Illness in the full term baby

Question 1

During labour what should fetal heart rate be?

Answer 1

1201-60

Question 2

What should the pH of cord blood be during labour?

Answer 2

• part of baby’s circulation
  7-35-7-45
• 6.94 is very acidotic and cells stop working at 7.2

Question 3

How do you study the state of the fetus during labour?

Answer 3

APGARS
Appearance
Pulse
Grimace
Activity
Respiration
Skin Colour

Question 4

Why is the baby kept intubated during labour?

Answer 4

• anticonvulsants given stop breathing

Question 5

What is the normal CV state of the baby during labour?

Answer 5

• high CRP (no problems with heart)
• reduced conscious, poor tone
• CSF white if from T2
• if CSF gray from T1

Question 6

What is perinatal asphyxia?

Answer 6

Hypoxic-ischaemic encephalopathy

• deprivation of O2 to newborn
• lasts long enough during birth to cause physical harm
• harm normally to brain

Question 7

How does perinatal asphyxia clinically present?

Answer 7

• resuscitation at birth needed
• absent heart rate
• not breathing
• may require airway/resp/haemodynamic support
• encephalopathic

Question 8

How does an encephalopathic infant present?

Answer 8

• abnormal neurological function
• abnormalities of tone and reflexes
• autonomic dysfunction
• seziures

Question 9

What are the warning signs of perinatal asphyxia?

Answer 9

• decreased fetal movement
• sentinel events (placenta abruption, uterine rupture, cord prolapse)
• kidneys, GI tract, liver, muscle more vulnerable
• CNS, heart, adrenals preserved

Question 10

How can neurological damage occur as a result of perinatal asphyxia?

Answer 10

Secondary energy failure:

• hypoxic insult -> primary energy failure -> derangement of cellular function
• over time leads to secondary energy failure as glutamate/free radicals produced but no longer hypoxia/damage
• prevent this with cooling

Question 11

What are potential targets for neuroprotection?

Answer 11

• decrease energy depletion
• inhibit glutamate release
• inhibit leukocyte/microglial/cytokine effects
• block downstream cellular events (free radical synthesis inhibitors, free radial scavengers)

Question 12

What is the significance of therapeutic hypothermia?

Answer 12

• decreases cerebral metabolism
• decreases energy use
• decreases accumulation of excitotoxicity amino acids
• decrease NO synthase/free radical activity

Question 13

What is vertical transmission?

Answer 13

Infection from mother

- transmitted when passing through canal/into outside environment

Question 14

What is neonatal sepsis?

Answer 14

• bacterial blood stream infection

- meningitis, pneumonia, gastroenteritis

Question 15

What are the signs of early-onset group B strep?

Answer 15

• apnea
• severe hypoxia
• CR failure
• hypotension
• metabolic acidosis
• tachycardia
• poor perfusion

Question 16

What are the predisposing factors of Group B strep?

Answer 16

• chorioamnionitis with maternal fever
• prolonged labour
• prolonged rupture of membranes
• lower birthweight

Question 17

What is the treatment of Group B strep?

Answer 17

Amikacin

Gentamicin