neonatal hypoglycaemia/tonia + sepsis Flashcards
can hypoglycaemia occur in normal births?
yes, transient hypoglycaemia in first hours after birth is common
numerical definition of neonatal hypoglycaemia
<2.6mmol/L
causes of persistent/severe neonatal hypoglycaemia
preterm birth (<37wks)
maternal diabetes mellitus
IUGR
hypothermia
neonatal sepsis
inborn errors of metabolism
nesidoblastosis
Beckwith-Weidemann syndrome
features of neonatal hypoglycaemia
hitteriness/irritable
tachypnoea
pallor
poor feeding/sucking
weak cry
drowsy
hypotonia
seizures
management of neonatal hypoglycaemia
asymptomatic
- encourage normal feeding (breast or bottle)
- monitor blood glucose
symptomatic or v low blood gluc
- admit to neonatal unit
- IV infusion of 10% dextrose
causes of neonatal hypotonia
neonatal sepsis
spinal muscular atrophy
hypothyroidism
prader-willi
maternal causes
- drugs - benzos
- myasthenia gravis
neonatal sepsis categories
within first 28days
early onset (EOS) = <72hrs
late onset (LOS) = 7-28days
-> has different set of causes
commonest causes of early onset neonatal sepsis
GBS infection !
- cause comes from mum during delivery
- Ecoli!
EOS = <72hrs
commonest causes of late onset neonatal sepsis
staph epudermidis
staph aureus
pseudomonas aeruginosa
neonatal sepsis risk factors
- mum with prev baby with GBS infection
- current bacteruria, intrapartum temp >38
- membrane rupture >=18hrs
- premature (<37wks) (85%)
- low birth weight (<2.5kg) (80%)
neonatal sepsis presentation
resp distress (85%)
- grunting, nasal flaring, accessory muscles
jaundice, poor feeding, apnoea
temp:
- term - likely febrile
- preterm - likely hypothermic
(clinical px can vary from v subtle signs to obvious septic shock)
neonatal sepsis investigation
blood cultures
FBC, CRP
blood gases
- metabolic acidosis
- base deficit of >=10
lumbar puncture
urine microscopy, culture, sens - more useful in LOS
management of neonatal sepsis
1st line = IV benzylpenicillin with gentamicin
therapeutic cooling/hypothermia
lowering a patients body temp to reduce the risk of ischaemic injury to tissues following a period of insufficient blood flow (ischaemia)
- primarily used in neonatal hypoxic-ischaemic encephalopathy
indications for therapeutic cooling
neonatal hypoxic-ischaemic encephalopathy
- newborns with signs of moderate to severe
- to reduce risk of severe brin damage + improve survival without severe disability
