Important symptoms in neonates

Question 1

What are 10 signs of illness in the newborn?

Answer 1

1. Excessive sleepiness and lack of interest in feeding
2. Slow feeding
3. Diminished or, occasionally, excessive crying
4. Poor muscle tone, with limbs held extended rather than flexed
5. Skin pallor or slate-grey coloration with mottling
6. Temperature instability
7. Vomiting and abdominal distension
8. Episodes of apnoea
9. Tachynpoea and tachycardia
10. Grunting respirations

Question 2

If a baby shows a worrying non-specific symptom, what is the likeliest cause?

Answer 2

infection

Question 3

What are 3 important things to ask in the history of a neonate with signs of illness?

Answer 3

1. Maternal health during pregnancy
2. Risk factors for infection e.g. prolonged rupture of membranes, maternal illness or pyrexia during labour, maternal group B streptococcus or nursery contact with sick babies
3. Family history of neonatal illness or neonatal death

Question 4

What are 4 risk factors for infection in the neonate to ask about in the history?

Answer 4

1. Prolonged rupture of membranes
2. Maternal illness or pyrexia during labour
3. Maternal group B streptococcus
4. Nursery contact with sick babies

Question 5

What examination should you perform if a neonate has signs of illness?

Answer 5

assess severity of illness, and seek signs of superficial infection which may have led to sepsis, and sign of organ dysfunction

Question 6

What are 10 investigations to perform in a neonate showing nonspecific signs of illness?

Answer 6

1. blood culture
2. full blood count and film
3. blood glucose
4. arterial blood gas, if the baby is breathless or seriously ill
5. C-reactive protein
6. urine culture
7. swabs, from any inflamed lesions
8. chest X-ray
9. stool culture, if stools abnormal
10. lumbar puncture, if sepsis is suspected and the source is unclear

Question 7

When should you perform a lumbar puncture for neonates with signs of illness?

Answer 7

if sepsis is suspected and the source is unclear

Question 8

What treatment should be given to a neonate if infection seems a possibility?

Answer 8

broad spectrum antibiotic therapy e.g. with benzylpenicillin (or ampicillin) + gentamicin (or 3rd gen cephalosporin)