All of the following therapies may be required in a 1-hour-old infant with severe bih asphyxia except-
Correct Answer: Dexamethasone
Description: Ans. is 'b' i.e., Dexamethasone Coicosteroids should not be used' - Paediatrics for doctors - Frankshann & John Vince Management Protocol The management protocol of babies with asphyxia : Oxygen. In the absence of continuous oxygen saturation monitoring, it is reasonable to give nasopharyngeal oxygen (0.5 litre/min) until the baby recovers. If monitoring is available, oxygen is given as appropriate. Thermal control. Baby's body temperature should be kept in the normal range of 36.5-37.2degC (sometimes the babies become hyperpyrexic). Correction of shock, If peripheral perfusion is poor, it is reasonable to give 20 ml/kg of normal saline initially. If perfusion remains poor, the use of dopamine should be considered. Fluid balance. Give IV fluids at 2/3 maintenance. Use 10% dextrose. Monitor blood glucose with dextrostix and do not let it fall below 2.2 mmol (explains glucose administration) Prevent/control convulsions. In less severely affected babies, phenobarbitone should be given when there is anyuspicion of actual or impending convulsions (phenobarbitone loading dose 20 mg/kg IM or 10mg/kg slowly IV, then 5 mg/kg daily orally). Treat hvpocaleaemia if it occurs (or more practically, if the baby has uncontrollable fitting with anormal dextrostix). (explains calcium gluconate administration) Notes I. Coicosteroids should not be used, and although many paediatricians use mannitol, there is no evidence for its effectiveness. 2. Babies with severe asphyxia may appear to settle relatively quickly after the resuscitation - but there is likely to be a deterioration after 6-12 hours or so as cerebral oedema develops.
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