Illness in the full term baby Flashcards
What are the warning signs of hypoxia-ischaemia?
Reduced foetal movements
Placental abruption
Uterine rupture
Cord prolapse
What are some effects fo encephalopathy?
Abnormal neurologic function + conscious level
Abnormalities of tone and reflexes
Autonomic dysfunction
Seizures
Describe the stages of perinatal asphyxia and what is seen on an EEG at each stage.
Stage 1: lasted <24 hours
- hyperalertness
- sympathetic effects
- normal EEG
Stage 2: reduced consciousness and slow response to stimulus
- hypotonia
- multifocal seizures
- EEG shows a perioidic pattern which is sometimes preceded by continous delta activity
(<5 days = norma outcome; >7 days = poor outcome)
Stage 3: stuporous
- flaccid
- brainstem and autonomic functions are suppressed
- EEG is isopotential/infrequent periodic discharges
What are the different methods of neuroprotection in hypoxia?
- reduce energy depletion:
- glucose
- hypothermia
- barbiturates - inhibition of leukocyte/microglial/cytokines effects
- glutamate:
- fix glutamate uptake impairment (hypothermia)
- glutamate receptor blockade (Mg)
- inhibition of glutamate release - blockade of downstream intracellular events:
- NOS inhibitors/scavengers
- anti-apoptotic agents
- hypothermia
- free radical scavengers (vitamin E)
- free radical synthesis inhibitors (allopurinol, indomethacin, iron chelators, magnesium)
How can hypothermia be neuroprotective?
- reduces cerebral metabolism
- reduces energy use
- reduces accumulation of excito-toxic amino acids
- reduces NO synthase activity
- reduces free radical activity
What is early onset sepsis (of neonates)? How many live births does it occur in? What can cause this?
- Sepsis within 48hours of birth
- microbes are acquired from the mother either before or during the passage through the birth canal
- 2-3/1000 live births
- caused by premature rupture of membranes (PROM), prematurity, maternal UTI
What is late onset sepsis (of neonates)? How many live births does it occur in? What can cause this?
- sepsis >48hours after birth
- from post-natal environment (nosocomial)
- 4-5/1000 live births
- caused by coagulase negative staphylococci, staphylococcus aureus
What organisms can cause early-onset sepsis?
- E. coli
- Group B Strep (+ other streps)
- chlamydia trachomatis
- fungi
- H influenza
- L monocytogenes
- Grame negative anaerobes
How might an early-onset infection by GBS in a neonate present?
- can mimic perinatal hypoxia-ischaemia
- apnoea
- severe hypoxia
- cardioresp failure
- hypotension
- metabolic acidosis
- tachycardia
- poor perfusion
What are the predisposing factors for infection by GBS in a neonate?
- evidence of chorioamnionitis
- prolonged labour or prolonged rupture of membranes
- low birthweight
How can an early-onset infection by GBS in a neonate be prevented/treated?
Prevention:
- intrapartum antibiotic prophylaxis
Treatment:
- benzylpenicillin with amikacin or gentamicin
