Tag Archives: NICU

New Changes in NRP

The new 7th edition of the NRP (Neonatal Resuscitation Program) has a significant change over the previous recommendations.

The new book has been released and you can Order it from Amazon.

NRP Book

NRP Book

Now. We don’t need to routinely intubate non-vigorous newborns with meconium-stained fluid. Previously we used to intubate such newborns before we do stimulation (the fear was stimulating them to breathe would make them aspirate more meconium into the lungs) and do tracheal suctioning.

However, I think the word “routinely” is important here. Yes, no need to do that routinely but if the newborn is sick and not ventilating adequately we still have to do tracheal intubation and tracheal suctioning and follows the regular NRP algorithms.

D10 Water Dose and Numbers in the Neonate

Ever wondered how much in each one ml of 10% Dextrose Water? Do give IV D10W to neonates? Here is some numbers that can help.

By convention when we say 10% Dextrose, this means there is 10 Grams of Glucose in each 100 ml of water. This translates to 100 mg of glucose in each milliliter (ml) of D10W.

D10W

 

The IV Bolus in emergency situations is 0.2 to 0.3 Grams of glucose per kilogram and so we now know this means it’s 2-3 ml/kg of D10, give slowly (2 min) because rapid increase will biget a decrease in glucose level.

While if you are going to use D10 for IV maintenance fluid therapy and If there is no hypoglycemia you can start with 65-80 ml/kg/day just like a regular day 1 neonate total fluid volume. If there is hypoglycemia it is recommended  to start with 100-120 ml/kg/day.

Glucagon dose (if you could not get IV) is 0.03 mg/kg with maximum 1 mg

To calculate the GIR (Glucose Infusion Rate) which is in (mg/kg/min) you use this formula:

Percent glucose in the bag X 10 X  you current infusion rate (ml/hr) divided by 60 X Weight in kg

If your GIR approaches 12 mg/kg/min then think hyperinsulinesm and it’s not just your everyday neonatal hypoglycemia.