Neonatal distress

Rationale

Neonatal distress is common and often presents nonspecifically. Physicians must identify and manage cases of neonates in distress as a matter of urgency; failure to do so can result in significant morbidity and mortality.

Causal Conditions

(list not exhaustive)

1. Prematurity
2. Pulmonary (e.g., meconium aspiration, pneumothorax)
3. Decreased respiratory drive (e.g., maternal medications, asphyxia)
4. Cardiovascular (e.g., anemia, congenital heart disease)
5. Infection (e.g., group B streptococci sepsis, meningitis)

Key Objectives

Given a neonate in distress, the candidate will assess the need for and initiate resuscitation, identify underlying and ongoing pathologies, determine ongoing clinical requirements, and determine whether Level II or Level III neonatal intensive care is indicated.

Enabling Objectives

Given a neonate in distress, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. physical signs and symptoms necessitating immediate resuscitation,
   2. a relevant maternal and perinatal history, and
   3. a physical examination that is relevant to formulating a differential diagnosis;
2. list critical investigations targeted towards identifying an underlying cause and interpret the results of the investigations (e.g., cord blood gas analysis, blood glucose level, chest radiography, blood cultures);
3. construct an effective initial management plan, including
   1. neonatal resuscitation,
   2. elements of ongoing supportive care, including
      1. cardiorespiratory support
      2. sepsis management
      3. hypoglycemia management
      4. fluid electrolyte balance management
      5. thermoregulation,
   3. appropriate communication with caregivers, and
   4. appropriate consultation and/or referral including initiating transport to a facility providing tertiary neonatal care if indicated.