Admission to NICU Flashcards
How does baby with sepsis present
Pyrexia or hypothermia Poor fed Lethargy Early jaundice Hypoglycaemia Hypotonia Hypoxia Resp distress / apnoea Vomiting Collapse DIC Seizure Tachy or Brady Signs of specific infection
What are the causative organisms in sepsis
Congenital
- HSV
- CMV
- Rubela
Early onset <24 hours
Group B strep
E.coli
Klebsiella = more rare
Late - due to line or from others S.Aureus Listeria H. influenza Klebsiella Maternal HX useful in identifying cause
What organism when there is a line in situ
Coagulase negative staph - s.epididermis
What are the RF for sepsis
Have low threshold for Ax if signs
PPROM Premature babies Maternal pyrexia Maternal chorioamnitiis Maternal vaginal GBS carriage GBS in previous pregnancy
If 1+ RF = observe 12 hours Start Ax + sepsis screen in presence of 2+ RF or red flags Benpen and Gentamicin Can stop Gent if CRP <4 x2 Continue Benpen till culture back
When does group B strep sepsis present
Early onset - birth - 1 week Late onset or recurrence up to 3 months - Lines - Malformation - Malnutrition - Immunodeficiency
What are the complications of group B strep
Meningitis DIC Pneumonia Respiratory collapse Hypotension Shock
How do you invetigate sepsis
Admit NNU
SEPSIS 6 Protocol - culture, lactate, 02, fluids, Ax, urine
Full septic screen
Repeat CRP in newborn as could be delayed
Blood gas, FBC, CRP, glucose = helpful
Culture as many places as possible to identify cause before Ax
Consider CXR and LP if CRP increasing / specific signs
How do you manage sepsis
Sepsis 6
IV benpenicillin and gentamicin 1st line at least 5 days
Vancomycin (If MRSA) and gentamicin 2nd line
Add metronidazole if surgical / abdominal
Diff for meningitis - cerftoaxime
Amox if listeria
Consider fungal if failure to respond
IV acyclovir for encephalitis
Fluid management
When CRP <4 for 2x consider stopping Ax (must maintain on benpen till culture back)
Gent trough levels if above need hearing screen
What can congenital infection result in
IUGR Rash - syphillis Brain calcification - CMV Hydrocephalus Neurodevelopmental delay Visual impairment Renitis in toxoplasmosis Microcephalus Deafness Bone marrow failure HSM / jaundice / hepatitis Heart defect
Do you swab for GBS
No
Only swab if previous GBS at 36 weeks
Give Ax if +Ve
Also give Ax to mother if any RF
What do you do if 1 RF
Observe
What do you do if 2 RF / any red flags
Full sepsis screen
IV Ax to baby even if no signs
Benzypenicillin and gentamicin
When can you stop gentamicin
If two CRP come back <4 Keep on benzylpenicillin until culture back Vanc if MRSA Metronidazole If surgical Cefotaxime for menignitis Amoxicillin for listeria
What are the RF for meconium aspiration
LBW Post due date Foetal distress / hypoxia Maternal DM Maternal hypertension / PET Smoking / substance abuse Infections Difficult labour
What are the symptoms of meconium aspiration
Pneumonitis due to aspiration before or during delivery
Green / yellow amniotic fluid - may not aspirate
Meconium staining of neonate - skin / nails
Resp distress
Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppy
Low Apgar score
Complication Airway obstruction Pneumonia Surfactant dysfunction Pulmonary vasoconstriction -> PPH Infection
How do you investigate meconium aspiration
Blood gas
Septic screen
CXR - patchy / atelectasis
How do you treat meconium aspiration
If no Sx = monitor freuqently if at risk every 4 hours
Amnionifusion intra-partum if thin meconium
Inhaled NO = vasodilator
Endotracheal suction at birth below vocal cords if not vigorous
Fluid + IV Ax
Surfactant + ventilation may be required
Respiratory support
ECMO - if all else fails
What requires assessment of neonate if meconium passed
RR >60 Grunting HR >100 CRT <3 Sats <95 Cyanosis
What is the primary phase of birth asphyxia
Acute injury / organ damage within minutes of no 02
What causes birth asphyxia
Placental problems Long delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia
What is the primary phase of birth asphyxia
Acute injury / organ damage within minutes of no 02
What is latent phase of birth asphyxia
Reperfusion injury
Toxins released from damaged cells
What is secondary phase of birth asphyxia and what does it lead too
Delayed injury
Secondary energy failure
Leads to hypoxic ischaemic encephalopathy
How do you manage birth asphyxia
Treat seizure Cardiac and respiratory support Monitor renal and liver Fluid resus - avoid if oedema Therapeutic hypothermia Cranial USS MRI at 7-10 days Neurofollow up
