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Pocket Emergency Paediatric Care - part 4

Đánh giá oxy hóa và cung cấp oxygen cho đến khi màu hồng và SaO2 94-98%. Tránh hyperoxaemia. • khí máu động mạch. • Cấy máu và IV kháng sinh nhất định. Ampicillin / penicillin và một aminoglycoside (hoặc một cephalosporin thế hệ thứ ba). • Ngực x ray. • Tránh ăn uống: IV glucose 10% (60 ml / kg / ngày) là an toàn nhất, | 58 POCKET EMERGENCY PAEDIATRIC CARE Principles of treatment Assess oxygenation and give oxygen until pink and SaO2 94-98 . Avoid hyperoxaemia. Arterial blood gas. Blood culture and IV antibiotics given. Ampicillin penicillin and an aminoglycoside or a third generation cephalosporin . Chest x ray Avoid oral feeding IV 10 glucose 60 ml kg day is safest peripheral vein or if not possible UVC. If no facilities for IV breastmilk or 10 glucose up to 60 ml kg day by orogastric tube. Early continuous positive airways pressure CPAP . Intermittent positive pressure ventilation IPPV . Causes of neonatal apnoea Apnoea of prematurity idiopathic . Hypoglycaemia temperature instability and anaemia. Pulmonary parenchymal disease. Airway obstruction for example hyperflexion or hyperextension of the neck especially in premature infants. Congenital airway anomalies for example trans-oesophageal fistula TOF or vascular sling . Infection. Antibiotics until excluded. Seizures. Maternal narcotics. Reversed by naloxone 100 micrograms kg usually IM but not if chronic narcotic dependency in pregnancy. Neonatal infections Subtle non-specific changes in feeding pattern emesis irritability pallor diminished tone and or decreased skin perfusion Lethargy apnoea tachypnoea cyanosis petechiae and early jaundice Fever uncommon especially with bacterial infection 7 days Temperature instability hypothermia Hypoglycaemia and or metabolic acidosis. Maternal risk factors for early onset sepsis Maternal chorioamnionitis Intrapartum maternal fever especially 38 C or greater Premature rupture of membranes Prolonged rupture of membranes 18 hours or greater Preterm labour Maternal bacteriuria especially P-haemolytic streptococcus Prior infected infant. Laboratory tests Blood culture about 1ml venous blood WBC and differential poorly predictive of infection. Normal 48 hours 10-30 X 109. If 5 X 109 or elevated ratio band forms to total neutrophil mature neutrophils plus bands 0 3 or greater supports infection