- Neonate in respiratory distress: remember NRP!
- Neonate in respiratory distress with true unilateral absent breath sounds = Congenital Diaphragmatic Hernia??!!-> confirm with CXR
Congenital Diaphragmatic Hernia (CDH)
- Neonates likely have high risk for pulmonary hypertension!
- Do not give PPV -> worsens GI distention/lung compression = worsening pulmonary HTN
- In neonates intubate early to prevent hypoxia (hypoxia worsens pulmonary HTN) with low pressure vent settings
- Maintain systemic BP to reduce right to left shunting
- Older children with CDH, less likely to have significant pulmonary HTN, keep calm and try to avoid intubation
- Persistent/worsening cyanotic neonate - think cyanotic congenital heart defect -> Start Prostaglandins
- Remember Prostaglandins cause apnea, will likely need intubation
- Neonate in extremis = call for back-up early!