Illness in the Full Term Baby

Question 1

What is Apgar stand for

Answer 1

o	Appearance
o	Pulse
o	Grimace
o	Activity (tone)
o	Respiration

Question 2

what is the maximum score of the Apgar scoring system

Answer 2

maximum score is out of 10

Question 3

What should a normal fetal heart rate be

Answer 3

110-160

Question 4

What should the pH of a baby be

Answer 4

o pH should be around 7.35-7.45.

 pH 6.94 is very acidotic (cells stop working at 7.2)

Question 5

if there is a reduction in blood flow to the brain where does it go

Answer 5

• if there is shortage of blood supply to the brain it goes to the basal ganglia and thalamus
• this is because these are the most metabolically active part of the brain

Question 6

What area of the brain can be devastated the most by ischemia

Answer 6

= basal ganglia and thalamus

- this is because it is important for movement, swallowing and feeding which is all affected

Question 7

What areas of the body tend to be preserved

Answer 7

the CNS, heart and adrenals are persevered preferentially, while kidneys, GI tract, liver, muscle are more vulnerable (although this is not always the case).

Question 8

What is a head lag

Answer 8

• sign of neurological dysfunction

once you sit the baby up if you tilt them forward the head flops forward and if you tilt them back the head flops back

Question 9

describe primary energy failure and secondary energy failure

Answer 9

• After hypoxic insult, there is primary energy failure which leads to the derangement of cellular function.
• Over time this leads to secondary energy failure despite there no longer being hypoxia/damage (glutamate, free radicals produced).
• Aim to prevent this with cooling.

Question 10

What do you aim to prevent with cooling

Answer 10

Secondary energy failure

Question 11

what happens in perinatal asphyxia

Answer 11

Tissue suffers hypoxaemia, ischaemia

- hypercarbia, metabolic acidosis

Question 12

How do newborns present with hypoxia ischameia

Answer 12

Infants needing resuscitation at birth

May have absent heart rate, infant not breathing

May require airway, respiratory and haemodynamic support

Infant subsequently encephalopathic

Question 13

What are the warnings of hypoxia ischameia

Answer 13

• Decreased fetal movement.

* Sentinel events (placenta abruption, uterine rupture, cord prolapse).

Question 14

what are types of sentinel events

Answer 14

placenta abruption, uterine rupture, cord prolapse

Question 15

What does encephalopathy refer to

Answer 15

Abnormal neurologic function and consciousness level

Abnormalities of tone and reflexes

Autonomic dysfunction
Seizures

Question 16

What are the grades in SARNAT score system

Answer 16

grade I
grade II
grade III

Question 17

describe each stage of the sarnat score system

Answer 17

Stage 1 lasted < 24 hours, hyperalertness, uninhibited Moro and stretch reflexes, sympathetic effects and normal EEG.

Stage 2 - obtundation, hypotonia and multifocal seizures. The EEG - periodic pattern sometimes preceded by continuous delta activity. (<5days – normal outcome; > 7days or persistent abnormal EEG – poor outcome)

Stage 3 - stuporous, flaccid and brain stem and autonomic functions suppressed. EEG is potential or infrequent periodic discharges

Question 18

What are the potential targets for neuroprotection

Answer 18

• Decrease energy depletion - increase glucose, use hypothermia and barbiturates.
• Glutamate (inhibition of release). = via calcium channel blockers, magnesia, adenosine, hypothermia, free radical scavengers
• Inhibition of leukocyte/microglial/cytokine effects. = hypothermia, free radical synthesis inhibitors

• Blockage of downstream cellular events.
o Free radical synthesis inhibitors
o Free radical scavengers etc…

Question 19

what do barbiturates do

Answer 19

decrease energy depletion

Question 20

what are the 5 effects that therapeutic hypothermia has

Answer 20

↓ cerebral metabolism

↓ energy use

↓ accumulation of excitotoxic amino acids

↓NO synthetase activity

↓free radical activity

Question 21

what is the leading cause of death in the new-born worldwide

Answer 21

infection

Question 22

How does infection from the mother to the new born commonly happen

Answer 22

o Vertical transmission: infection from the mother.

 Transmitted when passing through canal/into outside environment

Question 23

• Why are infections in the new-born important?

Answer 23

– Major cause of mortality and morbidity in the new-born worldwide

Question 24

What are the common infections that new borns suffer with

Answer 24

GBS (group B streptococcus) and E. Coli

• Also, note staphylococci  cause a problem in premature babies.

Question 25

What is the difference between early onset and late onset infection

Answer 25

Early onset is in the first 48-72 hours

Late onset is any infection after that

Question 26

What is the onset of neonatal sepsis

Answer 26

– 0.22% early onset

– 0.44% late onset

Question 27

why is it important to differentiate between early and late onset of neonatal sepsis

Answer 27

– Difference in how the infection may have been acquired

– Different organisms

Question 28

Which groups of newborns have a higher rate of infections and mortality from infection

Answer 28

• Infants requiring intensive care
• Preterm infants
• Newborns in developing world

Question 29

Name some organisms that can cause early onset sepsis

Answer 29

• Group B Streptococcus – (Strept. Agalactiae)
• E. coli
• Strepts other than GBS
• H. Influenezae
• L. Monocytogenes
• Gram negative anaerobes
• Fungi
• Chlamydia trachomatis

Question 30

What are the symptoms of early onset GBS

Answer 30

• Apnea
• Severe hypoxia
• Cardio-respiratory failure
• Hypotension
• Metabolic acidosis
• Tachycardia
• Poor perfusion

Question 31

How do you investigate early onset GBS

Answer 31

• Full blood count – neutropenia
• CRP – acute phase reactant – rise may be delayed by 12 hours
• Blood cultures
• Lumbar puncture
• Chest x-ray

Question 32

What are the predisposing factors to early onset GBS

Answer 32

• 1% of babies born vaginally to mothers who carry GBS become infected
• Predisposing Factors
– Evidence of chorioamnionitis including maternal fever
– Prolonged labour
– Prolonged rupture of membranes
– Low birthweight

Question 33

what is the prevention dn treatment of GBS

Answer 33

• Main principles of prevention of vertical transmission
– Intrapartum antibiotic prophylaxis to women who show carriage during screening in pregnancy
– Other risk factors

• Treatment
– Benzylpenicillin with amikacin or gentamicin

Question 34

describe the factors of late onset sepsis in the newborn

Answer 34

• > 48 hours after birth
• Acquired from the postnatal environment
• Nosocomial
• 4-5 per 1000 live births
• Mostly in preterm infants on neonatal units

Question 35

what are the organisms that cause late onset sepsis in the new-born

Answer 35

• Coagulase-negative staphylococci
• Staph Aureus
• Others