Neonatal Med Flashcards
What is Hypoxic Ischaemic Encephalopathy (HIE)?
During perinatal aspyhxia gas exchange is reduced giving hypoxia and metabolic acidosis. This reduces tissue perfusion giving hypoxic injury to the brain and other organs
What are some causes of Hypoxic Ischaemic Encephalopathy?
Uterine Contractions Placental Abruption Ruptured Uterus Umbilical blood flow obstruction Maternal Hypotension/Hypertension Compromised Fetus - IUGR, Anaemia Failure to breathe at birth
How will a neonate with mild Hypoxic Ischaemic Encephalopathy present?
Irritable Excessively responsive Hyperventilation Hypertonia Impaired feeding
How will a neonate with moderate Hypoxic Ischaemic Encephalopathy present?
Marked movement abnormalities
Hypotonia
Seizures
Cannot feed
How will a neonate with severe Hypoxic Ischaemic Encephalopathy present?
No normal spontaneous movements
No response to pain
Multi-organ failure
What is the recommended management for confirmed Hypoxic Ischaemic Encephalopathy?
Respiratory support
Anticonvulsants for seizures
Fluid restriction for transient renal impairment
Voulme and Inotrope support for hypotension
Monitoring and treatment of electrolyte imbalance
Induced hypothermia is associated with improved outcomes
What is Necrotising Enterocolitis?
Necrosis of a section of bowel in a newborn
Why are neonates more vulnerable to Necrotising Enterocolitis?
Preterm bowel is vulnerable to ischaemic injury and bacterial invasion, making NEC more likely
Which formulation of milk increases the risk of developing Necrotising Enterocolitis?
Cows milk formula
What are some clinical signs of Necrotising Enterocolitis?
Feed intolerance
Bile-stained vomiting
Abdominal distension requiring mechanical ventilation
Fresh PR bleed
Which investigation is appropriate for suspected Necrotising Enterocolitis?
AXR
What may be seen on an AXR with Necrotising Enterocolitis?
Distended bowel loops
Thickening of bowel wall
Gas in Portal Venous tract
What is the recommended management of confirmed Necrotising Enterocolitis?
Stop oral feed
Broad spectrum Abx covering both Aerobic and Anaerobic
TPN
Surgery if perforation
What are some potential complications of Necrotising Enterocolitis?
Development of strictures
Malabsorption due to surgical resection
Poor neurodevelopmental outcome
Why is neonatal jaundice so common?
High Hb concentration at birth leads to excessive haemolysis
Red cell lifespan is shorter in infants
Hepatic bilirubin metabolism is less efficient in first few days of life
What may neonatal jaundice indicate?
Haemolytic anaemia
Errors of metabolism
Liver disease
What is the serious complication of untreated neonatal jaundice?
Kernicterus
What is Kernicterus?
Encephalopathy secondary to unconjugated bilirubin being deposited in the brain
What are some causes of Jaundice in first 24h following birth?
Rh Haemolytic disease ABO incompatibility - Coombs/DAT +ve G6PDH Deficiency Spherocytosis Congenital infection Sepsis
What are some causes of jaundice within 2d-2w of birth?
Normal physiology - infant adapting
Breast milk jaundice
Dehydration
Infection
What are some causes of jaundice after 2w of birth?
Biliary atresia
Breast-milk jaundice
Infection
Congenital hypothyroidism
What are the treatment options available for acute neonatal jaundice?
Phototherapy
Exchange transfusion
How does Phototherapy help with neonatal jaundice?
UV light converts unconjugated bilirubin into a water-soluble pigment that is renally excreted
When is exchange transfusion the recommended treatment for neonatal jaundice?
If serum bilirubin reaches dangerous levels, the entire circulating volume is transfused.
What is Neonatal Sepsis?
Sepsis demonstrated withihn 48-72h of life
What are causes of Neonatal Sepsis?
Ascending infection in mother with Chorioamnitis
Perinatal contact in birth canal
Haematogenous spread of maternal infection
What are some causative organisms of neonatal jaundice?
Group B Strep. E.Coli Coagulase -ve Strep H.Influenzae Listeria
If a mother is found to be carrying Group B Strep in her genital tract, how should this be managed?
Empirical Abx
What are some risk factors for development of neonatal sepsis?
Previous Group B Strep infection of baby Known current Group B Strep PROM/Pre-term birth Suspected/Confirmed ROM for >18h in Pre-term child Intrapartum Fever >38 degrees Suspected/confirmed Chorioamnitis
What are some Red Flag signs for potential neonatal sepsis?
Parental Abx given to mother for confirmed/suspected infection for 24h either before/after birth
Suspected/confirmed infection of another child in multiple pregnancy
When should neonatal sepsis treatment be initiated?
Either 1 Red Flag sign or any 2 non red-flag signs are present
What are some symptoms of neonatal sepsis?
Altered behaviour Altered muscle tone Abnormal HR Signs of RDS Hypoxia Jaundice at <24h age Apnoea Signs of Encephalopathy Temperature anomaly Unexplained bleeding Metabolic acidosis Local signs of infection
What are some red flag signs suggestive of neonatal sepsis?
RDS >4h after birth
Seizures
Signs of Shock
Need for mechanical ventilation if term baby
What are some potential differentials for suspected neonatal sepsis?
TTN
RDS
Haemolytic disease of the Newborn
Which investigations are appropriate for suspected neonatal sepsis?
FBC
CRP
Cultures prior to Abx
LP if ?Meningitis/likely source of infection
What is the recommended management for Neonatal Sepsis?
IV Benzylpenicillin and Gentamicin
When should antibiotics for neonatal sepsis be stopped at 36h?
If cultures have returned as negative
Clinical suspicion is low
Clinical condition/CRP are reassuring
If blood cultures for suspected neonatal sepsis return as positive, how long should the child receive Abx for?
7-10 days
If CSF cultures for suspected neonatal sepsis return as positive, how long should the child receive Abx for?
14 days
If blood cultures for suspected neonatal sepsis return as negative but CRP is still rising, how long should the child receive Abx for?
5 days
