This document outlines a systems-oriented approach to caring for neonates using 10 organ systems: 1) fluids and nutrition, 2) glucose, 3) respiratory, 4) cardiovascular, 5) hematology, 6) GI/bilirubin/liver, 7) infectious disease, 8) medications, 9) neurological, and 10) social. Each system is discussed in 1-2 paragraphs covering assessments, common issues, and treatments. The overall approach aims to comprehensively capture all relevant medical information to bring order to neonatal care.

1. “1 THRU 10”
A Systems- Oriented
Approach to the Neonate
Dr. David Mendez
Kidz Medical Services

2. 1 thru 10
DISCLAIMER
No one offered to pay me anything for what I am about to say.
I did, however, borrow, use and steal almost all of the
concepts I am about to talk about.

3. 1 thru 10
1. Fluids, Electrolytes,Nutrition
2. Glucose
3. Respiratory
4. Cardiovascular
5. Hematology

4. 1 thru 10
6. GI/Bilirubin/Liver
7. Infectious Disease
8. Medications
9. Neurological
10.Social

5. 1 thru 10
History
 Systems approach is older than me
 Babies can’t tell you what’s wrong
 Captures all the information
 Brings order to chaos

6. 1 thru 10
1.FLUIDS AND NUTRITION
 Primary focus of Neonatal Care
 Can change hourly
 Responsible for decreasing Mortality
 Responsible for decreasing Morbidity

7. 1 thru 10
1.FLUIDS AND NUTRITION
 ENTERAL vs PARENTERAL

8. 1 thru 10
1.FLUIDS AND NUTRITION
ENTERAL
 NPO
 OG
 GT
 PO

9. Louise Recht
“Aunt Louise, The
Mother of Neonatal
Care”
Taught the French
Technique of Gavage
Feeds
Led the Nursing Staff
and Wet Nurses

10. 1 thru 10
1.FLUIDS AND NUTRITION
PARENTERAL
 Central vs. Peripheral
 Angiocaths invented in the 60’s
 Intra abdominal injections of fluid

11. 1 thru 10
1.FLUIDS AND NUTRITION
INS AND OUTS
IV FLUID URINE
TPN STOOL
FORMULA OSTOMY
LIPIDS REPLOGLE
COLLOIDS

12. 1 thru 10
1.FLUIDS AND NUTRITION
INTAKE
Admission Fluids
D10 at 80 ml/kg/day
Starter TPN--- D10 with 2gm A.A.+
200mg/100ml of CaGluconate

13. 1 thru 10
EVERYONE STARTS AT 80 – 100 CC/KG/DAY
WHY?

14. 1 thru 10
2. GLUOSE
BASAL METABOLISM
4 – 8 MG/KG/MIN

15. 1 thru 10
2. GLUOSE
QUICK FORMULA TO CALCULATE GLUCOSE
INFUSION RATE (GIR)
MG/KG/MIN = (dex conc.) X rate (cc/hr)
Current wt( kg) x 6

16. 1 thru 10
2. GLUOSE
GLUCOSE INFUSION RATE (GIR)
A 3 Kg baby given 80ml/kg day of D10W
10 x 10 ml/hr = 5.5 mg/kg/min
3 kg x 6

17. 1 thru 10
3. RESPIRATORY

18. 1 thru 10
2. RESPIRATORY

19. 1 thru 10
2. RESPIRATORY

20. 1 thru 10
3. RESPIRATORY
 Clinical Exam (changes, new problems, O2 sats)
 Disease State
 Blood Gases
 Radiology

21. 1 thru 10
3. RESPIRATORY
LEVEL OF SUPPORT
 ROOM AIR
 NASAL CANULA,VAPOTHERM
 CPAP, ASSISTED VENTILATION

22. 1 thru 10
4. CARDIOVASCULAR
 Clinical Exam (changes, new problems, O2 sats)
 Disease State
 Blood Gases
 Radiology

23. 1 thru 10
4. CARDIOVASCULAR
CYANOSIS vs ACYANOSIS
MURMUR vs NO MURMUR
BLOOD PRESSURE, HR, RHYTHM

24. 1 thru 10
4. CARDIOVASCULAR
PDA’S
THE 5 “T”s DO ESP
ARRYTHMMIAS

25. 1 thru 10
5. HEMATOLOGY
 HEMOGOLBIN/HEMATOCRIT
 WHITE COUNT AND DIFF
 PLATELET COUNT
 COAGULATION PROFILE

26. 1 thru 10
5. HEMATOLOGY
ANEMIA vs POLYCYHTEMIA
THROMBOCYTOPENIA vs POLYCYTOSIS
NEUTROPENIA vs LEUKEMOID

27. 1 thru 10
5. HEMATOLOGY
 TRANSFUSIONS (number, last time)
 FRESH FROZEN PLASMA
 EPOGEN,NEUPOGEN,FACTORS

28. 1 thru 10
6.GI/BILIRUBIN/LIVER
 Most Varied Clinical Exam
 Organomegaly
 Jaundice
 Stool ( output, type, heme +/-)

29. 1 thru 10
6.GI/BILIRUBIN/LIVER
GI
 INTOLERANCE TO FEEDS
 ABDOMINAL DISTENSION
 NEC UNIQUE TO PRE-TERMS

30. 1 thru 10
6.GI/BILIRUBIN/LIVER
BILIRUBIN
 UNIQUE TO NEWBORNS
 PRETERMS AT RISK
 PHOTORX, EXCHANGE, IVIG
 ULTRASOUNDS, CT, DOPPLERS

31. 1 thru 10
6.GI/BILIRUBIN/LIVER
LIVER
 ORGANOMEGALY
 CHOLESTASIS
 RESILIENT ORGAN

32. 1 thru 10
7. INFECTIOUS DISEASE
 SUBTLE TO CATASTROPHIC PRESENTATION
 LITTLE WARNING
 MATERNAL ENVIRONMENT
 NICU ENVIRONMENT
 PUBLIC ENVRIRONMENT

33. 1 thru 10
7. INFECTIOUS DISEASE
 CULTURES,CULTURES,CULTURES
 CBC,CRP INDICATE TRENDS
 TITERS ARE LIMITED
 RADIOLOGY

34. 1 thru 10
7. INFECTIOUS DISEASE
BACTERIAL
GROUP B STREP E.COLI
STAPH SPECIES KLEBSIELLA
PSEUDOMONAS H. INFLUENZAE

35. 1 thru 10
7. INFECTIOUS DISEASE
VIRAL
HERPES SPECIES HIV
TOXOPLASMOSIS CMV
ENTEROVIRUS RUBELLA
HEPATITIS PARAMYXOVIRUS
INFLUENZA( H1N1, etc)

36. 1 thru 10
7. INFECTIOUS DISEASE
FUNGAL/OTHER
SYPHILLIS TUBERCULOSIS
CHLAMYDIA CANDIDA
PNEUMOCYSTIS PROTOZOAN
MYCOPLAMSA ACREMONIUM

37. 1 thru 10
8.MEDICATIONS
 OFTEN AS NUMEROUS AS AN ADULT
 “1 THRU 10” IS YOUR FRIEND
 BEGINNING, DOSING, ENDING
 TOXICITY

38. 1 thru 10
8.MEDICATIONS
WHILE THIS CATEGORY SERVES AS A
PLACEHOLDER TO KEEP TRACK OF
MEDICATIONS, THEY ARE DISCUSSED AS
PART OF THE SYSTEM

39. 1 thru 10
8.MEDICATIONS
1. FLUIDS AND NUTRITION
VITAMINS, IRON
HUMAN MILK SUPPLEMENTS
ELECTROLYTE SUPPLEMENTS

40. 1 thru 10
8.MEDICATIONS
2. GLUCOSE
INSULIN
GLUCAGON
HYDROCORTISONE

41. 1 thru 10
8.MEDICATIONS
3. RESPIRATORY
SURFACTANT
DIURETICS
STEROIDS
AERSOLIZED MEDS, INHALED MEDS
APNEA MEDS- CAFFIENE,THEOPHYLLINE

42. 1 thru 10
8.MEDICATIONS
4. CARDIOVASCULAR
BLOOD PRESSURE MEDS( RAISE/LOWER)
DIGOXIN
ANTI-ARRYTHMIC
DIURETICS

43. 1 thru 10
8.MEDICATIONS
5. HEMATOLOGY
EPOGEN
NEUPOGEN
FERRINSOL
FACTORS

44. 1 thru 10
8.MEDICATIONS
6. GI/BILIRUBIN/LIVER
IVIG
ACTIGALL
PHOTOTHERAPY(?)
ANTACIDS

45. 1 thru 10
8.MEDICATIONS
7. INFECTIOUS DISEASE
ANTI-BACTERIAL
ANTI-VIRAL
IVIG
ANTI-FUNGAL

46. 1 thru 10
8.MEDICATIONS
9. NEUROLOGIC
PHENOBARBITAL
PHOSPHENYTOIN
SEDATION MEDS
ANTI-SEIZURE MEDS
PARALYTIC MEDS

47. 1 thru 10
8.MEDICATIONS
10. SOCIAL
MEDICATIONS THAT THE MOTHER IS TAKING THAT
CAN BE EXCRETED IN THE BREAST MILK
GENERAL AFFECT OF THE PARENTS THAT MAY
RAISE CONCERN

48. 1 thru 10
9. NEUROLOGICAL
 SEIZURES AND IVH PRIMARY ISSUES
 TONICITY
 METABOLIC DISORDERS
 EVOLUTIONARY PROCESS vs STATIC

49. 1 thru 10
9. NEUROLOGICAL
 STUDIES, STUDIES, STUDIES
HEAD ULTRASOUNDS
EEG, vEEG, CT, MRI
ALMOST ALL STUDIES REQUIRE FOLLOW UP

50. 1 thru 10
9. NEUROLOGICAL
ONE OF THE BEST PREDICTORS FOR NORMAL
NEUROLOGIC DEVELOPMENT IS A NORMAL
NEUROLOGIC NEWBORN EXAM

51. 1 thru 10
9. NEUROLOGICAL
BRAIN COOLING (TOTAL BODY COOLING)
 RX FOR HIE - TIME SENSITIVE
 APPEARS TO REDUCE MORTALITY
 APPEARS TO NOT INCREASE MORBIDTY

52. 1 thru 10
10. SOCIAL
 IDENTIFICATION OF PRIMARY CAREGIVERS
 WHO COMES TO THE BEDSIDE
 COMMUNICATE THE “1 THRU 10”
 BEST ROLE IN REDUCING MALPRACTICE
SUITS

53. 1 thru 10
10. SOCIAL
 SOCIAL SERVICE OFTEN KEY
 GOSSIP IS DEADLY
 NICU PSYCHOSIS
 MEDICAL ERRORS- inform, address, apologize