Neonatal Physiology to Remember
👶 The vulnerable newborn
- Often preterm & small-for-gestational-age → limited reserve
- Prone to hypothermia (large surface area, poor insulation, exposed bowel) and hypoglycaemia (small glycogen stores)
- Transitional circulation — a patent ductus arteriosus (PDA) may reopen with hypoxia/acidosis
- Screen for other congenital anomalies — cardiac evaluation especially
Pre-operative Resuscitation & Preparation
Getting the neonate ready
Protect the exposed bowelCover with a clear bowel bag / cling film / warm saline-soaked gauze; nurse to reduce traction & kinking → ↓ heat & fluid loss, ↓ ischaemia
Decompress the stomach — NG / orogastric tubePrevents regurgitation, aspiration pneumonia and bowel distension
Fluid resuscitation & fluid challengeCorrect hypovolaemia, acidosis & haemoconcentration; warm fluids; titrate to a urine output of 1–2 mL/kg/h
Keep warm & prevent heat lossRadiant warmer, warmed theatre, warmed fluids/gases; maintain glucose
Clinical assessment before theatre: skin perfusion, capillary refill, HR & BP, blood gases, electrolytes & glucose. A significantly hypovolaemic, acidotic neonate needing large-volume resuscitation is best electively intubated and stabilised before transfer.