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KMID : 0381219740060030166
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Journal of RIMSK
1974 Volume.6 No. 3 p.166 ~ p.171
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Preoperative management of the neonate
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Abstract
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In previous paper, both environmental, and internal physiologic challenges to the neonate and metabolic responses to surgical stress were discussed briefly. Some details in preparing children for neonatal surgery will be discussed in this paper.
1. Patient transport: Importance of nasogastric decompression and maintenance of body temperature during patient transport were emphasized.
2. Maintenance of body temperature: Lability of children´s temperature maintenance, effect of prolonged exposure to cold environment, sclerema neonatorum and hyperthermia were discussed.
3. Preoperative patient evaluation: Important determinants of potential difficulty in management .of any neonatal surgical emergency are the relative maturity and size of the infant, presence of concommitent anormaly and assessments of physiologic function and general activity. Some danger signals of the neonate reviewed.
4. Monitoring: The margin for error in these tiny patient is limited and may be easily exceeded in the absence of reliable monitors. Cardiovascular, respiratory, and temperature monitoring are used for assessment of the condition of a critically ill infant. Other laboratory findings as well as vital signs served well for same purpose. Importance of serial determination and observations .is stressed.
5. Management of G-I tract and vomiting: Effective naso-gastric decompression and other management of G-I tract saved many preventable death. Continuous suction with large bore, multiholled tube is necessary for effective decompression. Patency of tube should be tested hourly intervals.
6. Fluid therapy: Fluid loss from 1 day old infant is 5^´25 ml/kg of urine, 27. 6 ml/kg. of insensible loss. Infant under 5-7 days old needs 30^50 cc/kg of wt. /day besides abnormal loss. Older infant, 1 week or more needs 60^80 cc/kg/day, while older neonate(2-´4 weeks of age) needs 100 cc/kg per day. Determination of hidden loss is difficult.
7. Acid-Base balance: Astrup technic woth Siggard-Anderson Nomogram is useful for assessment
of acid-base reaction. blood gas analysis is aho important for understanding of hemodynamic changes.
8. Drug therapy: premedication, vitamin, and antibiotics and their unusual drug reactions were discussed.
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