- Difficult intubation due to severe edema of head/neck/oropharynx. → Consider ENT or anesthesia support for intubation as needed.
- Varying degrees of pulmonary hypoplasia due to large pleural effusions or other extrinsic in utero compression of lungs → May need emergent thoracentesis in delivery area to alleviate lung compression from large effusions.
- Chest tube placement for rapidly reaccumulating pleural effusions.
- Hypotension should be treated with appropriate inotropic support.
- Remember that most hydropic infants are euvolemic intravascularly, often with depressed cardiac function → Avoid large fluid shifts.
- Pericardiocentesis may be necessary if cardiac tamponade from pericardial effusion is suspected → Should ideally be done under US guidance.
- Arterial access is helpful to follow invasive blood pressures.
- Echocardiogram should be obtained to evaluate for structural abnormalities as a cause of hydrops.
Fluids and electrolytes
- Infants are total body fluid overloaded but are usually euvolemic (intravascular status).
- Fluid intake should be based on a “dry” weight (ie, the 50th percentile for gestational age).
- Fluids should be restricted (40–60 mL/kg/day) to avoid further fluid overload and to allow diuresis.
- Vigilant attention to ...
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