow.com Revisit ACEP Nowcast podcast episodes.  Catch up on all of ACEP Now in past issues.

Send us a textA pilot study of a virtual reality-based simulation platform for Neonatal Resuscitation Program training.Trinh G, McAdams RM.J Perinatol. 2024 Oct 14. doi: 10.1038/s41372-024-02145-5. Online ahead of print.PMID: 39402131As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

This is the Little Resus that could! We are covering Neonatal Resuscitation on this episode, simplifying the most complex, most scary aspects of caring for the tiniest humans. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here. Cite this podcast as: Briggs, Blake. 234. . September 17th, 2024. Accessed [date].

This is the final episode of our "Neonatal Resuscitation for EMS" series. We were joined by Arielle Olicker, MD. Thanks to the Willoughby Fire Department for hosting this month's live show.  If you would like to host one of our live shows, message us! In addition to providing clinical care in the NICU, Dr. Olicker is part of the team providing follow-up care to our NICU graduates at the Neonatal Extended Outpatient Clinic. Dr. Olicker serves as the medical director for Neonatal Critical Care Transport and is the neonatal director of the Synagis administration program at UH Rainbow.

Send us a Text Message.Use of Initial Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database.Halling C, Conroy S, Raymond T, Foglia EE, Haggerty M, Brown LL, Wyckoff MH; American Heart Association's Get With The Guidelines–Resuscitation Investigators.J Pediatr. 2024 Apr 16;271:114058. doi: 10.1016/j.jpeds.2024.114058. Online ahead of print.PMID: 38631614 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Psychotherapy in the debrief room, Sim to improve blood transfusion systems sand safety,  exploring simulation ‘dose' for maintenance of skills, and comparing student self-assessment with educators and SPs . Another great month on Simulcast.  The articles: -  Drake, G. Drewek, K. “I Hate Sim!”—Using Psychotherapeutic Concepts to Help Educators Attend to Challenging States of Mind During Simulation Prebriefs. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare February 27, 2024.  Dube et al. Harnessing system-focused simulation, debriefing and FMEA to inform healthcare blood transfusion safety and policy. International Journal of Healthcare Simulation. July 2022  Haynes, J.  Rettedal, S. Ushakova, A. Perlman, J. Ersdal, H. How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation. Simulation in Healthcare: March 6, 2024  Sullivan, C.C., O'Leary, D.M., Boland, F.M. et al. A comparative analysis of student, educator, and simulated parent ratings of video-recorded medical student consultations in pediatrics. Adv Simul 9, 10 (2024).  And…  Don't forget to register for SESAM. Program and speakers released now. Will be an awesome few days in Prague in June 19th – 21st.    Happy listening    vb 

In this episode Michelle J. White MD, MPH, FAAP, explains the concept of a “built environment” and how the infrastructure where people live can affect their health. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also speak with Henry Lee, MD, FAAP, about new suggested changes to the Neonatal Resuscitation Program. For resources go to aap.org/podcast.

Overcoming Fear in Neonatal Resuscitation: A Step-by-Step Guide Blog post: Neonatal Resuscitation Introduction: Welcome to another episode of EMScast, where high-level education meets real-world emergency medical scenarios. Today, we have Dr. Avery MacKenzie, an ER physician from Southwest Colorado, joining us to discuss a topic that often induces stress – neonatal resuscitation. Dr. MacKenzie shares her experiences and insights into handling neonatal emergencies in rural settings. Summary: Dr. MacKenzie opens the episode by acknowledging the inherent fear associated with neonatal resuscitation, especially in rural emergency departments where one might be the sole provider. She emphasizes that despite the fear, the process is not hard, and providers already possess the necessary skills. Key Takeaways: 1. **Facing the Fear:**    - Dr. MacKenzie encourages listeners to remember that while neonatal resuscitation may seem intimidating, the skills required are well within their expertise. 2. **Algorithm Overview:**    - The neonatal resuscitation algorithm is simplified into manageable steps, beginning with stimulating, warming, and drying the baby for the first 30 seconds.    - The next 30 seconds involve providing positive pressure ventilation to initiate breathing.    - Monitoring the heart rate is crucial, and if it remains below 100, providers should focus on correcting ventilation strategies. 3. **Initial Assessment:**    - Dr. MacKenzie introduces a simple three-question assessment for determining the need for resuscitation: term gestation, good muscle tone, and respiratory effort. 4. **Positive Pressure Ventilation:**    - The trigger for initiating positive pressure ventilation is if the heart rate is less than 100 or the baby is apneic or gasping.    - The emphasis is on adequate ventilation, and adjustments, such as using the MR. SOPA mnemonic, can be made to improve ventilation. 5. **Advanced Airway Considerations:**    - While advanced airways, such as intubation, are possible, Dr. MacKenzie highlights that pre-hospital protocols may favor supraglottic airways due to the challenging nature of neonatal intubation and the need to limit pauses in oxygenation and respiratory support. 6. **Continued Support:**    - The algorithm emphasizes a continuous loop of assessment, correction, and reassessment, with the goal of maintaining the baby's heart rate above 100. Conclusion: Dr. MacKenzie wraps up the episode by reassuring providers that familiarity with the neonatal resuscitation algorithm and periodic mental reviews can alleviate the fear associated with these critical situations. The key is to focus on what providers already know and apply those skills with confidence.

pemplaybook.org

On August 24, 2020, during the midst of the COVID pandemic outbreak in New York City, Tracy Harris began having severe abdominal pain that prompted her to call 9-1-1 for help. Just prior to EMS arrival, she realized that she was in full active labor (23 weeks pregnant at the time) and her pre-term baby girl had just unexpectedly delivered while she laid on the floor. In this episode, Station 20's first-arriving EMTs Silverio Moreno and Johnathan Rivera—who had never worked together before—recall how they upgraded the call from OB-OUT to a cardiac arrest as they discovered the newborn baby was not breathing and had no pulse, and the events that followed. Mother and daughter were taken to Jacobi Hospital Medical Center, and eventually both made a complete recovery. In 2023, the patients and their rescuers were reunited at the FDNY's Second Chance Ceremony; a precious full-circle moment for all. Captain Randy Li hosts.

In this podcast, Dr. Hana Wiemer breaks down neonatal resuscitation in the ED. How to prepare for what happens after a delivery in the ED; we discuss airway management, medications and more.For more FOAM resus related content, head to www.theresuscourse.com

Delivering a baby is one of the most amazing things that can happen in this job. But what happens if things don't go as we hope? A huge thanks to Paramedic Derek Ratzel for stopping in to the podcast studio once again and sharing his incredible case with us!

Nechama Nerenburg is a wife and mother of 4 children. She has worked as a doula for over 20 year. In her training, Nechama has completed courses in Breast Feeding, Emergency Birth, EMT, Neonatal Resuscitation, Techniques on More Efficient Pushing, BRM Body Balancing, to alleviate pain during pregnancy and for easier birth. https://mishpacha.com/dear-doula/ https://evidencebasedbirth.com/the-evidence-for-doulas/ Read about Nechama's miraculous story here: https://vinnews.com/2022/07/21/its-all-in-hashems-hands-says-husband-of-woman-who-survived-niagara-cliff-fall/ www.jowma.org

Find out more about Nathan and this episode at: www.the-incubator.org/095-dr-nathan/____________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

  In this episode Deanna Behrens, MD, FAAP, describes the tools pediatricians can use to help their patients and families gain access to important elections. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Louis P. Halamek, MD, FAAP, about the Neonatal Resuscitation Program, which turned 35 this year. For resources go to aap.org/podcast.

For depressed preterm neonates, initiating positive pressure ventilation is the most important factor in facilitating transition. Therefore the recommendation for depressed neonates is to immediately cut the umbilical cord and begin resuscitation. However, many studies have shown that delaying the clamping of the umbilical cord also benefits preterm infants by increasing a neonate's blood volume, oxygenation and circulatory stabilisation, thus aiding transition. In this episode, we meet Early Career Investigator, Praveen Chandrasekharan from the State University of New York. He has used an asphyxiated preterm ovine model to ascertain the best practice of placental transfusion in a depressed neonate requiring resuscitation. Read the full article here. Placental transfusion during neonatal resuscitation in an asphyxiated preterm model | Pediatric Research (nature.com) Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.

I speak with Dr Kathryn Leccese consultant paediatrician working in Southern NSW about neonatal resuscitation and we work our way through the ARC newborn life support flow diagram.

On this month's EM Quick Hits: Christina Shenvi on ACS in older people, Nour Khatib on rural NRP, Jess McLaren on how not to get fooled by ECG computer interpretation, Brit Long on hemophilia recognition and workup, Maria Ivankovic on persistent and intractable hiccups from EM Cases Summit 2021... The post EM Quick Hits 38 ACS in Older Patients, Rural Neonatal Resuscitation, Hemophilia, Hiccups, ECG Computer Interpretation appeared first on Emergency Medicine Cases.

Lindsey Meehleis, LM, CPM offers wisdom that has been passed down through many different lineages of midwives. Midwifery is not a job to Lindsey, it is her passion. She trusts & has deep reverence for the pregnancy & birth process. Everything else she offers are different modalities of things that help with the process of pregnancy, birth and parenthood. In addition to being a midwife and graduating from the only California State accredited midwifery school, Nizhoni Institute of Midwifery, Lindsey is a Doula, Lactation Consultant, Prenatal Yoga Instructor, CPR Instructor and a Emergency Medical Technician who is a provider in Neonatal Resuscitation. Time Stamps: 00:08:58 Podcast begins 00:10:17 Placental health and placental abruption 00:21:40 Delivery of placenta and delayed cord clamping 00:25:10 Placental stem cells 00:30:00 The medicalization of birth versus the roots of birth 00:33:00 Birthing positions 00:34:45 Thoughts on epidurals 00:37:35 Animal based diets during pregnancy and pre-conception 00:41:00 Optimal prenatal vitamin 00:48:08 Pregnant women eating raw food 00:53:08 Liver dosage during pregnancy 1:04:10 Nausea in the first trimester 1:07:50 Female and male infertility and thoughts on folic acids 1:12:30 Intuitive eating during pregnancy 1:16:40 Thoughts on birth control 1:30:00 Animal based for children 1:32:00 Postpartum nutrition 90 seconds to change the world | Alan Green | TEDxBrussels Sponsors: White Oak Pastures: www.whiteoakpastures.com, use code CarnivoreMD for 10% off your first order Sacred Hunting: sacredhunting.com/PAUL, get $250 off your hunt Lets Get Checked: 20% off your order at www.TRYLGC.com/carnivoremd Eight Sleep: $150 off the PodPro cover at www.eightsleep.com/carnivoremd

Join your hosts Sophia and Nina for an interview with local midwife, Tracy Lough. They discuss her work at Thrive Birth Center, her home birth services in LA, precipitous birth, rural midwifery, and kids at births. Tracy Lough, LM, CPM When I was growing up, I yearned to serve my community in a way that would bring children love and peace while fostering a connection to nature. In college I came across a book called Midwives; after reading it I felt deeply called to one day birth my own baby with a midwife. I got married, moved to Yellowstone National Park for a time, and then became an elementary school teacher in LA Unified School District. When my daughter was born at home I was forever changed. My midwifery journey began the moment I lifted her into my arms: I felt inspired to empower parents to educate themselves about the choices they have around birth. Nine years later, my third child was born swiftly into the hands of my oldest daughter, with her sister and my husband by my side. Welcoming siblings into the pregnancy and birth experience is a passion of mine.For years I taught Bradley Method Childbirth classes and hypnobirthing out of my home, educating women and couples about natural childbirth. My formal education began with Elizabeth Davis' Heart and Hands course, and continued with the National Midwifery Institute. As I studied, I apprenticed with a busy home birth practice in Los Angeles. In 2010, I traveled to Bali, Indonesia with my family to work at the internationally recognized Bumi Sehat Birth Clinic under the guidance of Robin Lim – winner of CNN's 2011 Hero Award. I am now a Licensed Midwife (LM) under the Medical Board of California and a Certified Professional Midwife (CPM) with the North American Registry of Midwives (NARM).I am the founder of The Birth Yurt, Humboldt County's first out-of-hospital birthing option. The yurt, on my 5-acre homestead in the redwoods, served as a sacred space for women and families to birth in. Together, my husband and I also offered the community a Waldorf-inspired, outdoor nature preschool on the property. Many of the babies born in the yurt later attended our school, where I had the privilege of watching them play and grow.I am committed to providing a safe space for women who choose to birth out of the hospital. I value building relationships of mutual trust with families through relaxed prenatal visits and meaningful care. I am certified in IV therapy and Neonatal Resuscitation, and bring knowledge of homeopathy and herbalism to my work with families. I am currently deepening my studies of craniosacral therapy with the Upledger Institute in order to continue providing healing for the babies and families I work with.I am based in Occidental, CA and enjoy spending time with my family in the redwoods. I am currently writing a book called The Birth Yurt, which I hope will bring harmony and change to our birth culture through stories and education. My work is so much more than a job - it is my calling and passion. I am thrilled to be part of Sonoma County, to continue welcoming babies in with a loving and gentle beginning.

Today Mel and I are having a chat about her second VBAC with her third baby Emilia.Her birth was a surprise breech homebirth, which was somewhat poetic given her primary caesarean was due to her first baby being breech. Her second birth in a public hospital under caseload midwifery care was a successful unmedicated VBAC (You can listen to this story in episode 2).We talk about Mel's decision to homebirth, the implications of covid on her pregnancy, the complications she faced in Emilia's pregnancy when she was found to have a Ventricular Septal Defect at 20 weeks and how her third birth unfolded at home.~ Notes ~Books:Welcome Home by Alisha BourkeBirth With Confidence by Rhea DhempseyGentle Birth, Gentle Mothering by Sarah BuckleyAcupuncturist: Keely from Lawson Acupuncture Clinichttps://www.lawsonacupunctureclinic.comMidwife Thinking: midwifethinking.comSpinning Babies:spinningbabies.comHomebirth NSW:https://www.homebirthnsw.org.auBreech Birth Australia & New Zealand Support Group:https://www.facebook.com/groups/233980109958642**VBAC Birth Stories features women's lived experiences. It is not intended to replace medical advice. Should you have any concerns during your pregnancy please always consult your healthcare provider.Please connect with us on Facebook or Instagram: @vbacbirthstories

Neonatal Resuscitation *THIS IS A BASIC FRAMEWORK AND IS NOT COMPREHENSIVE* EVALUATE Is the newborn crying/breathing spontaneously? Does the newborn have good tone? Is the newborn a term infant? If YES, hand baby to mom for direct skin-to-skin. If NO, proceed to step 2. INTERVENE STIMULATE – dry vigorously WARM – place cap on head, […]

Refrigerator Nurse: A Potential Pandemic Side Effect by Jeanette Zaichkin Jeanette Zaichkin, RN, MN, NNP-BC has worked as both a staff nurse and a clinical nurse specialist in Level II and Level III nurseries for more than 30 years. Jeanette has been a consultant to the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) Steering Committee since 1998 and currently serves as editor of the NRP Instructor Toolkit and associate editor of the Textbook of Neonatal Resuscitation. Jeanette is also the editor of a book for parents, titled Understanding the NICU.

Another week, another episode! This week we discuss the APGAR score including what the score represents, what it means for baby, and the limitations of the scoring system. We also outline neonatal resuscitation techniques, when they're used and what they mean for baby. We hope you guys love this episode, and as always, remember to share and review our episode! Much love xx

Thomas Balga, PA-C and Dr. Michael Goldman interview Dr. Christie Bruno on neonatal resuscitation with a focus on drying, stimulation and warmth immediately after delivery. Dr. Bruno reviews how to recognize the neonate who requires resuscitation and emphasizes the role of effective positive pressure ventilation. Dr. Bruno also shares some of the common pitfalls of neonatal resuscitation after precipitous delivery.

Approximately 10% of all babies born in the United States require some form of resuscitation after birth.  Learn about how midwives work to prevent this from happening and how it's managed in the home setting.  This is a key topic that separates the home birth experience from a hospital birth. --- https://hearthandhomemidwifery.com

Happy New Year! Well 2020 certainly wasn't what we were all expecting, so here's hoping for a phenomenally better 2021. We've got some really exciting episodes for you this year including Supraglottic Airways, Neonatal Resuscitation, Diabetic Emergencies, New Resuscitation guidelines and much much more! We're kicking off the podcast year with three really interesting papers! First up we consider the importance of first pass success of both supraglottic airways and endotracheal intubation in the context of cardiac arrest; a lot of attention has been shone recently on question of which approach we should consider after bag valve mask ventilation, but how important is the first pass of either of the approaches to the outcomes of our patients? Next up we have a look at a paper that challenges the use of TXA in our patients with a severe traumatic brain injury after the publication of CRASH 3. Finally we have another look at the mantra of 'GCS 8-intubate' with a systematic review which draws together all of the evidence across the age ranges and both traumatic and non-traumatic presentations. Make sure you take a look at our new CPD apps on both Android and iOS to log your time listening to this episode. Enjoy! Simon & Rob  

FDA 批准鱼油脂肪乳用于肠道衰竭相关肝病儿童的治疗JAMA 持续肺膨胀与间歇正压通气对极早产儿支气管肺发育不良NEJM 喉罩通气在新生儿复苏中的随机试验European Respiratory Journal 利用早产儿心率特征指数预测拔管结果Scientific Report 肠道菌群移植治疗对自闭症ω-3鱼油脂肪乳（fish oil triglycerides）2018年7月，FDA批准ω-3鱼油脂肪乳（fish oil triglycerides）作为儿童肠外营养相关胆汁淤积症患者的热量和脂肪酸来源。《多阶段回顾性分析：作为热量和脂肪酸的来源，静脉注射鱼油脂肪乳可促进患有肠道衰竭相关肝病的患儿的适龄生长》Journal of Pediatrics，2020年4月 (1)研究的目的是比较静脉注射鱼油脂肪乳（fish oil liquid emulsion，FOLE）和静脉注射大豆油脂肪乳（soybean oil liquid emulsion，SOLE）治疗肠衰竭相关性肝病（intestine failure associated liver disease，IFALD）患儿的疗效和患儿的生长情况。研究纳入41名患儿和82例历史对照组，接受开放标签鱼油脂肪乳 (1g/kg/d），直到IFALD消失或停止肠外营养；历史对照组接受大豆油脂肪乳（3g/kg/d）的治疗。 28周后，接受鱼油脂肪乳治疗的患儿的平均体重的z评分在-1到1范围内，显示出与年龄相适应的生长。与大豆油脂肪乳治疗的患儿相比，鱼油脂肪乳治疗的患儿的前白蛋白更高、甘油三酯更低、血糖浓度更正常。结论：与接受大豆油脂肪乳的儿童相比，接受鱼油脂肪乳的IFALD儿童生长指标更正常、代谢异常更少。《多中心回顾性分析鱼油脂肪乳减少肠衰竭相关肝病患儿肝损伤及肝移植风险》Journal of Pediatrics，2020年10月 (2)研究旨在比较经静脉注射鱼油脂肪乳（FOLE）和大豆油脂乳（SOLE）治疗的肠衰竭相关肝病患儿的转氨酶与血小板比值指数、肝移植和死亡率。在这项多中心综合分析中，将189例接受鱼油脂肪乳（1g/kg/d）治疗的儿童，与73例接受大豆油脂肪乳（3g/kg/d）的历史对照组进行比较。与历史对照组相比，接受鱼油脂肪乳的患儿在基线时的直接胆红素水平更高（212.28μmol/L vs 109.8μmol/L，P

FDA 批准鱼油脂肪乳用于肠道衰竭相关肝病儿童的治疗JAMA 持续肺膨胀与间歇正压通气对极早产儿支气管肺发育不良NEJM 喉罩通气在新生儿复苏中的随机试验European Respiratory Journal 利用早产儿心率特征指数预测拔管结果Scientific Report 肠道菌群移植治疗对自闭症ω-3鱼油脂肪乳（fish oil triglycerides）2018年7月，FDA批准ω-3鱼油脂肪乳（fish oil triglycerides）作为儿童肠外营养相关胆汁淤积症患者的热量和脂肪酸来源。《多阶段回顾性分析：作为热量和脂肪酸的来源，静脉注射鱼油脂肪乳可促进患有肠道衰竭相关肝病的患儿的适龄生长》Journal of Pediatrics，2020年4月 (1)研究的目的是比较静脉注射鱼油脂肪乳（fish oil liquid emulsion，FOLE）和静脉注射大豆油脂肪乳（soybean oil liquid emulsion，SOLE）治疗肠衰竭相关性肝病（intestine failure associated liver disease，IFALD）患儿的疗效和患儿的生长情况。研究纳入41名患儿和82例历史对照组，接受开放标签鱼油脂肪乳 (1g/kg/d），直到IFALD消失或停止肠外营养；历史对照组接受大豆油脂肪乳（3g/kg/d）的治疗。 28周后，接受鱼油脂肪乳治疗的患儿的平均体重的z评分在-1到1范围内，显示出与年龄相适应的生长。与大豆油脂肪乳治疗的患儿相比，鱼油脂肪乳治疗的患儿的前白蛋白更高、甘油三酯更低、血糖浓度更正常。结论：与接受大豆油脂肪乳的儿童相比，接受鱼油脂肪乳的IFALD儿童生长指标更正常、代谢异常更少。《多中心回顾性分析鱼油脂肪乳减少肠衰竭相关肝病患儿肝损伤及肝移植风险》Journal of Pediatrics，2020年10月 (2)研究旨在比较经静脉注射鱼油脂肪乳（FOLE）和大豆油脂乳（SOLE）治疗的肠衰竭相关肝病患儿的转氨酶与血小板比值指数、肝移植和死亡率。在这项多中心综合分析中，将189例接受鱼油脂肪乳（1g/kg/d）治疗的儿童，与73例接受大豆油脂肪乳（3g/kg/d）的历史对照组进行比较。与历史对照组相比，接受鱼油脂肪乳的患儿在基线时的直接胆红素水平更高（212.28μmol/L vs 109.8μmol/L，P

This podcast provides an update on the Neonatal Resuscitation Program (NRP) Guidelines. It will provide an overview of the latest available evidence on umbilical cord milking and sustained inflation during neonatal resuscitation. This podcast was developed by Catalina Garcia Hidalgo, a 2nd year medical student at the University of Alberta, in collaboration with Dr. Georg Schmölzer, executive member of the NRP within CPS and a neonatologist-scientist at the University of Alberta.

References:https://www.ahajournals.org/doi/10.1161/CIR.0000000000000902Links:CorePendium Neonatal Resuscitation: https://www.emrap.org/corependium/chapter/recqppKscstY0c541/Neonatal-ResuscitationNeonatal resuscitation lecture: https://www.emrap.org/corependium/chapter/recqppKscstY0c541/Neonatal-Resuscitation

This episode covers neonatal resuscitation.Written notes can be found at https://zerotofinals.com/paediatrics/neonatology/neonatalresus/ or in the neonatology section in the Zero to Finals paediatrics book.The audio in the episode was expertly edited by Harry Watchman.

Samantha and I chat with fellow doula Katie Olliffe about the benefits of optimal cord clamping and the controversial subject of intact resuscitation. You can find out more about Katie on her website here or follow her on Facebook here. The Wait For White website is a great resource for further information on optimal cord clamping. Also, here are some useful AIMS articles about Neonatal Resuscitation and Delaying the Clampers. As usual, full permission has been given to share the information discussed in this podcast.

Neonatal Resuscitation

Apgar score & neonatal resuscitation

Neonatal resuscitation part1 |Obstetrics and paediatrics | Voice - Laco_spartan

Dr. Hilary Whyte, Dr. Jabeen Fayyaz, Dr. Emily MacNeill discuss a neonatal resuscitation algorithm, airway management, fluid resuscitation, central access tips, glucose and temperature control and transport tips... The post Ep142 Neonatal Resuscitation – Airway, Temperature Control, Central Access, Hemodynamics, Glucose Control and Tranport appeared first on Emergency Medicine Cases.

Thieme Verlagamrican perinatly0:00Wed, 15 Apr 2020 00:00:00 +0200

Thieme Verlagamrican perinatly0:00Wed, 15 Apr 2020 00:00:00 +0200

I had the honor of speaking to three accomplished women about the current state of birth both locally and nationally. We discuss the increasing interest in home births, the advantages and disadvantages of home versus hospital births and how those expecting, or expecting to be expecting, can best prepare especially with the extra consideration of Covid19. Corrine Pellard is an Empath, Psychic Medium and Reiki Master. She is also a mom of two and tells us about her experience of both a hospital birth and an at-home birth. Corrine discusses the lack of control over the birthing experience that she experienced with her first child. She discusses being considered high risk because of her age and weight and how the entire birth experience was centered around preconceived notions based on the masses and not her individually. She was induced, unnecessarily in her view, was sick from the drug used to induce and delivered by cesarean section. She shares, “It was traumatic, and my healing my first two months of being a mother was physically painful and my anxiety post, I had postpartum anxiety to a very severe degree.” When Corrine became pregnant again, she knew she wanted a different birthing experience. She found Birth Matters and decided to try a natural, vaginal delivery at home. Jodi Churchill Chapin has been a Registered Nurse for 32 years, most of which she has spent in Labor and Delivery. Jodi discusses bridging the traditional birth and hospital procedures with less traditional therapies such as Reiki. Jodi states, “And we incorporated, you know, you're there, you’re exchanging energy. It's how the patient uses her energy and is able to focus on the birth process. And I think what’s important is that being able to balance, you know, following policy and procedure, but also carrying out the patient (and) the family's wishes of how they envisioned birth. I mean birth is, you know, one of those things, it's like, even planning a wedding, you look forward to this one day you plan you plan you plan, you think it's going to go one way and then plans change on a dime. And how it's handled can make it or break it.” Jessica Petrone is a Certified Professional Midwife (CPM), RN and BSN who has been in practice for 13 years. Her practice saw a record number of home births last year and Jessica believes that number will continue to grow. She relates, “But I think specifically in the last couple of years, there seems to be a shift in people just taking charge of their health care even in the medical setting. There's more conscious awareness, practices and practitioners breaking away from the traditional systems and framework but yeah, we love home birth. We do a lot of water birth we work with a lot of different practitioners to enhance really healthy pregnancies. We absolutely consult with medical providers when it's necessary.” Corrine shared about her experience with Jessica and Birth Matters, “So, I will say one of the biggest differences that I noticed on my very first appointment with a Birth Matters in the home birth midwives is they asked my consent, which nobody asked my consent. I mean, sure I signed forms but before touching me, nobody offered before examining me, nobody asked permission to touch my body.” The conversation continues to the state of birth currently with the threat of COVID19. Jodi discusses the difficulty of taking the necessary precautions in the time of a pandemic while trying to connect with an expectant mom during the labor and delivery process. “This Covid19 has put a huge damper on healthy women wanting to come in to have their normal birth. Especially right now, today. Anybody and everybody walking into the hospital or around the hospital has to wear a mask. You cannot take that mask off anytime you are on hospital property that includes in the labor room, that includes the patient that includes the patient's one person that's helping them with birth, there are no visitors allowed, no children, family, nobody else. The only person allowed in the room is the one that will be wearing that second baby bracelet that's given out when a baby's born. I mean, labor, you're breathing with women, you're teaching. I mean, it's all about the closeness. How do you socially distance yourself from somebody who needs your support, your encouragement, your empowerment?” Jessica discusses the fact that more women are considering home births currently. “The influx of inquiries is so unexpected, I can't keep up. I'm getting probably 10 emails a day, which it is impossible for us to entertain the idea of taking all these women on. And that's true of a lot of midwives across the state, really. Not everybody is a good candidate. I mean most people probably inquiring last minute. We had yesterday, a woman inquire and she's due March 30. That's like, less than a week from now. If people are making choices out of fear and panic it is not what's happening, and whenever we get an inquiry that somebody is so afraid of the hospital and so afraid of other providers and afraid of needles, I mean, we all encounter that in patient care, but they may not be a great candidate. But that's not what's happening right now. These are women that are realizing that their birth plan, what they thought they were going to experience in the hospital, is drastically different and there is obviously a great concern about becoming sick and being exposed but a lot of the women are making the choice based on the fact that their support person might not be able to be present with them.” Jessica recommends that women do their research before opting for a home birth. I am grateful to these remarkable women for sharing their wisdom. Corrine Pellard is an Empath and a Psychic Medium. Even as a small child, Corrine has had a special insight into other people’s emotions. Beginning in her early teenage years, her intuition would alert her when something important was about to occur, either for herself or a loved one. At age 14, Corrine began using the wisdom of Tarot Cards to enhance her psychic connection. As years went on, Corrine became more aware of her ability as her readings became more accurate and her predictions began to materialize. At the age of 30, she began having premonition dreams. After seeking the guidance of her Shaman, she came to accept that she is an Empath & an Intuitive. Corrine is a natural healer, using her Empathy, Intuition, and Reiki to heal others emotionally, spiritually, and physically. Corrine is also able to mediate communication between people who are no longer living to those who still are. She offers private readings and hearings and in-home parties. She is a wedding officiant offering custom designed ceremonies. Her true passion is teaching others to honor their own abilities and helping others heal themselves. Beyond the Gate 508-690-0444 gobeyondthegate@gmail.com https://www.gobeyondthegate.com/ https://www.buzzsprout.com/865777/2868628-sobriety-as-an-empath-corrine-s-story Jodi Churchill Chapin has been a Registered Nurse for 32 years. She has an extensive background in women’s health as a labor and delivery nurse and has also worked in oncology. She resides in Framingham with her husband of 25 years. Together, they have 3 children ranging from middle school age to college, 2 dogs, 2 cats and a bunny named Kiwi. Jodi firmly believes that vulnerability is to be met with compassion, respect, and active listening to ensure that her patients have the very best outcomes. She credits her extensive nursing career and healer background with these virtues and skills. Jodi is also a Usui Shiki Ryoho Reiki Level II Practitioner. Through this healing art, Jodi may be able to help people who are struggling with a wide range of health conditions such as headaches, insomnia, back pain, cancer, heart disease, chronic pain, depression, anxiety, and may even be used to help in the recovery from injuries and surgery. As an active member of the American Cannabis Nurses Association and a GNG team member, she helps advocate for people who choose to use cannabis as a complementary or alternative treatment, providing education, insight, guidance, and support in the process. https://www.greennursegroup.com/our-team https://www.emedevents.com/speaker-profile/jodi-churchill-chapin https://green-nurse-sandbox.iriebliss.com/green_nurse_staff/jodi-chapin/ Jessica Petrone, CPM, RN, BSN Jessica's experience in birth includes her work as a doula, her completion of a 3 year midwifery apprenticeship in a very busy home birth practice and being a mother of four, with the last being an unassisted home birth attended only by her husband and herself. Her own births led her to become a doula which led her to become an apprentice and, in turn, a midwife. But that’s the abbreviated version! Jessica has been attending home births since 2006. She is co-president of the Massachusetts Midwives Alliance, a member of ALACE (Association of Labor Assistants and Childbirth Educators), and a member of the Birth Year Network (a Southeastern Mass, Cape and Islands Birth Resource Network). She holds certifications in CPR and Neonatal Resuscitation. She completed her formal education remotely through the National College of Midwifery in Taos, New Mexico, where she earned a degree in the Science of Midwifery. Most recently, Jessica has completed a Bachelor of Science in Nursing, which included a 6-month preceptorship in a high volume/high risk maternity unit at Massachusetts General Hospital. https://homebirthmatters.com/about/jessica-petrone/ https://www.modernmamamidwifery.com/the-midwives http://bostonvoyager.com/interview/meet-jessica-petrone-sarafina-kennedy-birthmatters-llc-boson/ Supplemental Article: https://nypost.com/2020/03/23/pregnant-women-share-what-its-like-to-be-expecting-during-coronavirus-pandemic/

I had the honor of speaking to three accomplished women about the current state of birth both locally and nationally. We discuss the increasing interest in home births, the advantages and disadvantages of home versus hospital births and how those expecting, or expecting to be expecting, can best prepare especially with the extra consideration of Covid19. Corrine Pellard is an Empath, Psychic Medium and Reiki Master. She is also a mom of two and tells us about her experience of both a hospital birth and an at-home birth. Corrine discusses the lack of control over the birthing experience that she experienced with her first child. She discusses being considered high risk because of her age and weight and how the entire birth experience was centered around preconceived notions based on the masses and not her individually. She was induced, unnecessarily in her view, was sick from the drug used to induce and delivered by cesarean section. She shares, “It was traumatic, and my healing my first two months of being a mother was physically painful and my anxiety post, I had postpartum anxiety to a very severe degree.” When Corrine became pregnant again, she knew she wanted a different birthing experience. She found Birth Matters and decided to try a natural, vaginal delivery at home. Jodi Churchill Chapin has been a Registered Nurse for 32 years, most of which she has spent in Labor and Delivery. Jodi discusses bridging the traditional birth and hospital procedures with less traditional therapies such as Reiki. Jodi states, “And we incorporated, you know, you're there, you’re exchanging energy. It's how the patient uses her energy and is able to focus on the birth process. And I think what’s important is that being able to balance, you know, following policy and procedure, but also carrying out the patient (and) the family's wishes of how they envisioned birth. I mean birth is, you know, one of those things, it's like, even planning a wedding, you look forward to this one day you plan you plan you plan, you think it's going to go one way and then plans change on a dime. And how it's handled can make it or break it.”Jessica Petrone is a Certified Professional Midwife (CPM), RN and BSN who has been in practice for 13 years. Her practice saw a record number of home births last year and Jessica believes that number will continue to grow. She relates, “But I think specifically in the last couple of years, there seems to be a shift in people just taking charge of their health care even in the medical setting. There's more conscious awareness, practices and practitioners breaking away from the traditional systems and framework but yeah, we love home birth. We do a lot of water birth we work with a lot of different practitioners to enhance really healthy pregnancies. We absolutely consult with medical providers when it's necessary.” Corrine shared about her experience with Jessica and Birth Matters, “So, I will say one of the biggest differences that I noticed on my very first appointment with a Birth Matters in the home birth midwives is they asked my consent, which nobody asked my consent. I mean, sure I signed forms but before touching me, nobody offered before examining me, nobody asked permission to touch my body.”The conversation continues to the state of birth currently with the threat of COVID19. Jodi discusses the difficulty of taking the necessary precautions in the time of a pandemic while trying to connect with an expectant mom during the labor and delivery process. “This Covid19 has put a huge damper on healthy women wanting to come in to have their normal birth. Especially right now, today. Anybody and everybody walking into the hospital or around the hospital has to wear a mask. You cannot take that mask off anytime you are on hospital property that includes in the labor room, that includes the patient that includes the patient's one person that's helping them with birth, there are no visitors allowed, no children, family, nobody else. The only person allowed in the room is the one that will be wearing that second baby bracelet that's given out when a baby's born. I mean, labor, you're breathing with women, you're teaching. I mean, it's all about the closeness. How do you socially distance yourself from somebody who needs your support, your encouragement, your empowerment?” Jessica discusses the fact that more women are considering home births currently. “The influx of inquiries is so unexpected, I can't keep up. I'm getting probably 10 emails a day, which it is impossible for us to entertain the idea of taking all these women on. And that's true of a lot of midwives across the state, really. Not everybody is a good candidate. I mean most people probably inquiring last minute. We had yesterday, a woman inquire and she's due March 30. That's like, less than a week from now. If people are making choices out of fear and panic it is not what's happening, and whenever we get an inquiry that somebody is so afraid of the hospital and so afraid of other providers and afraid of needles, I mean, we all encounter that in patient care, but they may not be a great candidate. But that's not what's happening right now. These are women that are realizing that their birth plan, what they thought they were going to experience in the hospital, is drastically different and there is obviously a great concern about becoming sick and being exposed but a lot of the women are making the choice based on the fact that their support person might not be able to be present with them.” Jessica recommends that women do their research before opting for a home birth. I am grateful to these remarkable women for sharing their wisdom. Corrine Pellard is an Empath and a Psychic Medium. Even as a small child, Corrine has had a special insight into other people’s emotions. Beginning in her early teenage years, her intuition would alert her when something important was about to occur, either for herself or a loved one. At age 14, Corrine began using the wisdom of Tarot Cards to enhance her psychic connection. As years went on, Corrine became more aware of her ability as her readings became more accurate and her predictions began to materialize. At the age of 30, she began having premonition dreams. After seeking the guidance of her Shaman, she came to accept that she is an Empath & an Intuitive. Corrine is a natural healer, using her Empathy, Intuition, and Reiki to heal others emotionally, spiritually, and physically. Corrine is also able to mediate communication between people who are no longer living to those who still are. She offers private readings and hearings and in-home parties. She is a wedding officiant offering custom designed ceremonies. Her true passion is teaching others to honor their own abilities and helping others heal themselves.Beyond the Gate508-690-0444gobeyondthegate@gmail.comhttps://www.gobeyondthegate.com/https://www.buzzsprout.com/865777/2868628-sobriety-as-an-empath-corrine-s-story Jodi Churchill Chapin has been a Registered Nurse for 32 years. She has an extensive background in women’s health as a labor and delivery nurse and has also worked in oncology. She resides in Framingham with her husband of 25 years. Together, they have 3 children ranging from middle school age to college, 2 dogs, 2 cats and a bunny named Kiwi. Jodi firmly believes that vulnerability is to be met with compassion, respect, and active listening to ensure that her patients have the very best outcomes. She credits her extensive nursing career and healer background with these virtues and skills. Jodi is also a Usui Shiki Ryoho Reiki Level II Practitioner. Through this healing art, Jodi may be able to help people who are struggling with a wide range of health conditions such as headaches, insomnia, back pain, cancer, heart disease, chronic pain, depression, anxiety, and may even be used to help in the recovery from injuries and surgery. As an active member of the American Cannabis Nurses Association and a GNG team member, she helps advocate for people who choose to use cannabis as a complementary or alternative treatment, providing education, insight, guidance, and support in the process. https://www.greennursegroup.com/our-teamhttps://www.emedevents.com/speaker-profile/jodi-churchill-chapin https://green-nurse-sandbox.iriebliss.com/green_nurse_staff/jodi-chapin/ Jessica Petrone, CPM, RN, BSNJessica's experience in birth includes her work as a doula, her completion of a 3 year midwifery apprenticeship in a very busy home birth practice and being a mother of four, with the last being an unassisted home birth attended only by her husband and herself. Her own births led her to become a doula which led her to become an apprentice and, in turn, a midwife. But that’s the abbreviated version! Jessica has been attending home births since 2006. She is co-president of the Massachusetts Midwives Alliance, a member of ALACE (Association of Labor Assistants and Childbirth Educators), and a member of the Birth Year Network (a Southeastern Mass, Cape and Islands Birth Resource Network). She holds certifications in CPR and Neonatal Resuscitation. She completed her formal education remotely through the National College of Midwifery in Taos, New Mexico, where she earned a degree in the Science of Midwifery. Most recently, Jessica has completed a Bachelor of Science in Nursing, which included a 6-month preceptorship in a high volume/high risk maternity unit at Massachusetts General Hospital. https://homebirthmatters.com/about/jessica-petrone/https://www.modernmamamidwifery.com/the-midwives http://bostonvoyager.com/interview/meet-jessica-petrone-sarafina-kennedy-birthmatters-llc-boson/ Supplemental Article: https://nypost.com/2020/03/23/pregnant-women-share-what-its-like-to-be-expecting-during-coronavirus-pandemic/

Take-Home Points Before starting a neonatal resuscitation, take some deep breaths to calm yourself Call in your friends – get a second team to manage... The post REBEL Core Cast 30.0 – Neonatal Resuscitation appeared first on REBEL EM - Emergency Medicine Blog.

“But I would say a lot of intuitive knowing; a lot of deep knowing has sort of been lost. And so it's helpful to remember and to plug back into how we came into being and what is really embedded in our sequence. Because from there are the tools for healing.”     Karen Strange is a Certified Professional Midwife and an instructor at the American Academy of Pediatrics (AAP). Basically, her job is to educate midwifes about the latest techniques in birthing children. She also founded a workshop on neonatal resuscitation. But, why would there be an instructor for neonatal resuscitation in a podcast for families with addiction? Well, let our guest tell you the secret around your birth.   To know how to proceed, one must know where he came from. Karen’s words above give a glimpse of why this topic is essential. An individual’s personality is shaped as soon as we breathe life. Learn how one’s conception and birth has a bearing on one’s predisposition to addiction. And even if many unplanned events happened around this time where we didn’t have control, find out how ‘repair’ can still be done in order to attain this elusive healing. Today’s episode will bring you back to your memory that only your infant self can remember.   Get the show notes, transcription and resources mentioned at    http://thefamilyrecoverysolution.com/   Highlights: 04:59 An instructor for Neonatal Resuscitation in a Family with Addiction Podcast 10:53 How the Mother’s Emotional World Shapes Personality 17:33 Two Layers of Support- Essential for Healthy Neonatal Development 22:59 Our Implicit Memory 27:30 Repair of the Unplannned 30:33 The Birth Sequence 37:29 The Pacing Where Healing Occurs 46:20 Aware of How We Are In the Inside

EM Basic is finally back with a new episode. Today's episode will discuss neonatal resuscitation with Dr. Azif Safarulla, a neonatologist at Augusta University. Dr. Dan McCollum and Dr. Jessica Gancar interview Dr. Safarulla on the nuts and bolts of running a successful neonatal resuscitation in the ED. These can be one of the scariest populations we have in the ED so it's important to have a rational and logical approach to quickly assess and intervene on our smallest and youngest patient population.

Author:  Erik Verzemnieks, MD Educational Pearls:   In the panic of a precipitous ED delivery, remember: Warm. Dry. Stim.  It will solve most of your problems in most scenarios Start compressions if heart rate is less than 60 Put the pulse ox on the right hand - it may make a difference as it is preductal   Editor’s note: detecting a heart rate can be tough in a newborn - you can feel the umbilical stump or just listen with your stethoscope   References Gary Weiner & Jeanette Zaichkin. Textbook of Neonatal Resuscitation (NRP), 7th Ed, 2016. American Academy of Pediatrics & American Heart Association.

This podcast covers the principles of neonatal resuscitation and reflects the updated 7th Edition Neonatal Resuscitation Program Guidelines released in 2016. This podcast was developed by Drs. Julia DiLabio, Emer Finan, Colin Siu, and Chloe Joynt for PedsCases.com.

Neonatal Resuscitation with Dan Drzymalski

Success is the sum of small efforts, repeated day in and day out. -Robert J. Collier Welcome back to Episode 29! This week we are starting out with a bit of psychiatry before swinging over to the Pediatric ER for a quick neonatal resuscitation. We may even stop by the trauma bay to see what read more... The post Podcast Ep 29: Personality Disorders, Neonatal Resuscitation & More appeared first on RoshReview.com.

Informal Debrief of Neonatal Resuscitation (Critiques Scenario and Models Informal Call Review) Informal debriefing with your colleagues is an important part of continuous quality improvement and should be a regular part of your practice. In addition, being able to reflect on your own performance in a productive manner is an important skill to hone for personal growth. Fostering a culture that is supportive of these discussions allows providers to benefit from the experience and perspective of their colleagues. This video provides an example of how we would conduct such a debriefing in the context of the protocols and how we would address some of the issues and concerns that you may have identified regarding the patient care delivered in the previous two episodes.  Cast in Alphabetical Order: Michael T. Benenati, BS, AAS, EMT-P Tyler F. Cominsky, NRP Seth Goldstein, BA, AS, AEMT-P/CIC Susie Surprenant, BBA, BS, NRP David Violante, MPH, MPA, AEMT-P Faizan H. Arshad, MD @emscritcare Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1  

Neonatal Resuscitation Simulation - NYS Collaborative Uncomplicated delivery in the field is fairly straightforward. Unfortunately, things do not always go as planned. Thankfully, resuscitating a neonate in distress is a rare event but something that requires acute clinical acumen. This video depicts a newborn that is not responding to initial interventions. Review the neonatal resuscitation protocol along with this video. The next episode will depict an informal debrief of both this scenario as well as the OB field delivery scenario covered in the previous episode. Cast in Alphabetical Order: Michael T. Benenati, BS, AAS, EMT-P Tyler F. Cominsky, NRP Seth Goldstein, BA, AS, AEMT-P/CIC Susie Surprenant, BBA, BS, NRP David Violante, MPH, MPA, AEMT-P Faizan H. Arshad, MD @emscritcare Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Pediatric Grand Rounds with William Keenan, MD. Saint Louis University School of Medicine, St. Louis, MO.

Pediatric Grand Rounds with Carol Lynn O’Dea, MD

This episode covers Chapter 11 of Rosen's Emergency Medicine. Episode Overview: List the equipment needed for neonatal resuscitation List 5 questions to ask the mother during an imminent delivery Describe the components of the initial assessment of the newborn (APGAR) What is the management of meconium? When should oxygen be used in the neonatal resuscitation period? What is the indication for CPR in a neonate? Describe how to perform CPR on a neonate What are the indications for intubation of a neonate? List 4 reasons not to resuscitate a newborn Wisecracks What are some special considerations for resuscitating a preterm infant? Describe the Neonatal Resuscitation algorithm A quick review of specific neonatal disorders: Diaphragmatic hernia Meningomyelocele Omphalocele Choanal atresia Pierre-Robin sequence Neonatal Resuscitation Case (shownotes only)

This episode covers Chapter 11 of Rosen's Emergency Medicine. Episode Overview: List the equipment needed for neonatal resuscitation List 5 questions to ask the mother during an imminent delivery Describe the components of the initial assessment of the newborn (APGAR) What is the management of meconium? When should oxygen be used in the neonatal resuscitation period? What is the indication for CPR in a neonate? Describe how to perform CPR on a neonate What are the indications for intubation of a neonate? List 4 reasons not to resuscitate a newborn Wisecracks What are some special considerations for resuscitating a preterm infant? Describe the Neonatal Resuscitation algorithm A quick review of specific neonatal disorders: Diaphragmatic hernia Meningomyelocele Omphalocele Choanal atresia Pierre-Robin sequence Neonatal Resuscitation Case (shownotes only)

You have all of the skills you need to care for an acutely ill infant.  Learn a few pearls to make this a smoother endeavor. The Pediatric Assessment Triangle is a rapid, global assessment tool using only visual and auditory clues to make determinations on three key domains: appearance, work of breathing, and circulation to the skin.  The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Appearance "TICLS"Tone - the newborn should have a normal flexed tone; the 6 month old baby who sits up and controls her head; the toddler cruises around the room. Interactiveness - Does the 2 month old have a social smile?  Is the toddler interested in what is going on in the room?  Consolability - A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise.  Look/gaze - Does the child track or fix his gaze on you, or is there the "1000-yard stare"? Speech/cry - A vigorously crying baby can be a good sign, when consolable - when the cry is high-pitched, blood-curling, or even a soft whimper, something is wrong.  If the child fails any of the TICLS, then his appearance is abnormal. Work of Breathing Children are respiratory creatures - they are hypermetabolic - we need to key in on any respiratory embarrassment. Look for nasal flaring.   Uncover the chest and abdomen and look for retractions.  Listen - even without a stethoscope - for abnormal airway sounds like grunting or stridor.  Grunting is the child's last-ditch effort to produce auto-PEEP.  Stridor is a sign of critical upper airway narrowing.Look for abnormal positioning, like tripodding, or head bobbing Circulation to the skin Infants and children are vasospastic - they can change their vascular tone quickly, depending on their volume status or environment.  Without even having to touch the child, you can see signs of pallor, cyanosis, or mottling.  If any of these is present, this is an abnormal circulation to the skin. Pattern of Abnormal Arms = Category of Pathophysiology Differential Diagnosis in a Sick Infant: "THE MISFITS"     Trauma - birth trauma, non-accidental - check for a cephalohematoma which does not cross suture lines and feels like a ballotable balloon, as well as for subgaleal hemorrhage, which is just an amorphous bogginess that represents a dangerous bleed.  Do a total body check.     Heart disease or Hypovolemia - is there a history of congenital heart disease? Was there any prenatal care or ultrasound done?  Does this child look volume depleted?     Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock? Look for clitoromegaly in girls, or hyperpigmented scrotum in boys.  Could this be congenital hypothyroidism with poor tone and poor feeding?  Any history of maternal illness or medications? Congenital hyperthyroidism with high output failure?     Metabolic - What electrolyte abnormality could be causing this presentation? Perhaps diGeorge syndrome with hypocalcemia and seizures?      Inborn Errors of Metabolism - there are over 200 inborn errors of metabolism, but only four common metabolic pathways that cause a child to be critically ill.  Searching for an inborn error of metabolism is like looking for A UFO - amino acids, uric acids, fatty acids, organic acids.  If the child's ammonia, glucose, ketones, and lactate are all normal in the ED, then his presentation to the ED should not be explained by a decompensation of an inborn error of metabolism.        Seizures - Neonatal seizures can be notoriously subtle - look for little repetitive movements of the arms, called "boxing" or of the legs, called "bicycling"     Formula problems - Hard times sometimes prompt parents to dilute formula, causing a dangerous hyponatremia, altered mental status, and seizures.  Conversely, concentrated formula can cause hypovolemia     Intestinal disasters - 10% of necrotizing enterocolitis occurs in full-term babies - look for pneumatosis intestinalis on abdominal XR; also think about aganglionic colon or Hirschprung disease; 80% of cases of volvulus occur within the 1st month of life     Toxins - was there some maternal medication or ingestion?  Is there some home remedy or medication used on the baby?  Check a glucose ad drug screen     Sepsis - Saved for last - You'll almost always treat the sick neonate empirically for sepsis - think of congenital and acquired etiologies. Hyperoxia TestThe hyperoxia test is the single most important initial test in suspected congenital heart disease - we can test the child's circulation by his reaction to oxygen on an arterial blood gas.  Place the child on a non-rebreather mask, and after several minutes, perform an ABG.  (Ideally you obtain a preductal ABG in the right upper extremity, and compare that with one on the lower extremity, but this may not be practical.) In a normal circulatory system, the pO2 should be high - in the hundreds - and certainly over 250 torr. This effectively excludes congenital heart disease as a factor.  If the pO2 on supplemental oxygen is less than 100, then this is extremely predictive of hemodynamically significant congenital heart disease.  Between 100 and 250, you have to make a judgement call, and I would side on worst first. If you are giving this child 100% O2, and he doesn't improve 100% -- that is, his ABG is not at least 100 - then he has congenital heart disease until proven otherwise.  Give prostaglandin if the patient is less than 4 weeks old (typical presentation is within the first 1-2 weeks of life).  Start at 0.05 mcg/kg/min.  PGE keep the systemic circulation supplied with some mixed venous blood until either surgery or palliation is decided.  Summary Points* When you see a sick infant, keep THE MISFITS around to keep you out of trouble.* Before you decide on sepsis, ask yourself, could this be a cardiac problem?* When in doubt, perform the hyperoxia test.* All the rest, you have time to look up. Before You Go: The Availability HeuristicSelected References Brousseau T, Sharieff GQ. Newborn Emergencies: The First 30 Days of Life. Pediatr Clin N Am. 2006; 53:69-84. Cloherty JP, Eichenwald EC, Stark AR: Manual of Neonatal Care, 5th edition. Philadelphia, PA, Lipincott Williams & Wilkins, 2004. Horeczko T, Young K: Congenital Heart Disease, in Pediatric Emergency Medicine-A Comprehensive Study Guide, 4th Ed. ACEP/McGraw-Hill, 2013. McGowan et al. Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines. Circulation. 2010;122:S909-S919. Okada PJ, Hicks B. Neonatal Surgical Emergencies. Clin Ped Emerg Med. 2002; 3:3-13.