Neonatal problems Flashcards
What are the red flags for neonatal sepsis?
Suspected sepsis in mother
Signs of Shock
Seizures
Resp distress > 4hrs after birth
Suspected sepsis in other baby if multiple
What are the risk factors for neonatal sepsis?
GBS colonisation/sepsis in previous pregnancy
Maternal sepsis, chorioamnionitis >38 degrees
<37 weeks
Premature rupture of membranes
Prolonged rupture of membrane
For neonatal sepsis when do you
Observe
Start Antibiotics
1 risk factor/feature = observe
>=2 factors/features = start abx
What Abx do you give in neonatal sepsis?
Penicillin + Aminoglycoside
eg benpen + gent
How do you provide further management in neonatal sepsis?
24hr CRP
36hrs Blood cultures
Consider stopping abx if well/results normal
What constitutes the APGAR score?
Appearance
Pulse
Grimace
Activity
Respiration
Get up to 2 points for each
APGAR appearance score
2: Pink
1: Blue extremeties
0: Blue
APGAR pulse score
2: >100
1: <100
0: Absent
APGAR Grimace score
2: Cries/sneezes/coughs
1: Grimace
0: Nothing
APGAR Activity Score
2: Active
1: Flexed arms and legs
0: Floppy
APGAR Respiratory Effort
2: Strong/Crying
1: Slow/Irregular
0: Absent
APGAR
Good
Moderate
Low
7-10
4-6
0-3
What is the most common organism for late onset (>72hrs) neonatal sepsis?
Coag negative staph eg Staph Epidermidis
Outline Neonatal resuscitation
Birth
Dry baby and APGAR
Gasping/no breath: Airway + 5 breaths
No chest movement: Repeat airway + breaths
Reassess chest + HR, repeat above if needed
If HR < 60 now: Compressions 3:1
Reassess + consider direct access drugs
Male delivered via C-section displays raised RR and intercostal recession. His mother is diabetic. What is his likely condition?
Surfactant deficient lung disease/ARDS
How do you manage ARDS?
Antenatal steroids to prevent
Oxygen
Assisted ventilation
What is seen in transient tachypnoea of the newborn and how do you manage it?
Hyperinflation of the lungs + fluid in horizontal fissure
Observation + supplementary oxygen
Which congenital infection causes:
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
Cytomegalovirus
Which congenital infection causes:
Itchy rash on head/trunk that spreads
Macular –> Papular –> Vesicular
Fever
Chickenpox
What congenital infection causes
Skin scarring
Eye defects
limb hypoplasia
Microcephaly
Learning disabilities
Fetal varciella syndrome
Mother unsure if immune to chickenpox, what do?
Check maternal blood for antibodies
If a woman is VZ antibody -ve, what is the plan if they are…
19 weeks
27 weeks
under 20 weeks: VZIG ASAP up to 10 days post-exposure
Over 20 weeks: VZIG/antivirals between 7-14 days post-exposure
How do you manage a pregnant woman who has chickenpox rash after 20 weeks?
Oral aciclovir within 24 hours exposure
What childhood infection causes
Fever
Rash behind ears then all over: maculopapular –> blotchy
White spots in mouth
Measles
How do you confirm and treat measles?
IgM antibodies
Supportive unless IC/pregnant
Which childhood infection causes
Pink rash on face that spreads to body, stops between day 3-5
Lymph nodes behind ears and back of head
Rubella
What childhood infection causes
Viral symptoms
Slapped cheek 3 days later
Itchy rash on trunk and limbs
Parovirus B19
Which childhood infection causes
Sudden high fever
Truncal rash that spreads to extremeties
Affects 6-36 month olds
Roseola infantum
What infection causes strawberry tongue and tonsilitis? How do you treat it?
Scarlet fever (GAS)
Oral penicillin/aminoglycoside 10 days
What is the school exclusion for the following?
Scarlet fever
Whooping cough
Measles
Rubella
Chickenpox
Mumps
Diarrhoea & vomiting
Impetigo
Scabies
Influenza
Scarlet fever: 24 hours after abx therapy
Whooping: 2 days after abx start/21 days from onset
Measles: 4 days from rash onset
Rubella: 5 days from rash
Chickenpox: All lesions crusted/5 days after rash onset
Mumps: 5 days from gland onset
Diarrhoea + Vomiting: 48 hours after settling
Scabies: Until treated
Influenza: Until recovery
Which congential infections cause sensorineural deafness?
Rubella
Cytomegalovirus
