To facilitate the optimal case management and. monitoring of newborns requiring mechanical ventilatory support we have developed a resident friendly quick care easy recall guide by using the numbers 1 to 9 (Table I).
The first column uses numbers 1 to 3 and represents the weight of baby in Kg.
The second column uses numbers 4 to 6; by putting zero in front of each of these digits gives the acceptable lower limit of systolic blood pressure in
mm of mercury(1).
The third column uses the numbers 7 to 9 which represents the appropriate tip to
I
lip distance in cm [Tochen's formula] for
orotracheal intubation(2). These numbers
I
also represent the estimated length of umbilical venous catheter (UVC) in cm to be inserted for it to be in proper place(3).
The fourth collunn is obtained by dividing the first digit of second column by 2, which then represents the appropriate size of endotracheal tube. By adding 0.5 to this we can get the acceptable range of the tube size for that particular weight group(4).
The optimal length of high position of umbilical arterial catheter (UAC) in cm is obtained by adding the first digits of column I, II and III (e.g., for 1 kg group = 1 +4+7=12). This is shown in the fifth column(3).
Optimal size of endotracheal tube suction catheter is obtained by multiplying the inner diameter of endotracheal tube by two.
(e.g., for 2.5 size endotracheal tube 5f suction catheter)(4) and is represented in column VI.
Thus by using Table I it becomes very easy to remember the acceptable lower limit of systolic blood pressure, endotracheal tube size and length of insertion, size of suction catheter for endotracheal tube, and length of UVC and UAC insertion for a
particular weight group of babies. This facilitates optimal care of very sick neonates.
TABLE I
KEM Resident Friendly Table for Optimal Management of Sick Neonates.
|
I |
II
|
III |
IV |
V |
VI |
Birth
weight
(kg) |
Acceptable
lower limit
of systolic
blood pressure
(mm Hg) |
(a) Tip to lip
distance for
Endotracheal
tube in cm (b) length
of UVC in cm |
Size of
endotracheal
tube, inner
diameter in
mm |
Length of
UAC in
cm
|
Size of suction
catheter for ET
tube in French
units |
|
1 |
40 |
7 |
2-2.5 |
12 |
5 |
|
2 |
50 |
8 |
2.5 - 3 |
15 |
6 |
|
3 |
60 |
9 |
3-3.5 |
18 |
7 |
Nandkishor S. Kabra,
Ganesh Srinivasan,
Department of Neonatology,
KEM Hospital, Parel,
Mumbai 400 012,
India.
1.
Versmold HT, Kittermann IA, Phibbs RH, Gregory GA, Tooky WHO et al. Aortic blood pressure during the first 12 hours of life in infants with birth weight 610-4,220. Pediatrics 1981; 67: 607-613.
2.
Tochen ML. Orotracheal intubation in the newborn infant: A method for determining depth of tube insertion.
J
Pediatr 1979;
95: 1050.
3.
Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in
newborns. Am
I
Dis Child 1986; 140: 786.
4.
Quinn W, Sandifer L, Goldsmith IP. Pulmonary care. In: Assisted ventilation of the Neonate, 3rd edn. Eds. Goldsmith IP, Karotkin EH. Philadelphia, W.B. Saunders Co, 1996; pp 101-124.
