2025 – PAGE 175 – NEONATOLOGY
SUDDEN INFANT DEATH SYNDROME (SIDS)
The risk of Sudden Infant Death Syndrome (SIDS) is increased with smoking, low socioeconomics, low birth weight, younger parents, co-sleeping, and tummy sleeping.
ANURIA
For anuria lasting > 24 hours after birth, first gently attempt to obtain a catheter urine specimen. If unsuccessful, obtain a RENAL ULTRASOUND.
ANEMIA
For newborns, anemia is considered any hemoglobin < 13.
APT TEST
When bloody NG aspirate is noted, an APT test is done to identify whether or not the blood is from the baby or the MOTHER. The test is based on the difference between maternal and fetal hemoglobin.
NEONATAL HYPOGLYCEMIA
The definition for hypoglycemia is different in the neonatal population. Neonatal hypoglycemia is defined as a glucose level < 40 (NOT 60)! It may be caused by use of a beta-adrenergic tocolytic (which can inhibit glucagon and allow insulin to continue working, and thus cause hypoglycemia). Symptoms of hypoglycemia include apnea, tachypnea, cyanosis, shaking, seizures, and poor feeding. Treat with a bolus of 2 ml/kg of D10 solution. For an average-sized newborn (4 kg), that is 8 ml of D10 bolus. Glucagon may not work in low birth weight babies because of low glycogen stores in the liver. If the hypoglycemia is persistent, or recurrent, consider an IV infusion rate of D10 at 80 ml/kg/day.
SHOCK-LIKE SYMPTOMS
If shock-like symptoms are noted within 10 days of life, consider bacterial sepsis and inborn errors of metabolism high in your differential. Also consider congenital adrenal hyperplasia (CAH), ductal dependent complex congenital heart disease (CHD), intentional/non-intentional trauma, and viral sepsis.
(DOUBLE TAKE) MECONIUM ASPIRATION SYNDROME (MAS)
Meconium is rarely passed in utero before 34 weeks. Do not intubate and suction reflexively if there is Meconium Stained Amniotic Fluid (MSAF). Suctioning has not proven to provide any benefit. Intubation should be reserved for those showing signs and symptoms related to respiratory distress (labored breathing, hypoxia and bradycardia). Newborns showing evidence of respiratory distress within 15 minutes of birth, or those with APGAR scores of < 8, are at greatest risk for developing Meconium Aspiration Syndrome (MAS) requiring ventilatory support. The most common complication of MAS is persistent pulmonary hypertension. Vigorous newborns with APGAR scores > 9 rarely require ventilatory support (warm, dry and stimulate if needed).
(DOUBLE TAKE) NECROTIZING ENTEROCOLITIS (NEC)
Necrotizing enterocolitis (NEC) is a serious complication in a newborn that happens when the mucosa of the colon gets inflamed. It is most common in premature infants < 1,500 grams. The cause is unknown but thought to be related to hypoxia to the intestines resulting in secondary bacterial infection and possible intestinal perforation. It commonly presents with a sudden change in feeding intolerance. Additional signs and symptoms may include thrombocytopenia, anemia, bloody stool, apnea, bilious residuals, distended abdomen, tender abdomen or poor feeding. Diagnosis is with the presence of clinical features and a KUB showing air in the intestinal walls (PNEUMATOSIS INTESTINALIS). Treatment is with NPO status, NG tube to suction and broad-spectrum antibiotics. Sometimes surgical removal of a portion of the intestine is required.
PEARL: If you are presented with a similar clinical description in an older child with leukopenia or neutropenia, choose typhlitis (AKA neutropenic enterocolitis) as the answer instead.