Post operative Management

1)Myelomeningocele

Sterile management

Thermoregulation/Thermoneutral environment

Prevent hypothermia

Careful hand hygiene

Keep stool off the wound/frequent diaper change

Nurses prone or at least side lying

Avoid pressure on suture line

Cardio respiratory monitoring

Close monitoring of apnea,hypoxia, HR,BP,

W/F raised ICP

Record daily head size

F/U UGS cranium

F/u neonatal hearing evaluation

Pain management/neonatal Infant pain scale

Morphine or fentanyl

Institute latex allergy precaution

To

2) Hydrocephalus

Pt should be nursed flat to avoid subdural haemorrage because of rapid collapse of ventricle in head high pressure

Infant Of Diabetic Mother

Glucose monitoring 0 1 2 4 8 12 24 36 & 48 hrs

Calcium should be checked at 4&24h

HCT @ 4 & 24 hrs

SBR @ 24 hrs

Breast feeding should be encouraged as early as possible

Hypoglycemia <2.6mmol < 45 mg/dl

Asymptomatic baby >25(1.4mmol/l)

Plasma glucose level

Early feeding

Glu level are monitored 30-60 mins until stable(Glu > 2.6 ) then every 4 hr

If Glu remain low IV Glu infusion @ 6mg/kg/min

Glu < 2.5 (<1.4 )

Plasma Glu level

IV Glu inf @ 6-8 mg /kg/min

Monitor Glu every 30 min

Glucagon can be given 0.3 mg/kg s/c,IM

Symptomatic Hypoglycaemia

Plasma Glu level

IV Glu Bolus o

If convulsion 400mg/kg(4 ml/kg)

Other symptoms 200 mg/kg(2ml/kg)

Then cont infusion of Glu @ 6-8 mg/kg/min

Increase the rate if needed (till 16-20 mg/kg/min)

Monitor bl Glu every 30- 60 min until stable

If no IV catheter Glucagon can be tfc ggiven 0.3 mg/kg s sSC IM

Persistant Hypoglycaemia tt

Cont admin of IV Glu and increase the rate to 16-20 mg/kg/min by increase the conc from 10% DW to 20% DW

Serum Glu, ketones free fatty acidts lactate alanine UA insulin GH cortisolre glucagon T4 TSH

Urine for catecholamines organic acids specific redusing sugars

Endo consultation

Corticosteroids if the infant require more then 12 mg Glu/ kg/min

Hydrocortisone 10 mg/ kg / day BD

Prednisolone 2 mg/ kg

Diazoxide 2-5 mg/kg/dose po Q8H

Octreotide 2-10 micrograms /kg/day

SC Q6-8H

Hypocalcemia

Preterm Tsc :< 1.75 mmol/L

Isc: : <1 mmol/L

Term. Tsc: < 2mmol/L

Isc : < 1.2 mmol/L

mg/L can be converted by dividing it by 4 to make mmol/ L

Causes of Early Onset Hypocalcemia

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Prematurity

Preeclampsia

IDM

Perinatal asphyxia

Maternal hyperparathyroidism

Maternal anticonvulsant use

Iatrogenic ( alkalosis, diuretics, phototherapy blood products and lipid infusion)

Clinical presentation

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Neuromusculary irritability, myoclonic jerks, jitteriness, exaggerated startle and seizure, tachycardia heart failure prolonged QT interval apnea cyanosis tachypnea vomiting laryngospasm

Treatment

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Asymptotic

IV/PO calcium gluconate

80 mg/kg/day for 48 hrs

40 mg/kg/day for 24 hrs

Then stop

Symptomatic

IV calcium gluconate

2 ml/kg as Bolus

80 mg/kg/day for 48 hrs

Documents normal Scalcium level and reduce to 40 mg/kg for 24 hrs

Then stop

1 ml of ca glu contains 9 mg of elemental ca

Diluted 1:1 in 5% dextrose and adm under cardiac monitoring

Take care of extravastion as that can results into skin sloughing

TTN

X-ray

Prominent peri hilar streaking

Fluid in the minor fissure

Prominent pulmonary vascular markin

Lung hyperinflation with depression of diaphragm

Brachial injury

After the initial rest period of 7 to 10 days after birth, physical therapy interventions can typically commence safely. However, aggressive movements that force joints or overstretch the involved UE must be avoided because these may cause further damage. After the physical therapy examination has been completed, a home exercise program (HEP) should be initiated that includes appropriate ROM techniques for all UE joints at risk for contracture. The HEP should also emphasize precautions related to joint dislocation and subluxation.

Anticonvulsant dosage

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Valproic Acid initial 10-15 mg/kg/day qid/tid increment 5-10mg/kg/day at weekly interval to max 60 mg/kg/day

Maintenance30-60 mg/kg/day bd tid

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Phenobarbital

Maintenance dose Po/IV

Neonate 3-5 mg/kg/day qid bid

Infant 5-6 mg/kg/day qid bid

Child(1-5). 6-8 mg/kg/day qid bid

Child(6-12). 4-6 mg/kg/day qid bid

>12. 1-3mg/kg/day qid bid

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Clonazepam

Child <10 yrs or < 30 kg

Initial 0.01-0.03 mg/kg/day q8h

Increment 0.25-0.5 mg/day q3days max 0.1-0.2mg/kg/day

Child >10 yrs > 30 kg

Initial 1.5 mg/day tid

Increment 0.5-1mg/day q3day max 20mg/day

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Levetiracetam keppra

4-15yrs. 10mg/kg/dose. Bd to max

30mg/kg/dos

Topiramate Topamax

Child 2-16yrs start with 1-3mg/kg/dose max 25mg/dose QHS for 7 days then increase by 1-3mg/kg/day increment at 1-2 week Usual maintenance dose is 5-9mg/kg/day

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Lamotrigine

Resuscitation Flow Chat


Blood transfusion complication

Fluid overload

Hyperkalamemia arrthymias

Hypocalcamenia

Hypocalcamenia

Hypoglycaemia

Hypo or hypertension

Anaphylactoid reaction

Hyperviscosity

Line complication , coagulapathy

Thrombocytopenia

Convulsions

NEC

Transfusion reaction

Fever ,

Circulatory overload

Allergy

Haemolysis

Infection