By Joel Amato, Steve Mack
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Growthhormone. 30 BLOOD GLUCOSE HOMEOSTASIS It may be necessary to also assay P-hydroxybutyrate, amino acids, glycerol, pyruvate, ketones, free fatty acids and lactate. g. cold stress). Early (<3-4hours)enteral feeding inhealthyterm or pretenn infants should be given priority. At-risk, well newborns unableto feed orally should be fed by gavage within 1-3 hours of birth. For at-risknewborns,breastmilk is nutritionallymost appropriate and thesafest(unless mother has HIV infection). g. v. e. 3-5mg/kg/minfor term appropriate for gestational age (AGA) infants; 4-6 mglkg/min for preterm AGA infants; and 6-8 mglkglmin for SGA infants).
In neonates, VT is seen with cardiac tumours, myocardial diseases, prolonged QT syndrome, asphyxia, acidosis, hypokalaemia or hyperkalaemia. VT associated with cardiovascular compromise needs synchronized cardioversion, beginning with 2 J k g followed by 4 J k g if no response occurs. During cardioversion the patient ideally should be intubated and ventilated with 100% oxygen with adequate sedation and analgesia. Underlying acid-base and electrolyte abnormalities should bepromptlycorrected. P-blockers are commonly used in patients with prolonged QT syndrome for prevention of VT.
If there is no response, give a second dose of 1 0 0 & k g after 1-2 min. A third dose of 150 p g k g can be given after a further 1-2 min. Adenosine is a potent blocker of A-V nodal conduction with an extremely short halflife (c1Os) and can successfully terminate acute attacks of SVT in up to 90% of cases. Intravenous infusion of amiodarone or flecanide forms the second line of therapy for refractory episodes of SVT. 3. Long-term therapy. Maintenance treatment is required to prevent recurrent episodes of SVT, especially when the attacks are frequent, long lasting and difficult to control and also after an episode of SVT associated with cardiovascular compromise.