UMEM Educational Pearls

Category: Pediatrics

Title: Initial Management of the Premature Infant in Your ED

Keywords: Neonatal Respiratory Distress Syndrome, RDS, Cold Stress, Surfactant (PubMed Search)

Posted: 12/7/2007 by Sean Fox, MD (Updated: 10/18/2019)
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The Premature Infant Delivered in Your Department

An ode to my final NICU Call… just because you don’t work in a Pediatric ED, doesn’t mean you won’t encounter premature infants.

What do you need to remember when a premature infant is born in your ED (or the ambulance / cab / car)?

  • Warm them and keep them warm
    • Cold stress, often overlooked, worsens acidosis and decreases surfactant function.
  • Neonatal Respiratory Distress Syndrome manifests as cyanosis, tachypnea, grunting, retractions, and/or respiratory failure.
    • CXR has “ground-glass” appearance and air bronchograms
    • It is due primarily to inadequate surfactant.
    • Early administration of surfactant has proven to improve outcomes
    • Contact a neonatologist ASAP and determine if you have easy access to a surfactant product (it really is an amazing therapy).
    • You administer it down the ETT… you’ve likely intubated them by now.
  • Fluids
    • Fluid Boluses are done with normal saline (10ml/kg)
    • Maintenance Fluids should be D5W or D10 (no electrolytes at first!)
  • Antibiotics
    • One of the most common reasons for premature delivery is neonatal infections… don’t be stingy, start Amp/Gent (consider acyclovir) and send blood cultures at least.