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Complex Care 2 > Neonate Complications and NICU Cares > Flashcards

Neonate Complications and NICU Cares Flashcards

1
Q

Define: Surfactant

A

‘a lipoprotein found in the lungs which keeps the alveoli inflated and reduces surface tension of the pulmonary fluids. It allows exchange of gases in the alveoli and aids the elasticity of pulmonary tissue.

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2
Q

Explain: Surfactant production in premature babies

A

Preterm babies lack enough surfactant, making respiration laborious and potentially leading to the development of respiratory distress syndrome

  • Synthesis of surfactant is thought to be affected by acidosis and/or hypothermia
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3
Q

List respiratory disorders in neonates

A
  • Asphyxia
  • Meconium aspiration syndrome (MAS)
  • Transient tachypnoea of the newborn (TTN)
  • Respiratory distress syndrome (RDS)
  • Apnoeas
  • Chronic lung disease (CLD)
  • Pneumothorax
  • Diaphragmatic hernia (CDH)
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4
Q

Define: Asphyxia

A

Oxygen deprivation

  • Failure of initiation of respiration in the newborn infant.
  • Blood oxygen levels are low and the carbon dioxide level is very high
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5
Q

List some causes of Asphyxia

A
  • Preterm birth
  • Obstruction
  • Certain drugs
  • Congenital anomalies
  • Cerebral damage
  • Infection
  • Haemorrhage
  • Pneumothorax
  • Pharyngeal suctioning
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6
Q

What are some antenatal factors contributing to risk Asphyxia

A 
Maternal diabetes
Pre-eclampsia
Anaemia or isoimmunisation
Previous fetal or neonatal death
Maternal infection
Polyhydramnios 
Oligohydramnios
PROM/PPROM
APH
Post term
Multiple gestation
IUGR/SGA
Drug therapy
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7
Q

What are some intrapartum factors contributing to risk Asphyxia

A 
LSCS
Breech or other malpresentation
Premature labour
Prolonged ROM
Precipitous labour
Prolonged labour > 24 hours
Prolonged second stage > 2 hours
Mec stained liquor
Cord prolapse
Placental abruption
Placenta previa
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8
Q

Define: Meconium aspiriation syndrome (MAS)

A

Is when the fetus has already passed meconium in-utero (due to fetal hypoxia) and fetal gasping occurs under stress- meconium then becomes trapped in the airways allowing air in but not out

  • MAS more common in near-term or term babies, especially small for dates and postmature babies.
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9
Q

What is the treatment for Meconium aspiration syndrome

A
  • Oxygen therapy and antibiotics may be needed to avoid pneumonia.
  • Surfactant therapy commenced within 6 hours of birth may reduce the severity of respiratory problems with MAS and may improve the prognosis.
  • In the majority of cases there is a milder disease process that requires initial supportive treatment but quickly resolves over 24 - 48 hours.
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10
Q

Define: Transient tachypnoea of the newborn (TTN)

A

occurs due to a mild surfactant deficiency, or failure to adequately absorb lung fluid following birth
- Commonly found in otherwise healthy, near term or term babies

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11
Q

List signs and symptoms of Transient tachypnoea of the newborn (TTN)

A
  • Tachypnoea > 60 up to 120 breaths per minute
  • Nostril flaring
  • Sternal recession
  • Expiratory grunting
  • Possible cyanosis
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12
Q

What is the treatment/management for Transient tachypnoea of the newborn (TTN)

A
  • Do not suction the oropharynx if not obstructed
  • Paed r/v
  • Symptoms usually resolve within 24 hours, although tachypnoea may persist a little longer
  • May be a NICU/SCN admission. Baby may need oxygen and observation in an incubator
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13
Q

Define: Respiratory Distress Syndrome (RDS)/(HMD)

A

A condition seen in preterm infants caused by a lack of surfactant. Lung expansion cannot be maintained, and oxygen and CO2 exchange is impaired.
- The baby becomes exhausted by the efforts of breathing and there is characteristic flaring of the nares, expiratory grunt, sternal and intercostal recession

  • Initial S/S occur within 4 hours of birth and increase in severity over 2-3 days
  • Occurs in 70% of neonates born at 29 weeks, declines sharply to near 0% at 39 weeks and is rarely seen after 37 weeks
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14
Q

What is the treatment/management of Respiratory distress syndrome

A
  • Correct diagnosis
  • Exclude septicaemic pneumonia, antibiotic therapy
  • Blood cultures and blood gases
  • Surfactant therapy: administered directly into the bronchi in RDS within 15 minutes of birth
  • Ventilation support
  • Intermittent and continuous observations
  • Documentation
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15
Q

Define: Apnoea

A

is the cessation of respiratory effort for 20 seconds or more, and requires constant monitoring.

  • More common in preterm neonates.
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16
Q

Define: Chronic Lung Disease

A

Seen in the preterm neonate who continues to require supplemented oxygen supply at 36 weeks post conceptual age.

Risk factors:

  • Prematurity
  • Endotracheal intubation
  • High level ventilator PIP
  • Oxygen toxicity
  • LBW neonates with mild RDS with PDA and nosocomial infections
17
Q

Explain: Pneumothorax

A

Occurs when the alveoli rupture causing air to enter the pleural cavity.

Spontaneous: at birth on initial inspiration or following meconium aspiration.
Induced: by high ventilator pressures.

Baby’s condition suddenly deteriorates.

18
Q

Explain: risk of infection for neonates

A

Neonates are born immunocompromised and are susceptible to infection. Defense mechanisms are immature at full term, and even less mature in preterms

Their immune system is supported by natural passive immunisation from the placental transfer of IgG and colostrum/breast milk provision of IgA

19
Q

List some prenatal infections

A 
TORCH viruses:
- Toxoplasmosis, 
- Other viruses (e.g. syphillis, parvovirus),
- Rubella,
- Cytomegalovirus
- Herpes.
Varicella zoster
Listeriosis
Hepatitis
20
Q

What are the 4 ways of acquiring an Intrauterine infection

A
  • Ascending infection from the lower genital tract (most common)
  • Retrograde passage of organisms from the peritoneal cavity via the fallopian tubes (less common)
  • From the maternal circulation
  • From invasive antenatal diagnostic procedures, such as amniocentesis
21
Q

What are some predisposing factors for intrauterine infection

A 
Transplacental infection
Preterm birth
Low birth weight
Prolonged ROM
Hypothermia
Some congenital malformations e.g. meningomyelocele, urinary tract abnormalities
Birth trauma
22
Q

List ways we can prevent infection

A
  • Inutero: vaccinations, see GP
  • Handwashing
  • Sterile, clean and single use equipment
  • Clean environment
  • Avoiding invasive procedures where possible
  • Minimal visitors, healthy and free from illness
23
Q

Explain: Mild eye infection ‘sticky eye’

and management

A

In the first 1-2 days, often due to chemical irritation and clears spontaneously

  • Treat by wiping away secretions with cotton wool soaked sterile water or normal saline solution
  • If not resolved after this time more likely to be infective
24
Q

Explain: Conjunctivitis and management

A

Purulent discharge, relatively common

  • May be caused by: staphylococci, E.coli or streptococci
  • Treatment: clean eyes as above and 1 drop of chloramphenicol 1.0% 4 times a day for up to 5 days
25
Q

List signs of neonatal infection

A 
Raised/depressed neutrophil count
Raised C-reactive protein (CRP) 
Lethargy
Vomiting
Diarrhoea
Jaundice
Mild respiratory difficulty
Pyrexia
Hypothermia
Irritability
Poor feeding
Weak cry
Abdominal distension
Failure to thrive
Rashes
Purpura
Respiratory distress
Shock and renal failure
26
Q

What investigations are used to determine neonatal infection

A 
Full blood count and blood gases 
Blood culture
Urine culture
Swabs
Lumbar puncture and CSF culture
Chest X-ray, CT, MRI scans
C-reactive protein (CRP)
Culture of amniotic fluid, placental tissue and cord blood
27
Q

What are possible causes of Sepsis and treatment

A

Causative organisms:

  • Early onset – (first few days) GBS, E.coli, L.monocytogenes (blood borne from GIT infections)
  • Late onset – over half caused by coagulase negative Staphylococci- many of which are resistant to Methicillin

Treatment

  • IV Antibiotics will commence prior to ID of causative organism
  • Combination of Ampicillin & Gentamicin or Cefotaxime
28
Q

Explain: GBS infection in neonates

A

If mum is a carrier 10% neonates acquire GBS through vertical transmission at birth

Causes

  • early (at or within 12 hours of birth up to day 6) or
  • late onset disease (usually at 4-5 weeks of age: range 7 to 89 days)

Potentially deadly to the neonate: 20% of cases

Complex Care 2 (8 decks)

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