There are few things more fear provoking to Emergency Physicians than the presentation of a sick neonate.
Everything is different; not only in size but also the pathophysiology of disease with some serious conditions presenting uniquely in this group.
Hopefully this module will provide you with a systematic approach to evaluation and management of the very young.
In Leicester GPs hold the contract for performing baby-checks so if mums are discharged within the first 24 hours this will not be performed in hospital and there may be a few days wait until a GP appointment for this can be secured.
As a result for many very young babies presenting to the department it is entirely possible that the ED doctor is the first person to ever examine the child and therefore the opportunity should be taken to perform a thorough assessment.
LEARNING OUTCOMES FROM COMPLETING THE TASKS
Take a history from and examine a child presenting with ALTE and propose an appropriate plan for investigation and management.
Recall the NLS algorithm.
Describe the care of a woman in labour who is about to deliver imminently.
Understand the unique physiology of neonates including thermoregulation.
LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING
Perform a systematic examination of a neonate.
Demonstrate resuscitation of the newborn as per NLS/APLS guidelines.
Recognise a healthy neonate.
Formulate a differential diagnosis for a variety of common presenting complaints.
Complete the following before the face-to-face session:
TASK 1: ALTE
Duration: 20 mins
Read this guideline from the Royal Children's Hospital Melbourne.
Task 2: Delivery in the ED & Neonatal resuscitation
Duration: 40 mins
This guideline for paramedics gives a useful overview ofhow to assist in a normal delivery and how to manage some common problems that can occur at or shortly after delivery
This video provides a great run through of neonatal resuscitation as per the NLS protocol. A copy of the NLS algorithm can be found in the Additional Resources area of this module.
Task 3: Newborn Examination
Duration: 20 mins
Ready this guide to the Newborn Baby Check by Don't Forget the Bubbles.
Task 4: Neonatal Physiology
Duration: 20 mins
This is a thorough overview of fetal and neonatal physiology and the changes that occur at birth.
Task 5: The Sick Baby
Duration: 28 mins
This podcast discusses the approach to a sick baby under 3 months and features our very own PEM Consultant Dr Rachel Rowlands
We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.
Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.
Part of the face-to-face teaching will be spent discussing the case(s) below:
Here are some extra resources to review if you want more information:
This guideline from Queensland is a thorough guide to performing a baby check.
A great resource containing hundreds of pictures of both normal and abnormal findings in neonates.
This article from American Family Physician is a very informative reference on common exanthems in neonates with plenty of photos.
The Neonatal Life Support algorithm.
The following are helpful resources on the assessment and management of sick neonates:
Review article: Newborn Emergencies: The first 30 days of life
Review Article: Evaluation and Management of the Sick Neonate
Podcast: Neonatal nightmares – SMACC
Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: