Ill-Appearing Neonate

Question 1

Resp rate normal is ___/min

• ___ breathing: breathe quickly for a few seconds, then slowly for a few seconds.
• Obligate ___ breathers.

Normal heart rate is ___/min, BP___ (term neonate).

Acrocyanosis and perioral cyanosis are common and normal

Answer 1

Resp rate normal is 30-60/min

• Periodic breathing: breathe quickly for a few seconds, then slowly for a few seconds.
• Obligate nose breathers.

Normal heart rate is 90-180/min, BP 60/40 (term neonate).

Acrocyanosis and perioral cyanosis are common and normal

Question 2

3. Name the most important diagnosis in the differential for a sick neonate

Answer 2

Differential Diagnosis

Sepsis

Everything else.

Question 3

Key organisms for neonatal sepsis

Answer 3

Organisms: GBS, E.coli, Listeria, staph

Question 4

Symptoms of neonatal sepsis and management

Answer 4

Symptoms of neonatal sepsis: irritable, and lethargic, do not rely on a fever (temp may be low, normal or high).

Other sites of infection are not readily identifiable on PE: Bacteremia, UTI, meningitis.

Neonates with fever often will be these 3 causes.

Investigations: Full septic workup: CBC, blood culture, urine culture (catheter sample), CSF culture (lumbar puncture)

Management: ABCs/ resuscitation, hospital admission, antibiotics

• Ampicillin and gentamicin, OR ampicillin and ceftriaxone.

Question 5

5 T’s of cyanotic heart lesions (which shunts blood from __- to ___)

Answer 5

Cyanotic heart lesions: from RIGHT to LEFT

5Ts; Tetralogy of fallot (boot shaped heart), transposition of the great arteries, total anomalous pulmonary venous return (snowman).

• tetralogy of fallot
• transposition of the great arteries
• total anomalous pulmonary venous return

Question 6

in a ventriculo-septal defect (VSD), blood is shunted from the __ to the __. Main presentation is:

Answer 6

LEFT TO THE RIGHT. Presents with CHF: respiratory distress, wheezing?crackles, tiring or diaphroesis with feeds, FTT.

• not enough blood getting to the body, pulmonary hypertension because too much blood running through right system.

Question 7

___ emesis is ___ in color and is a surgical emergency until proven otherwise.

Answer 7

Bilious emesis is a surgical emergency until proven otherwise

Question 8

key finding of necrotizing enterocolitis on XRAY

Answer 8

NEC; pneumatosis intestinalis. Air leaks from bowel wall and goes up to the right)

Question 9

4. List 10 things to do in the first 5 minutes of management of any sick neonate

Answer 9

I. recognize they are a critically ill child

Ii. Resuscitation room

Iii. resuscitation team

Iv. standard precautions.

V. monitor, full vitals

Vi. O2

Vii. IV/IO/UVC with bedside glucose

Viii. airway

Ix. breathing

X. circulation.