ACoRN First Edition Update. What s new in this third printing? ACoRN Neonatal Society Société néonatale ACoRN.

Transcription

1 ACoRN Neonatal Society Société néonatale ACoRN A Canadian non-profit Society Vancouver, British Columbia ACoRN First Edition 2010 Update What s new in this third printing?

2 What What s new? - v /09 (2010 Update) ACoRN

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4 ACoRN 2010 Update ACoRN was first published in 2005 after a 6- year creative process A second printing was needed in 2006 ACoRN 2010 Update is the third printing of ACoRN s First Edition It has the same look and feel and is essentially the same book But it has been extensively reviewed and it has been updated to reflect our current knowledge and practice Consequently, the ACoRN Laminates and Power Point presentations have also been updated

5 ACoRN 2010 Update The straight reprinting in the year of a book first published in 2005 was just not an option that the ACoRN Neonatal Society, and its instructors and learners would have found acceptable. Therefore, this third printing of ACoRN needed to be updated to a 2010 scientific and practice standard. We hope to have achieved that goal.

6 ACoRN 2010 Update We thank all those who have embraced ACoRN worldwide since 2005, and all those who have made this new printing of ACoRN possible Our many reviewers and collaborators Our instructors and learners Our Board of Directors and Managing Editors Our many Institutional partners and supporters It has taken no less than 600 hours of review and editorial work to produce this third printing

7 ACoRN 2010 Update What is new? Errors and misunderstandings have been corrected Knowledge has been updated Flow has been improved One Sequence (F&G) has been modified Bibliographic list has been revised and enhanced However, regrettably, despite all of this work not all typos have been caught

8 Overview Statement added (to match the Slides) The objective of the ACoRN education program is not to memorize the textbook but to understand the ACoRN process, its application in the clinical setting, and to learn how to use the textbook as a resource.

9 Overview Figure and text added to match the slides ACoRN =

10 Process

11 Process

12 Resuscitation Error corrected (several chapters): Oxygen requirement is not an indication to enter the Resuscitation Sequence Babies who were cyanotic but are now pink on oxygen do not need to enter the Resuscitation Sequence

13 Resuscitation

14 Resuscitation

15 Respiratory Landmark Silverman diagrams and video of baby with labored respirations have been added to the slide presentations; improved description in textbook

16 Respiratory

17 Respiratory

18 Respiratory

19 Respiratory A Table of acceptable blood gas values in acute respiratory conditions has been added to the Laminates Pages 3-42, D-3

20 Respiratory

21 Cardiovascular The chapter has changed in order to flow in better congruence with the Sequence, but most of the content is unchanged All references in the book to level of consciousness have been changed to level of alertness There used to be two different but similar Tables describing the Clinical Assessment of Circulation; these have been merged into a single Table. This Table has been also added to the ACoRN Laminates.

22 Cardiovascular Clinical assessment of circulation Pages 4-6 to 4-8:

23 Cardiovascular

24 Cardiovascular A Table has been added to the Laminates

25 Cardiovascular

26 Cardiovascular

27 Neurology

28 Neurology

29 Neurology

30 Neurology

31 Neurology The Table of Clinical Assessment of Severity in HIE has been added to the Laminates (Page 5-25)

32 Neurology The Table of Documentation of Abnormal Movements has been added to the Laminates (Page 5-29)

33 Neurology The following information has been added to the Laminates, due to its importance (Page 5-17)

34 Other changes Neurology All references to near term have been changed to late preterm. Fetal monitoring terminology has been updated: Non-reassuring is now atypical Ominous is now abnormal

35 Neurology

36 Neurology Neonatal behavior syndrome (page 5-38)

37 Surgical

38 Fluid and Glucose This is the chapter that will require the most careful reading, as it is the one that has changed the most; it is impossible to indicate each change There are changes in flow, to make it more readable and congruent with the Sequence There are changes in the Sequence There are deletions All changes have been made in order to best support the literature and as a result of extensive feedback over the last 5 years by our instructors, learners, and reviewers and collaborators

39 Fluid and Glucose The Table of enteral and intravenous fluid intake for days 1 to 4 has been amended to acknowledge that many babies receive enteral feeds more frequently than 3 hourly (page 7-4)

40 Fluid and Glucose Intravascular volume expansion (p. 7-4) Replacement of ongoing losses (p. 7-5)

41 Fluid and Glucose Babies with hypoglycemia may be asymptomatic or present with signs such as (p. 7-5) Point of care glucose measurement (p. 7-9)

42 Fluid and Glucose

43 Fluid and Glucose p. 7-9 and Sequence

44 Fluid and Glucose p and Sequence: Feeding measured volumes

45 Fluid and Glucose p and Sequence: Feeding measured volumes

46 Fluid and Glucose p and Sequence: Can feed and does not have hypoglycemia

47 Fluid and Glucose What is normal? AGA, term, breastfed babies (see ACoRN slide presentations) Hoseth, E. et al. Arch. Dis. Child. Fetal Neonatal Ed. 2000;83:117-F119 Copyright 2000 BMJ Publishing Group Ltd.

48 Fluid and Glucose

49 Fluid and Glucose p. 7-13: Fluid requirements and replacement

50 Fluid and Glucose This Table no longer exists

51 Fluid and Glucose p. 7-14: Diagnostic categories after completing the Next Steps

52 Fluid and Glucose p. 7-14: Not hypoglycemic ( 2.6 mmol/l)

53 Fluid and Glucose p. 7-14: Hypoglycemic (< 2.6 mmol/l)

54 Fluid and Glucose p. 7-15: Suggested steps to increase glucose intake if the blood glucose remains 2.6 mmol/l (47 mg/dl)

55 Fluid and Glucose p. 7-19: Feeding intervals

56 Fluid and Glucose p. 7-22: Intravenous or enteral feeding?

57 Thermoregulation Minor changes Ref in p. 8-7 to see 5-7 for thermal management of babies with moderate to severe HIE

58 Thermoregulation p. 8-12: What happens when babies are cold stressed?

59 Thermoregulation p. 8-15: Simple interventions for warming

60 Infection p. 9-7: Specific diagnosis

61 Transport There have been many changes in the way this chapter reads and flows, in order to enhance clarity The Neonatal Pre-Transport Information sheet has been further modified for the Laminates in order to make it work better

62 Support p. 11-8: Non pharmacological strategies to minimize discomfort and/or pain

63 Support p. 11-9: Fentanyl and morphine p : Template for case review

64 Appendices Careful reading of this section as well of the whole textbook is suggested, as not all changes can be highlighted. p. B-3: Free flow oxygen administration p. B-4: Manual ventilation

65 Appendices p. B-19: Sodium bicarbonate p. C-3: Blood pressure measurement p. C-5: Blood sampling, capillary

66 Appendices p. C-12: CPAP - Equipment p. C-13: CPAP - Procedure

67 Appendices p. C-13: Mechanical ventilation - Indications

68 Appendices p. D-3: Blood gas interpretation - Principles

69 Appendices Medications Looks the same, and it is mostly the same, however it has been fully reviewed and updated, especially the information of drug infusion y-site compatibility / incompatibilty

70 Second Edition As much as the 2010 Update of ACoRN is still an updated version of its First Edition, we are aware that we need to start thinking what a second of ACoRN should entail. With that in mind, ACoRN is in the process of developing a systematic way of addressing this question early in 2010, far ahead of a future printing / edition.

71 Ongoing Review As a first step, ACoRN will establish a library that will assist us with further changes and updates. In the next weeks we will announce a new address to which you can submit messages highlighting errors, suggestions and information that needs reviewing. ACoRN is also hoping strengthen partnerships that will better align neonatal resuscitation and neonatal stabilization education in Canada.

72 Thank you for your support!!!