NEonatal presenations 2 Flashcards
3 DDxs for neonatal resp distress
- Transient tachypnoea of Newborn (TTN)
- Sepsis
- Meconium Ileus
What is ttn?
a delay in clearing foetal lung fluids
Looks like grunting, tachypnoea, O2 requirement but normal gasses
How can you test for and treat TTN?
CXR can spot the fluids & hyperinflation
O2, airway support, fluid and maybe Abx
What could lead to Meconium Aspiration?
Post-date
Maternal DM or HTN
Difficult Labour
How would meconium Aspiration present?
Cyanosis
High work of breathing + grunting
Apnoea
Floppiness
What would do if you suspect meconium aspiration?
Blood gas
CXR - hyperinflation, flat diaphragm & patchy areas of collapse
Also do a septic screen in case
Whats in a septic screen?
FBC U&Es Glc Blood culture CXR LP Urine dipstix & culture
How do you treat meconium aspiration?
Suction the meconium Intubate & ventilate IV fluids & Abx Surfactant NO or ECMO
Any complications of meconium aspiration?
Persistant Pulm HTN of Newborn (PPHN)
How can you treat neonatal hypoglycaemia?
Enteral Feeds IV 10% glc Fluids Glucagon Hydrocortisone
Birth Asphyxia is a serious problem in which low O2 at birth –> Multiorgan failure. What could cause it?
- Placental problems
- Cord Prolapse
- Infection
- Neonatal Airway abnormality
- Long, difficult delivery
What are the phases of birth asphyxia?
Stage 1 = cell damage occurring within minutes
Stage 2 = reperfusion injury due to toxins from damaged cells (Days or weeks)
How do you classify birth asphyxia?
Mild
Mod
Severe
How do you manage a baby with birth asphyxia?
Fluid restriction (prevent cerebral oedema) Monitor U&Es + C & LFTs for organ failure
Resp support (O2, intubate, ventilate etc)
Cardiac support
Treat any seizures
Therapeutic Hypothermia!
Which babies get diaphragmatic hernias?
Male > Female
Ass with some syndromes
Mostly left
Also associated with pulm hypoplasia
How do you manage a diaphragmatic hernia?
Intubate at birth
Resp support (O2, intubation, ventilation etc)
Surgery
How do you manage a blue baby?
- Examination/ history
- Sepsis screen
- Blood gas and blood glucose
- CXR
- Oximetry
- ECG
- Echo
- Hyperoxia test
What are you possible differentials for a blue baby?
- Transposition of great vessels
- Teratology of fallot
- TAPVD
- Hypoplastic left heart syndrome
- Tricuspid atresia (absence/ abnormal opening)
- Truncus arteriorosus
- Pulmonary atresia
What can cause neonatal abstinence syndrome?
- Opiods
- Benzodiazepenes
- Cocaine
- Amphetamines
- Maternal co-morbidity
- Social and discharge planning
what is neonatal abstinence syndrome? and how would you monitor it?
Abstinence from physically addictive substance taken by mother in pregnancy
Monitor
- urine toxicology
- Finnegran screen
How do you treat neonatal abstinence syndrome?
- comfort
- morphine
- Phenobarbitone
hypothermia in the NNU
- place on ventilator
- sepsis screen and antbx
- consider checking thyroid function
- monitor blood glucose
Complications from TORCH infections
- IUGR
- Brain calcification
- Neurodevelopmental delay
- Visual impairment
- Recurrent infections
Management of sepsis
´Admit NNU
´Partial septic screen (FBC, CRP, blood cultures) and blood gas
´Consider CXR, LP
´IV penicillin and gentamicin 1st line
´2nd line iv vancomycin and gentamicin
´Add metronidazole if surgical/abdominal concerns
´Fluid management and treat acidosis
´Monitor vital signs and support respiratory and cardiovascular systems as required
