Neonatal complications Flashcards

Question

Coagulase Negative Staphylococcus (CONS)

Answer 1

mortality higher in LBW babies and those babies who had undergone interventions. Prognosis worse if 3 or more sepsis screen parameters or clinical manifestations of sepsis are present

Answer 2

infection of the periumbilical skin risks the spread via the umbilical vein, giving rise to thrombophlebitis and possibly leading to suppuration in the liver with severe jaundice. May result in portal hypertension with oesophageal varices in later childhood.

Answer 3

need to culture and treat. Minor lesions with antiseptic powder. Don’t overdo antibiotics as encourages MRSA. If needed flucloxacillin is a good first choice as most skin infections are caused by staphylococci

Answer 4

- Snuffles – excess nasal secretion is common – blocks airways - Respiratory syncytial virus: relatively mild URTI - Acute bronchiolitis: seen in older infants and is severe

Answer 5

- Gastroenteritis or necrotising enterocolitis (NEC) NEC is inflammation of the gut wall as a result of infection. Recognised by acute abdominal pain, blood in the stools and vomiting, the condition may lead to septicaemia and be life threatening. - Causative organisms (for gastro) include: – Rotavirus, Salmonella, Shigella, and a pathologic strain of E.coli * Secretory IgA in breast milk offers protection against these especially rotavirus. Priority is urgent correction of fluid and electrolyte imbalance - Probiotic therapy for NICU babies

Answer 6

- Lethargy - Vomiting - Diarrhoea - Jaundice - Pyrexia - Hypothermia - Irritability - Poor feeding - Weak cry - Abdominal distension - Rashes

Answer 7

- Resp distress, bulging fontanelle - Raised C-reactive protein

Answer 8

- FBC and blood gases - Blood culture - Urine or mec culture - Swabs - Lumbar puncture - Chest x-ray, CT, MRI - CRP - Culture of amniotic fluid, placental tissue and cord blood

Answer 9

- Early onset – (first few days) GBS, E.coli, L.monocytogenes (blood borne from GIT infections) - Late onset – over half caused by coagulase negative Staphylococcimany of which are resistant to Methicillin - Treatment - IV Antibiotics will commence prior to ID of causative organism - Combination of Ampicillin & Gentamicin or Cefotaxime - Drugs may change when causative organism is identified and according to the pattern of infections seen in each neonatal unit

Answer 10

10% of babies - Early (within 12 hours of birth) or late (usually at 4-5 weeks) - Ongoing controversy regarding screening of GBS in pregnancy: Incidence of asymptomatic vaginal GBS carriers = 12-15% - May be subtle and nonspecific, within hours the baby can rapidly deteriorate - Acute septicaemic infection with the signs of respiratory distress – Local signs are generally confined to fine rales on auscultation - A chest X-ray is essential for differentiating infection from the many other causes of respiratory distress

Answer 11

- Antenatal history - Promote general nutrition - Labour and birth history - Attend to obs - Refer when indicated - Eye washes - B/F - Education - Documentation

Answer 12

- Fetal liver - Prominent by 7 weeks gestation – 9-12 weeks erythropoiesis decreases in the liver and begins in spleen – Reaches metabolic maturity relatively late in gestation, storing glycogen in the last 9 weeks – Bile production - Inutero the placenta removes the bilirubin from the fetus so that it can be processed by the mother’s liver - At birth the baby’s liver initiates that role

Answer 13

- When RBCs age, are immature or malformed they are removed from the circulation and broken down in the reticuloendothelial system (liver, spleen and macrophages) - haem which is converted to unconjugated bilirubin. – globin which is broken down into amino acids and then used by the body to make proteins. – iron which in turn is either stored by the body or recycled to make new blood cells

Answer 14

indirect bilirubin – Cannot be easily excreted from the body by urine or bile as it is fat soluble. – Is deposited in the connective tissue of the skin, with excess levels = yellow skin colour. – Is transported to the liver, linked/bound to albumin for processing. – Being fat soluble has the potential to cross the blood brain barrier to cause bilirubin staining and toxicity known as kernicterus.

Answer 15

= direct bilirubin - Has been processed by the liver to become water soluble, and then can be easily excreted from the body, mainly through faeces and urine. - Some conjugated bilirubin is hydrolysed back to unconjugated bilirubin in the colon. This unconjugated bilirubin is then absorbed across the intestinal mucosa into the capillaries.

Answer 16

- Yellow discolouration of the skin - Common - Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant, and its importance lies in the ability of the bilirubin pigment to cross the blood brain barrier resulting in neurotoxicity

Answer 17

- due to an immature liver system and not effectively coping with RBC destruction and the decreased hepatic blood flow. - During the first 3-4 months following birth, destruction of RBCs exceeds production. - Neonatal RBCs have a shorter lifespan than adult RBC, and preterms even shorter. - What babies are at risk? – 60% of term babies and 85% preterm babies develop jaundice in the first week of life NSW Health Agency for Clinical Innovation – About 10% breast fed babies are still jaundiced at age 1 month.

Answer 18

- Gestational age - Delivery - Hypoxia - Hypothermia - Hypoglycemia - Poor feeding - Urinary infection

Answer 19

- Abo incompatibility - Weak postivie to direct coombs test - Resulting jaundice usually treated with phototherapy - Rarely requires exchange transfusions

Answer 20

- Mum Rh negative and produces antibodies against an Rh positive baby who has inherited the dominant Rh positive gene from the Dad - More an issue in subsequent pregnancies when antibodies are pre-formed