Trish Woods guides you through some clinical pearls in the intensive care management of neonates. The complex physiology of the transitioning required in the journey from foetal life to neonatal presents many challenges and scary moments. Trish helps you to navigate these challenges and to unlock the key to providing quality neonatal intensive care. Many things can go wrong in the neonatal period as babies transition to life in the real world. Trish highlights her thoughts on the use of positive end expiratory pressure (PEEP), how deep to intubate, when to clamp the cord and the use of ultrasound. When babies arrive early their lungs can be full of meconium or fluid. Due to this, Trish recommends using PEEP – without which there is distal airway collapse and fluid accumulation. Aeration of the lungs is vital. To this end, how deep should intubation be aimed? The depth may not be overly important. This is because regional lung aeration triggers widespread, global increase in pulmonary blood flow. There is little definitive evidence to guide clinicians on when to clamp the cord – early or late. Trish recommends considering the physiology of clamping the cord. After clamping the cord there is a massive drop in cardiac output. Ventilatory support will turn this around – something to remember. In a compromised baby, perhaps we should aim to clamp the cord sooner and then initiate ventilation. Finally, Trish highlights the utility of ultrasound. Viewing the heart and lungs provides crucial information for the clinician. Furthermore, Trish discusses actively looking for aeration, collapse, consolidation and pneumothorax in the lungs and thorax. Overall, don’t forget the essentials. Trish reminds you to keep life sweet, warm, and tempting and help neonates to transition into the big world. Neonatal Intensive Care: Trish Woods For more like this, head to our podcast page. #CodaPodcast

2. SICK NEONATES ARE SIMPLE

3. SICK NEONATES ARE SIMPLE

4. SICK NEONATES ARE SIMPLE
A Nightmare

6. RUN AWAY!!

7. Get inside the mind of a newborn

8. Sweet IN-UTERO LIFE

9. Big Outside World

10. What Could Possibly
Go Wrong ?

11. What Could Possibly
Go Wrong ?

12. LOTS…

13. JUST BREATHE…

14. JUST BREATHE…
PEEP OR NO PEEP ?

15. JUST BREATHE…
PEEP OR NO PEEP ?

16. No PEEP
Phase contrast x-ray imaging of the lung
S.J.HOOPER et al SPring-8/SACLA 2012;17(3):232-237

17. No PEEP
Phase contrast x-ray imaging of the lung
S.J.HOOPER et al SPring-8/SACLA 2012;17(3):232-237

18. With PEEP

19. With PEEP

21. Don’t Be PEEP SHY

22. Going to intubate

23. Going to intubate

24. Going to intubate
Does Depth Matter?

25. PULMONARY FLOW
Ventilated
Lung
Non-
Ventilated
Lung
Increase in pulmonary blood flow at birth: role of oxygen
and lung aeration J.A.LANG et al J Physiol. 2016 594(5):1389-1398

26. PULMONARY FLOW
Ventilated
Lung
Non-
Ventilated
Lung
Increase in pulmonary blood flow at birth: role of oxygen
and lung aeration J.A.LANG et al J Physiol. 2016 594(5):1389-1398

27. Clamp the cord ?

28. Clamp the cord ?
early or delayed?

29. PULMONARY Blood FLOW Rise
Cardiovascular transition at birth: a physiological sequence
S.B.HOOPER et al Pediatric Research 2015;77(5): 608 - 614

30. failure To Transition

31. Switch the balance

32. SICK CARDIAC FUNCTION

33. SICK CARDIAC FUNCTION

34. SICK Filling & Pulmonary
resistance
SICK CARDIAC Filling

35. SICK Filling & Pulmonary
resistance
SICK CARDIAC Filling

36. SICK CARDIAC Output

37. Ductus Arteriosus Flow

38. Ductus Arteriosus Flow

39. TURN THE PDA WORM

40. TURN THE PDA WORM

41. lung Recruitment

42. lung Recruitment

43. lung Consolidation

44. lung Consolidation

45. Mirror image..
Screen the lungs for Air Leak
Ribs
pleural
line
More
Ribs ??!

46. Mirror image..
Screen the lungs for Air Leak
Ribs
pleural
line
More
Ribs ??!

47. Lack
Pleural
sliding
A Line
profile
Absent B
Lines
sliding
coarse
pleural
line
Coalescent
B Lines
LUNG POINT

48. Lack
Pleural
sliding
A Line
profile
Absent B
Lines
sliding
coarse
pleural
line
Coalescent
B Lines
LUNG POINT

49. Liver
huge
amount
of Pleural
fluid
squished
lung
Pleural EFFUSIONS

50. Liver
huge
amount
of Pleural
fluid
squished
lung
Pleural EFFUSIONS

51. The Essentials

53. The Adventure Begins…