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Paeds > Neonates > Flashcards

Neonates Flashcards

1
Q

Chronic perinatal infections

A 
CHEAP TORCHES
Chicken pox/shingles
Hep B
Ebstein-Barr virus
AIDS (HIV)
Parvovirus B19 (erythema infectious)
Toxoplasmosis
Other
Rubella virus
Cytomegalovirus/Coxsakievirus
Herpes simples virus
Every STI
Syphillis
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2
Q

Bacteria causing neonatal sepsis

A

common= GBS

less common - E.COli, Listeria, Klebsiella, Enterobacter

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3
Q

Signs of sepsis neonate

A
  • Tachycardia
  • Febrile (>38) temp instability
  • hypotensive
  • Tachyponea. respiratory distress
  • unexplained need for resusc
  • Poor peripheral perfusion
  • Apneoic episodes
  • lethargy
  • seizures
  • poor feeding
  • metabolic/respiratory acidosis
  • Hypoglycemic
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4
Q

APGAR

A

OUT OF 10
appearance, PR, grimace, activity, Resp effort
low score: <7 needs med attention

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5
Q

Antibiotics for sepsis (empirical)

A

penicillin 60mg/kg/dose BD or ampicillin 50mg/kg/dose BD +
>30wk = gentamicin 2.5mg/kg daily ; <30 = 2.5mg/kg 36hrs for 3days. (check levels after 2nd day)

duration Rx -

  • consult w paediatrician, ID
  • -ve BC: discontinue after 36hrs
  • sepsis proven, suspected cont for 5-7days
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6
Q

General D/C adivise to new parents

A

1) Personal health record (RED BOOK)
2) Child health info booklet
3) Feeding
4) Safe sleeping
5) Injury prevention, reducing home hazards
6) Vaccinations
7) Parent/carer pertussis vaccination
8) Role of GP
9) Role of child health nurse/commu midwife/healthcare worker
10) Repeat neonatal check 7 days w GP

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7
Q

Resusc steps:

A
  • Dry, stimulate and open airway
  • Positive pressure ventilation (+ sats monitoring)
  • Ensure open airway / reduce leaks / consider increasing pressure and oxygen
  • Start chest compressions
  • Consider intubation
  • Venous access, adrenaline
  • Consider volume expansion
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8
Q

Neonatal Hypoglycemia - maternal causes

A
  • DM, GDM
  • Medications - sodium valproate, citalopram, oral hypoglycemics, beta-blockers
  • Intrapartum glucose
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9
Q

Neonatal hypoglycaemia - neonate causes

A 
Prematurity
IUGR
Macrosomia
Hypoxic ischemic injury
Respiratory distress
Sepsis
Hypothermia
Congenital cardiac disease
Metabolic disease
Rh haemolytic disease
Inadequate feeding
Endo causes: hypopituitarism, hyperinsulinism
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10
Q

Fluid order for hypoglycaemic, unwell baby:

A

IV 10% dextrose at 60 ml/kg/day (divide w 24 to get hrly rate)
recheck after 30 minutes and adjust IV dextrose as required to achieve BGL ≥ 2.6.

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11
Q

Prematurity - short term risks

A
  • Respiratory distress
  • Intraventricular hemorrhoage
  • Jaundice of prematurity
  • Inability to suck feed
  • Apnoea of prematurity
  • Hypoglycemia
  • Hypothermia
  • Retinopathy of prematurity
  • PDA
  • Necrotising enterocolitis
  • Increased risk of infection
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12
Q

Prematurity - long term risks

A
  • Frequent hospitalizations (eg resp infections)
  • Hearing impairement
  • Visual impairement
  • Imparied cognitive skils
  • Motor deficits including fine or gross motor delay and cerebral palsy
  • Behvioural and psychological probs
  • Herniae
  • Growth impairement
  • Potential impacts on adult health such as – insulin resistance, HTN, vascular changes
  • Lower reproduction rates.
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13
Q

respi distress - common causes

A

TTN (retained fetal lung fluid
RDS (hyaline membrane dis)
Sepsis

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14
Q

Respi distress - not to miss

A 
RDS (prematurity)
Sepsis (RF GBS infection)
Isolated pneumothorax (resusc)
Meconium aspiration syndrome
Pneumonia
CHD
Congenital lung malformation
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15
Q

TTN

A
  • retained fetal lung fluid
  • parenchymal lung disorder of pulmonary oedema resulting fem delayed absorption/clearance of fetal alveolar lung fluid.
    RF:
  • late preterm 34-37wk
  • c/sec
  • SGA/LGA
  • Maternal DM
  • Maternal asthma
    onset frm birth –>2hrs
    lasts 12-24hrs
    spontaneous resolution
    rarely req supplemental oxygen or mech ventilation
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16
Q

RDS (hyaline membrane dis)

A
  • reduced amt of surfactant
  • preterm neonates
  • worsens if not Rx
  • S/S - tachypnoea, nasal flaring, grunting, recession, cyanosis, BS (may be reduced)
17
Q

PPH

A
  • abnorm persistence of high pulmonary vascular resistance
  • -> deoxygenated blood shunted R->L through foramen oval and ductus arteriosus –> hypoxia
  • cause - underdevelopment of pulmonary vasculature (other asso congen structural abnorm e.g. congenital diaphragmatic hernia) or maladaption (w chronic inter stress –> mec aspiration
  • term/post-term
  • tachypnoea & cyanosis
  • may be systolic murmur of tricuspid insuff
  • asso w: sepsis, hypoxia-ischemia, MAS, congenital diaphragmatic hernia
  • little improvement in sats w oxygen.
18
Q

Congenital cardiac disease

A
  • mild respi distress and tachycardia

- lung function, oxygenation and CXR doesn’t improve w resp support and surfactant.

19
Q

Pneumothorax

A 
- air leak more common in neonatal period than any other.
RF:
- prematurity
- mechanical ventilation
- MAS
- RDS
- TTN
- pulmonary hypoplasia
- pneumonia
S/S
- asymmetrical chest expansion
- affected side - larger, reduced air entry
- if large - bradycardia, hypotension, hypoxia (related to reduced CO)
20
Q

MAS

A
  • RF: Post term or SGA w mec liquor, asphyxiation
  • Resp distress IMMEDIATELY after birth
  • Mec –> infection, interferes w surfactant, chemical irritation
  • Signs - barrel shaped chest, crackles and wheeze
  • Complications = pneumothorax, PPHTN
21
Q

RF (5) Early onset neonatal sepsis

A
  • preterm labour 18hrs
  • maternal temp >38C
  • GBS colonisation current prey
  • previous child w EOGBSD
22
Q

Signs of Early onset neonatal sepsis

A
  • tachypnoea, respiratory distress, apnoeic episodes
  • tachycardia
  • fever, temp instability
  • hypotension, poor perish perfusion
  • unexpected need for resusc
  • lethargy
  • seizures
  • poor feedings
  • abdo distention
  • hypoglycaemia
  • metabolic/respi acidosis
23
Q

Mx - respi distress poss sepsis (6)

A
  • oxygen supp - 92-96%
  • CXR
  • IV access - FBC, BC,
  • IV antibios
  • IV fluids 60ml/kg/day 10% dextrose
  • transfer - SCN further mx and obs.
24
Q

Explain to parents - re baby going to SCN

A
  • Why going there.
  • What will be done (lines)
  • Parental involvement
  • how long baby will be there
  • any questions
25
Q

info b4 d/c newborn - baby

A 
GA - term?
age - hrs
blood group, rh, DAT/coombs (cord blood)
respiratory distress
resusc? 
agars? NICU?
feeding
birth weight 
passed mec/urine
hep b and vit k given
26
Q

info b4 d/c newborn - mum

A 
age
GsPs
problems during this pregnancy
serology
delivery - mode, complications
when ROMd, antibios?
Maternal fever
GA (term/pre/post)
medical conditions/medications
blood group, rh status
GBS status

Paeds (12 decks)

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