Case of the Month #36 Collapsed Neonate

Published 23/02/2023

What should you do next?

A mean arterial pressure of 40 is the target in a term neonate. 0.1ml/kg boluses of rescue adrenaline are titrated to pulse volume and blood pressure.  

To make up rescue adrenaline one dilutes the resuscitation dose (0.1ml/kg of 1:10 000) to 10mls sodium chloride. 

A peripheral adrenaline infusion can be prepared and commenced at 0.1mcg/kg/min after ensuring it has gone through any dead space in the line. Peripheral dopamine is a suitable alternative. Boluses of calcium gluconate 10% 0.5ml/kg are also very effective in this age group due to low intracellular stores in the neonatal myocardium. All these drugs can be given via an intraosseous needle while awaiting central access.  

Hypoglycaemia (blood sugar <2.6mmol/l) should be corrected concurrently. This might be the cause of the collapse and a hypoglycaemia screen should be performed before glucose correction. Hypoglycaemia could also just be lack of substrate as baby will have been feeding poorly. 

Blood pressure improves but the femoral pulses are barely palpable, and a blood pressure taken on the leg is much lower (systolic >20mmHg) than that of the upper limb. Lower limb saturations are also much lower than those of the right arm.