Immediate Procedure Calculations

Intubation

ET Size

• Rule of thumb: Gestational age / 10
• Based on weight
• <  1 kg or 25-30 weeks -----> 2.0
• 1-2kg or 30-35 weeks  ----->  2.5
• > 2kg or 35 weeks+   ------->  3.0

ET Length from lips

• Weight + 6
• Not accurate if < 1kg

Links

East of England Intubation Guideline

Neonatal Intubation Video

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Resuscitation Drugs

Link: NLS Guideline

Remember the mnemonic BADS: Bicarbonate, Adrenaline, Dextrose Saline

Note there is not much evidence (here and here) for using sodium bicarbonate in neonatal resuscitation  

Bicarbonate 1-2 mmol/kg = 2-4 ml/kg 4.2% Sodium Bicarbonate Solution

Adrenaline 10 micrograms/kg = 0.1ml/kg 1:10000 Adrenaline soluti on*

Dextrose 250mg/kg = 2.5ml/kg 10% Dextrose

Saline in the presence of hypovolaemia at 10ml/kg

*Adrenaline can be increased to 30micrograms/kg if not effective (0.3ml/kg 1:10000 Adrenaline)

Clearly you don't know the weight of your baby in a resuscitation situation.  In a term baby its reasonable to have a working weight of 3kg:

Bicarbonate 6-12 ml of 4.2% Bicarbonate

Adrenaline 0.3ml 1:10000 Adrenaline

Dextrose 7.5ml 10% Dextrose

Saline 10ml

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UAC (Umbilical Arterial Catheter)

Link: East of England UAC Insertion Guideline

UAC Size: 

• < 1.2 kg: 3.5 French
• > 1.2 kg: 5 French

UAC length =  (weight in kilos x 3 + 9) + length of stump
UAC Length rule of thumb:

• From umbilicus to R shoulder (high placement)
• From umbilicus to groin crease (low placement)

Safe placement of UAC:  T6-T10 or below L3 (ideally L4-L5)

Location of various arteries
T12/L1 coaelic
L1 superior mesenteric
L2 Renal
L3 Inferior mesenterial
L4 Bifurcation of abdominal aorta into illiacs

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UVC (Umbilical Venous Catheter)

Link: East of England UVC Insertion Guideline

UVC Size

• < 1.5kg: 3.5 french
• >1.5kg: 5 french

UVC length =  (weight in kilos x 2 + 5) + length of stump
UVC Length rule of thumb:  from umbilicus to xiphisternum
Safe placement:  Above diaphragm and below chambers of heart

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