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Intrapartum
Sepsis Risk
Antibiotic
Maternal Factors
Treatment Management
GBS Status (1 major or
(>4 hrs prior to
2 minor)
delivery)
+ - + Routine Care
+ - - CBC, blood culture, Treat if CBC
abnormal
+ + + CBC, blood culture
Treat if: CBC abnormal or <35 wks
+ + - CBC, blood culture
Treat with antibiotics
+ (-) Intact - Routine Care
Membranes,
no active
labor, C/S
- - +/- Routine Care
- + + CBC, blood culture, Treat if CBC
abnormal
- + - CBC, blood culture, Treat if CBC
abnormal
? - +/- Routine Care
? Only ROM + Routine Care
>24 hr
? Only ROM - CBC, blood culture, Treat if CBC
>24 hr abnormal
? + + CBC, blood culture
Treat if: CBC abnormal or <35 wks
? + - CBC, blood culture
Treat with antibiotics
Abnormal CBC: WBC <5,000, or I:T (bands ÷ (polys + bands)) ratio >0.2
DR to NICU:
1. <1800 gm
2. <34 weeks
3. Cyanosis on RA
4. Apnea
5. Seizures
6. Congenital malformations requiring surgery
7. IDM Class D and above
Nursery to NICU:
1. Apnea
2. RR >90/min x 2 episodes, greater than 4 hours of life
3. Feeding intolerance after 24 hours
4. Drug withdrawal
5. Hypoglycemia
6. Seizures
Lines
PPHN
cyanosis, progressive hypoxia, increased A-a gradient, low CVP and BP
TX: ventilation – use low MAP, high FiO2 (ideal ABG 7.5/25-30/>50), rapid rate ventilation,
alkalosis, volume, pressors. Consider nitrous oxide. Consider ECMO if OI > 40. OI = (MAP *
FiO2)/ PaO2
Seizures
Phenobarbital: load 15-20 mg/kg over 10-15 minutes, maintenance 3-5 mg/kg/day QD.
Therapeutic levels 15-40. Monitor apnea & ↓BP
IVH – Stages
I – subependymal (germinal matrix)
II – intraventricular, no dilatation
III – intraventricular, with dilatation
IV – intraparenchymal
Apnea of Prematurity
Caffeine: loading dose 10-20 mg/kg PO/IV, then maintenance dose 5-10 mg/kg/dose QD.
Check level 24h post loading, therapeutic level 20-25.
ABG guidelines:
Preterm Term PPHN
pH ≥ 7.25 ≥ 7.30 7.35-7.5
pCO2 35-55 35-55 30-40
pO2 45-65 60-80 80-120 (goal 100)
Surfactant
For low birth weight <1350 g at risk for RDS. Give 4cc/kg/dose Survanta via ETT. Repeat up
to 4doses q6h if FiO2 > 40%. If MAS: 6 cc/kg q6h X 2-3 doses. Watch out for pulmonary
hemorrhage.
Survival data (USC = 1994-1998, not including congenital anomalies): *Intact = without
blindness, deafness, MR or CP
Best Gest. Survival Intact Weight Survival Intact
Age (USC) Survival (gms) Survival
(national) * (national) *
18-21 0/30 = 0% 0% ≤ 500 4/55 = 7% 0%
22 3/23 = 13% 0% 501-600 19/38 = 50% 30
23 16/40 = 40% 30% 601-700 34/42 = 81% 60%
24 16/23 = 70% 60% 701-800 35/41 = 85% 70%
25 19/22 = 86% 70% 801-900 28-30 = 93% 80%
26-27 76/84 = 90% 80% 901-1000 43/44 = 98% 90%
≥28 297/308 = 90-95% 1001-1500 266/271 = 95%
96% 98%