Neonates Flashcards
What is early onset neonatal sepsis?
Sepsis occurring within the first 48-72 hours of life?
What is the most frequent cause of severe neonatal infection?
Group B strep
What is group B strep?
Gram positive coccus in chains
What are some risk factors for early onset neonatal sepsis?
Invasive group B strep infection in previous baby, maternal GBS in current pregnancy, prelabour rupture of membranes, preterm birth, intrapartum fever higher than 38, suspected chorioamniotiis
What are some clinical indicators suggestive of early onset neonatal sepsis?
Respiratory distress starting >4 hours after birth, seizures, signs of shock,, feeding difficulties, tachycardia or bradycardia, hypoxia, jaundice within 24 hours of birth, apnoea, temperature abnormalities
What are some differentials of early onset neonatal sepsis?
Transient tachypnoea of the new born, respiratory distress syndrome, meconium aspiration, haemolytic disease of the newborn
How is early onset neonatal sepsis managed?
IV benzylpenicillin with gentamicin
Continue for 7-10 days if blood cultures are positive or up to 14 days if CSF is also positive
How is early onset neonatal sepsis investigated?
FBC, CRP, blood cultures, LP
What causes physiological neonatal jaundice?
Due to increased red blood cell breakdown and immature liver not able to process high bilirubin concentrations
What is the natural history of physiological neonatal jaundice?
Starts at day 2-3, peaks at day 5 and usually resolves by day 10
What are the causes of pathological neonatal jaundice?
Haemolytic disease of the newborn, G6PD deficiency, dehydration, infection, breast milk jaundice, biliary atresia
What are some risk factors for pathological hyperbilirubinaemia?
Prematurity, low birth weight, previous sibling required phototherapy, exclusively breast fed, jaundice <24 hours, infant of diabetic mother
How could pathological neonatal jaundice present?
Yellowing of skin and sclera, drowsy, altered muscle tone, poor urine output
How is neonatal jaundice investigated?
Transcutaneous bilirubinometer, serum bilirubin, blood group, DCT, FBC, U+Es, infection screen, LFTs, TFTs
How can neonatal jaundice be managed?
Phototherapy, exchange transfusion, IVIG
What complication can arise from neonatal jaundice?
Kernicterus - bilirubin is neurotoxic and can accumulate in CNS gram matter causing irreversible neurological damange
What is the definition of extreme preterm?
Before 28 weeks
What is the definition of very preterm?
28 to 32 weeks
What is the definition of moderate to late preterm?
32 to 37 weeks
What are some reasons for prematurity?
Pre-eclampsia, severe IUGR, PPROM, placental abruption, severe infection, no identifiable cause
What are some risk factors for premature delivery?
Previous preterm delivery, multiple pregnancy, smoking, infections, diabetes, hypertension, physical injury, being underweight or overweight during pregnancy
How is a premature baby investigated?
FBC, U+Es, blood cultures, CRP, blood group and DAT, blood gas, CXR, AXR, CrUSS
How can RDS in a neonate be managed?
Exogenous surfactant administration, endotracheal intubation and mechanical ventilation, CPAP, NIPPV, high flow oxygen, caffeine administration for apnoeas
What medication can be given to close a PDA?
Indomethacin or ibuprofen
How can retinopathy of prematurity be managed?
Avoid excessive oxygen exposure, screening for ROP by ophthalmology team, laser treatment if indicated
Describe the results of the EPICure 2 study
Infants born at 22 weeks - 1/3rd will have no or mild disability
By 26 weeks - 75% have no or mild disability
What are some complications of prematurity
Retinopathy of prematurity
Respiratory distress syndrome which can lead to chronic lung disease
Neonatal sepsis
Intraventricular haemorrhage
Necrotising enterocolitis
Hypoglycaemia and electrolyte abnormalities
What should be covered in the NIPE?
General condition - colour, how they handle, birth marks etc
Head - shape, circumference, fontanelles
Mouth - sucking reflex, tongue, palate, cyanosis
Count fingers and toes, look at palmar creases
Genitals and anal patency
Eyes - red reflex
Check heart sounds and femoral pulses
Palpate testes
Check hips - Barlow (posterior force, adduct) and ortolans (push anteriorly and abduct)
What conditions are looked for on the blood spot test?
Congenital hypothyroidism, sickle cell disease, cystic fibrosis (measures trypsin), metabolic disorders (maple syrup urine disease, homocystinuria, phenylketonuria etc)
How and when are hearing problems screened in babies?
Ideally hearing tested in the first 4-5 weeks, can be done up to 3 months
Automated otoacoustic emission or auditory evoked brainstem response
What future condition is kernicterus associated with?
Athetoid cerebral palsy
How does phototherapy work for jaundice?
Blue-green 450-460nm fluorescent light converts bilirubin to soluble
What murmur is heard in PDA?
Continuous machinery murmur
What are the acyanotic congenital heart defects?
VSD, ASD, PDA, coarctation of the aorta
What are some cyanotic congenital heart defects?
Tetralogy of Fallot, transposition of the great arteries, hypo plastic left heart syndrome
What are some clinical features of NEC?
Crying too much or silent, fever, bruised, distended abdomen, feed intolerance, vomiting, haematochezia
What will be seen on the CXR in NEC?
Pneumatosis intestinalis (intramural gas)
How is NEC managed?
NBM, antibiotics, NG free drainage, IV fluids, maybe surgery
When do alveoli form?
32 weeks
What are some signs of respiratory distress in the newborn?
Cyanosis, high RR, tracheal tug, intercostal and subphrenic recessions, head bobbing
What will be seen on the CXR in respiratory distress syndrome?
Ground glass appearance, air bronchogram
When should a newborn be back to it’s birth weight?
By 3 weeks (should not lose >10% of BW)
What are the neonatal fluid requirements?
Birth to day 1 - 50-60ml/kg/day
Day 2 - 70-80ml/kg/day
Day 3 - 80-100ml/kg/day
Day 4 - 100-120ml/kg/day
Day 5-28 - 120-150ml/kg/day
What are the fluid requirements of a baby after 28 days?
0-10kg - 100ml/kg/day
10-20kg - 50ml/kg/day
> 20kg - 20ml/kg/day
What is the pathophysiology of respiratory distress syndrome?
Deficiency of alveolar surfactant which leads to atelectasis and possible respiratory failure
What is bronchopulmonary dysplasia?
Defined as a persistent oxygen requirement after 28 postnatal days or 36 weeks corrected gestational age (whichever is later)
What are some early and late sequelae of bronchopulmonary dysplasia?
Early - ventilator dependence, pulmonary hypertension, tracheobronchomalacia, feeding problems, GORD
Late - lower IQ, cerebral palsy, asthma and exercise limitation
