Neonatal Flashcards
what is Early onset neonatal sepsis (EONS) defined as?
sepsis occurring within the first 48-72 hours of life
what is the most common infection to cause early onset neonatal sepsis?
group B streptococcus causing chorioamnionitis
what type of bacteria is group B streptococcus ?
gram + coccus
what are risk factors for infection ?
invasive group B strep in previous baby
pre labour rupture of membranes
<37 weeks gestation
intrapartum fever >38
what are red flags for suggestion of neonatal sepsis?
resp distress starting more than 4 hours after birth
seizures
need for mechanical ventilation in term baby
signs of shock
infection in a co-twin
what are some DD for neonatal sepsis?
Transient Tachypnoea of the newborn (TTN) Respiratory distress syndrome (RDS) meconium aspiration haemolytic disease of the newborn meningitis UTI
what investigations can be done for neonatal sepsis?
FBC, CRP, blood cultures
swabs
LP
CRP should be repeated at 18-24hrs
what is the management of neonatal sepsis?
intravenous benzylpenicillin with gentamicin
when should the antibiotics for neonatal be considered stopping?
at 36hrs if
- blood cultures negative
- initial suspicion wasn’t strong
- no clinical indicators
- CRP is reassuring
how long should neonatal sepsis be treated for?
7-10days
what is the mortality from EONS?
16%
what % of pregnant women carry group B strep in their genital tract?
25%
how many term babies are jaundice ?
60%
how many pre mature babies are jaundice ?
80%
what is a complication of untreated jaundice ?
kernicterus
what % of breast fed babies are jaundice at 1 month?
10%
what pathological causes of jaundice is there?
haemolytic disease - ABO incompatibility, G6PD deficiency, spherocytosis
post natal infection
prolonged jaundice - infection, hypothyroidism, galactosaemia, breast milk jaundice, biliary atresia, choledocal cyst
state some risk factors of hyperbilirubinaemia ?
Prematurity, low birth weight, small for dates Previous sibling required phototherapy Exclusively breast fed Jaundice <24 hours diabetic mother
how old does a baby have to be to use a transcutaneous bilirubinometer ?
> 35/40 gestation and >24 hours old for first measurement
how can bilirubin be measured if <35 weeks or <24hrs old?
serum bilirubin
what value should transcutaneous bilirubinometer be under or else serum bilirubin is done?
<250
what other investigations can be done for neonatal jaundice apart from serum bilirubin?
U&Es infection screen glucose 6 phosphate dehydrogenase LFTs TFTs
what is a treatment for neonatal jaundice?
phototherapy
how often should bilirubin levels be repeated during phototherapy treatment?
4-6hrs
6-12hrs once level is stable
when should phototherapy be stopped?
once level >50µmol/L below treatment line on the threshold graphs
vie which artery/vein is exchange transfusion for neonatal jaundice done?
via umbilical artery or vein
in what circumstances is IV immunoglobulin used for neonatal jaundice?
rhesus haemolytic disease or ABO haemolytic disease.
what is kernicterus ?
billirubin-induced brain dysfunction
Bilirubin is neurotoxic and at high levels can accumulate in the CNS gray matter causing irreversible neurological damage.
when would U&Es be measured for neonatal jaundice?
for excessive weight loss
when is the onset of physiological jaundice usually?
2-3days and peaks at day 5 and usually resolves by day 10
How long after stopping phototherapy should bilirubin levels be checked to rule out rebound hyperbilirubinaemia?
12-18hrs
what can meconium aspiration cause?
respiratory distress
neonatal sepsis
iscahemic insults
what can cause in utero peristalsis ?
foetal hypoxic stress or vagal stimulation due to cord compression
when meconium is aspirated what does it stimulate?
the release of many vasoactive and cytokine substances that activate inflammatory pathways, as well as triggering vasculature changes. It also inhibits the effect of surfactant in the lungs.
this can cause persistent pulmonary hypertension
state some risk factors for meconium aspiration?
Gestational Age > 42 weeks
Foetal distress (tachycardia / bradycardia)
Intrapartum hypoxia secondary to placental insufficiency
Thick meconium particles
Apgar Score <7
Chorioamnionitis +/- Prolonged pre-rupture
Oligohydramnios
In utero growth restriction (IUGR)
Maternal hypertension, diabetes, pre-eclampsia or eclampsia, smoking and drug abuse
what are some clinical signs of meconium aspiration?
Tachypnoea – a respiratory rate of >60 breaths per minute
Tachycardia – a heart rate of >160 beats per minute
Cyanosis – this requires immediate management
Grunting
Nasal flaring
Recessions – intercostal, supraclavicular, tracheal tug
Hypotension – systolic blood pressure of <70 mmHg
what does APGAR score stand for?
activity pulse grimace appearance respiration
is meconium aspiration a clinical diagnosis?
yes
what will CXR show for meconium aspiration?
increased lung volumes asymmetrical patchy pulmonary opacities pleural effusions pneumothorax or pneumomediastinum multifocal consolidation – due to chemical pneumonitis
what investigations can be done for meconium aspiration ?
FBC, CRP, Blood cultures ABG dual pulse oximetry ECHO cranial US - to assess hypoxic damage
what are DD for meconium aspiration?
transient tachypnoea of the newborn
surfactant deficiency
persistent pulmonary HTN
will transient tachypnoea of the newborn have normal or abnormal ABG?
normal
what is the treatment of refractory pulmonary hypertension ?
inhaled NO
what are some complications of meconium aspiration?
air leak - ball valve effect causing a pneumothorax or pneumomediastinum
PPHN - 1/3rd MAS patients affected
cerebral palsy
chronic lung disease
what investigation is done for PPHN?
echo
what % of MAS new borns are discharged safely after 3-4days ?
80%
In up to what percentage of pregnancies does aspiration of meconium stained amniotic fluid occur?
23%
in a newborn infant, tachycardia is characterised what heart rate?
> 160
at what gestation is preterm?
<37 weeks
what is the number one cause of neonatal death globally
prematurity
why would an abdo X-ray be done on a premature baby?
used to assess the position of the umbilical venous and umbilical arterial catheters after insertion
risk of developing necrotising enterocolitis, perforation
why would a cranial US be done on a pre mature baby?
risk of intraventricular haemorrhage or ischaemic periventricular white matter damage
What tool can be used to estimate gestational age?
Dubowitz/Ballard examination
What percentage of babies delivered at 26 weeks are expected to survive?
75%
under what gestation should resuscitation be performed?
<23weeks
what resp complications occur during prematurity ?
Respiratory distress syndrome, Surfactant deficient lung disease
what CVS complications occur during prematurity ?
Hypotension, perfusion abnormalities, PDA
what neuro complications occur during prematurity ?
Intraventricular haemorrhage, seizures, post haemorrhagic ventricular dilatation
what endo complications occur during prematurity ?
Jaundice, hyperglycaemia, hypoglycaemia
