Neonatal Infection

Question 1

What is the normal neonatal HR?

Answer 1

100-160bpm

Question 2

What is the normal neonatal respiratory rate?

Answer 2

40-60

Question 3

What is the normal neonatal SPO2?

Answer 3

> 90%

Question 4

What is the normal neonatal temp?

Answer 4

36.5-37.4 degrees celsius

Question 5

What is the normal neonatal blood pressure?

Answer 5

Mean BP should be >gestational age of baby

Question 6

Describe initial care for babies suspected of infection?

Answer 6

Lumsden and Holmes (2010) state that the examination of clinical appearance is the first stage in identifying infection. Fully undress baby.
Listen to parents (Lumsden and Holmes, 2010)
Get full feeding and elimination history
Full set of observations including T, R, HR, SBR, BM’s, Sats, weight.
Prompt identification and referral for RV if any concerns (NICE, 2014)
Parents should receive written and verbal information and consent to be given.
Babies may be put on ABX

Question 7

During clinical examination what 11 features should midwives examine?

Answer 7

Airway, Breathing, Circulation
Colour
Tone and movement
Cry
Temperature
Feeding, vomiting,hydration and elimination
Other signs of common infection: eyes, umbilicus, smell, rash, mastitis, abrasions.

Question 8

What may the midwife notice with breathing?

Answer 8

Grunting, chest recession, nasal flaring, tachypnoea, apnoea, difficulty breathing. This could be transient taphycneoa of newborn or respiratory distress syndrome.

Question 9

What may the midwife notice with colour?

Answer 9

grey may indicate very sick baby, yellow = jaundice, cyanosis may indicate breathing or heart problems.

Question 10

What may the midwife notice with Temperature?

Answer 10

Babies with high temperature may have an infection or be overheating which is very dangerous. Babies with a low temperature may have hypothermia. WHO identifies hypothermia as below 34.

Question 11

What may the midwife notice with attitude?

Answer 11

Hypotonia is common with babies with congenital disorders. Babies may also have head retraction. Hypertonia can indicate drug withdrawal.

Question 12

What may the midwife notice with cry?

Answer 12

Long persistent cry can be normal but may indicate hunger, pain, wind or a long shrill cry can link to encephalopaphy.

Question 13

Describe Meconium Aspiration Syndrome?

Answer 13

More common in term, post term and hypoxic babies. Babies may need rescuscitation or suction. If they are breathing and crying with suspected MAS then Mec obs should be done according to local policy.

Question 14

Describe TTN?

Answer 14

Usually occurs 48-72 hours after birth and is more common in LSCS babies. Symptoms include breathing difficulties, grutning etc. Usually resolved by itself.

Question 15

Describe RDS?

Answer 15

Caused by deficiency in surfactant and more common in preterm, hypoglycaemic babies. It is a significant underlying cause of death. corticosteroids are given 24-34 weeks to avoid it. Symptoms are breathing irrgularities, grunting, cyanosis, chest recession. It can be treated with artificial surfactant, o2, temp maintenance.

Question 16

What is GBS and what are the risk factors for it?

Answer 16

A bacteria carried in the digestive tract and vagina that can be passed onto the baby as an infection. This is more likely to occur in babies <37 weeks, previous GBS baby, baby born >18 hours after PROM, increased temp in labour (NICE 2014)

Question 17

Care plan for mother’s at increased risk?

Answer 17

Urinalysis at every AN appointment
Vaginal swab
IAP (NICE, 2014)
Monitoring in labour for risk factors
PROM management
GBS obs for baby according to local policy
ABX for baby if showing any red flag symptoms (NICE, 2012). These symptoms include RDS >4hours after birth, tachycardia or bradycardia, oliguria, temp abnormaility.