Illness in the Full Term Baby Flashcards
What is Apgar stand for
o Appearance o Pulse o Grimace o Activity (tone) o Respiration
what is the maximum score of the Apgar scoring system
maximum score is out of 10
What should a normal fetal heart rate be
110-160
What should the pH of a baby be
o pH should be around 7.35-7.45.
pH 6.94 is very acidotic (cells stop working at 7.2)
if there is a reduction in blood flow to the brain where does it go
- 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
What area of the brain can be devastated the most by ischemia
= basal ganglia and thalamus
- this is because it is important for movement, swallowing and feeding which is all affected
What areas of the body tend to be preserved
the CNS, heart and adrenals are persevered preferentially, while kidneys, GI tract, liver, muscle are more vulnerable (although this is not always the case).
What is a head lag
- 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
describe primary energy failure and secondary energy failure
- 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.
What do you aim to prevent with cooling
Secondary energy failure
what happens in perinatal asphyxia
Tissue suffers hypoxaemia, ischaemia
- hypercarbia, metabolic acidosis
How do newborns present with hypoxia ischameia
Infants needing resuscitation at birth
May have absent heart rate, infant not breathing
May require airway, respiratory and haemodynamic support
Infant subsequently encephalopathic
What are the warnings of hypoxia ischameia
- Decreased fetal movement.
* Sentinel events (placenta abruption, uterine rupture, cord prolapse).
what are types of sentinel events
placenta abruption, uterine rupture, cord prolapse
What does encephalopathy refer to
Abnormal neurologic function and consciousness level
Abnormalities of tone and reflexes
Autonomic dysfunction
Seizures
What are the grades in SARNAT score system
grade I
grade II
grade III
describe each stage of the sarnat score system
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
What are the potential targets for neuroprotection
- 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…
what do barbiturates do
decrease energy depletion
what are the 5 effects that therapeutic hypothermia has
↓ cerebral metabolism
↓ energy use
↓ accumulation of excitotoxic amino acids
↓NO synthetase activity
↓free radical activity
what is the leading cause of death in the new-born worldwide
infection
How does infection from the mother to the new born commonly happen
o Vertical transmission: infection from the mother.
Transmitted when passing through canal/into outside environment
• Why are infections in the new-born important?
– Major cause of mortality and morbidity in the new-born worldwide
What are the common infections that new borns suffer with
GBS (group B streptococcus) and E. Coli
• Also, note staphylococci cause a problem in premature babies.
What is the difference between early onset and late onset infection
Early onset is in the first 48-72 hours
Late onset is any infection after that
What is the onset of neonatal sepsis
– 0.22% early onset
– 0.44% late onset
why is it important to differentiate between early and late onset of neonatal sepsis
– Difference in how the infection may have been acquired
– Different organisms
Which groups of newborns have a higher rate of infections and mortality from infection
- Infants requiring intensive care
- Preterm infants
- Newborns in developing world
Name some organisms that can cause early onset sepsis
- Group B Streptococcus – (Strept. Agalactiae)
- E. coli
- Strepts other than GBS
- H. Influenezae
- L. Monocytogenes
- Gram negative anaerobes
- Fungi
- Chlamydia trachomatis
What are the symptoms of early onset GBS
- Apnea
- Severe hypoxia
- Cardio-respiratory failure
- Hypotension
- Metabolic acidosis
- Tachycardia
- Poor perfusion
How do you investigate early onset GBS
- Full blood count – neutropenia
- CRP – acute phase reactant – rise may be delayed by 12 hours
- Blood cultures
- Lumbar puncture
- Chest x-ray
What are the predisposing factors to early onset GBS
• 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
what is the prevention dn treatment of GBS
• 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
describe the factors of late onset sepsis in the newborn
- > 48 hours after birth
- Acquired from the postnatal environment
- Nosocomial
- 4-5 per 1000 live births
- Mostly in preterm infants on neonatal units
what are the organisms that cause late onset sepsis in the new-born
- Coagulase-negative staphylococci
- Staph Aureus
- Others
