Neonatology Flashcards
Define Early onset neonatal sepsis (EONS).
Early onset neonatal sepsis (EONS)
What is the most frequent cause of severe neonatal infection?
Group B Streptococcus
Describe the gram stain of Group B Streptococcus.
Gram-positive coccus
Describe the pathophysiology go Group B Streptococcus.
Mainly caused by ascending infection in the mother with chorioamnionitis, perinatally via direct contact in the birth canal and haematogenous spread.
Name some risk factors of Group B Streptococcus infection.
Prelabour rupture of membranes
Preterm birth following spontaneous labour (before 37 weeks’ gestation)
Suspected or confirmed rupture of membranes for more than 18 hours in a preterm birth
Intrapartum fever higher than 38°C, or confirmed or suspected chorioamnionitis
Name some reg flags suggestive of neonatal infection.
Systemic anatibiotics given to mother for suspected bacterial infection within 24 hr of birth
Seizures
Signs of shock
Respiratory distress starting more then 4 hours after birth
Need for mechanical ventilation in a a term baby
Suspected or confirmed infection in a co-twin
Describe the medical management of neonatal Early onset neonatal sepsis (EONS)
Use intravenous benzylpenicillin with gentamicin as the first-choice antibiotic regimen for empirical treatment of suspected EONS unless microbiological surveillance data reveal local bacterial resistance patterns indicating a different antibiotic.
What might Janice in a healthy babe, born at term, result from?
Increased red blood cell breakdown: in utero the fetus has a high concentration of Hb (to maximise oxygen exchange and delivery to the fetus) that breaks down releasing bilirubin as high Hb is no longer needed
Immature liver not able to process high bilirubin concentrations
Describe the time course of physiological jaundice in a neonate.
Starts at day 2-3, peaks day 5 and usually resolved by day 10. The baby remains well and does not require any intervention beyond routine neonatal care.
Name some types of pathological jaundice in a neonate.
- Haemolytic disease
- Bilirubin above phototherapy threshold
- unwell neonate
- prolonged jaundice
Name some risk factors of pathological hyperbilirubinaemia.
Prematurity, low birth weight, small for dates Previous sibling required phototherapy Exclusively breast fed Jaundice <24 hours Infant of diabetic mother
Describe the clinical presentation of a baby with jaundice.
Colour: All babies should be checked for jaundice with the naked eye in bright, natural light (if possible). Examine the sclera, gums and blanche the skin. Do not rely on your visual inspection to estimate bilirubin levels, only to determine the presence or absence of jaundice.
Drowsy: difficult to rouse, not waking for feeds, very short feeds
Neurologically: altered muscle tone, seizures-needs immediate attention
Other: signs of infection, poor urine output, abdominal mass/organomegaly, stool remains black/not changing colour
Name some management steps of a jaundice neonate.
- Phototherapy
- Exchange transfusion
- IV Immunoglobulin
Describe the name complication of neonatal jaundice.
Kernicterus, billirubin-induced brain dysfunction, can result from neonatal jaundice. Bilirubin is neurotoxic and at high levels can accumulate in the CNS gray matter causing irreversible neurological damage. Depending on level of exposure, effects can range from clinically undetectable damage to severe brain damage.
How long after stopping phototherapy should bilirubin levels be checked to rule out rebound hyperbilirubinaemia?
12-12 hr
What is Meconium Aspiration Syndrome (MAS)?
the term used to describe a spectrum of disorders, marked by various degrees of respiratory distress in the new born infant. This follows the aspiration of meconium stained amniotic fluid (MSAF), which can happen either antenatally (2.8% of all pregnancies) or during birth (up to 23% of all pregnancies)
Name some common features seen with MAS-related respiratory distress.
- Partial or total airway obstruction
- Foetal hypoxia
- Pulmonary Inflammation
- Infection
- Surfactant inactivation
- Persistant pulmonary hypertension
Name some risk factors associated with Meconium Aspiration Syndrome (MAS).
Gestational Age > 42 weeks
Foetal distress (tachycardia / bradycardia)
Intrapartum hypoxia secondary to placental insufficiency
Thick meconium particles
Apgar Score <7
Chorioamnionitis +/- Prolonged pre-rupture
Oligohydramnios
In utero growth restriction (IUGR)
Maternal hypertension, diabetes, pre-eclampsia or eclampsia, smoking and drug abuse
Name some clinical features seen in Meconium Aspiration Syndrome (MAS).
Tachypnoea – a respiratory rate of >60 breaths per minute
Tachycardia – a heart rate of >160 beats per minute
Cyanosis – this requires immediate management
Grunting
Nasal flaring
Recessions – intercostal, supraclavicular, tracheal tug
Hypotension – systolic blood pressure of <70 mmHg
Name some complications of Meconium Aspiration Syndrome (MAS).
- Air leak
- PPHN
- Cerebral Palsy
- Chronic Lung Disease
When does the gestational age become a risk factor for MAS?
> 42 weeks
Define preterm birth.
Preterm birth is defined as delivery before 37 completed week’s gestation.
Define extreme preterm birth
before 28 weeks
Define very preterm birth.
28-32 weeks
Define moderate to late preterm
32 to 37 weeks
Name some risk factors of preterm birth.
Previous preterm delivery
Multiple pregnancy
Smoking and illicit drug use in pregnancy
Being under or overweight in pregnancy
Early Pregnancy (within 6 months of previous pregnancy)
Problems involving cervix, uterus or placenta, including infection
Certain chronic conditions such as diabetes and hypertension
Physical injury/trauma
Name an example of an assessment tool which can be used to estimate neonatal maturity.
Dubowitz/Ballard Examination
What should be offered antenatally in a planned preterm pregnancy to reduce the risk of respiratory distress syndrome?
Steroids
