neonatology Flashcards
categories of term admission
sepsis
resp
cardio
hypoglycaemia
hypothermia
jaundice
birth asphyxia
surgical problems
neonatal abstinence syndrome
symptoms of sepsis in the neonate
- pyrexia or hypothermia
- poor feeding
- lethargy or irritable
- early jaundice
- tachypnoea
- hypo/hyperglycaemia
- floppy
- asymptomatic
risk factors for sepsis in the neonate
premature rupture of membranes
maternal pyrexia
maternal GBS carriage
management of presumed neonatal sepsis
- admit NNU
- partial septic screen - FBC, CRP, blood cultures and blood gas
- consider CXR, LP
- IV penicillin and gentamicin 1st line
- add medronidazole if surgical/abdo concerns
- fluid management and treat acidosis
- monitor vital signs and support resp and CVS system as required
commonest causes of neonatal sepsis
- group B strep
- e coli
- listeria
- coag -ve staphylococci (if lines in situ)
- haemophilus influenzae
onset of GBS sepsis
early onset: birth - 1wk
late onset/recurrence - up to 3mths
difficulties w/ GBS sepsis
may be non-specific sepsis
may have no risk factors
complications of GBS sepsis
meningitis
DIC
pneumonia and resp collape
hypotension and shock
causes of congenital infection - TORCH
toxoplasmosis
other - syphilis, VZV
rubella
CMV
HSV
what is a congenital infection
infections acquired transplacentally or in utero
typically occurs when a woman contracts an infection w/ one of the responsible organisms for the 1st time during pregnancy and the foetus then becomes affected
what can congenital infections result in
IUGR
brain calcifications
neurodevelopmental delay
visual impairment
recurrent infections
signs and symptoms associated w/ congenital infection
how common is resp distress in neonates
one of the most common reasons for admission to NNU
causes of resp problems in neonates
sepsis
TTN - transient tachypnoea of the newborn
meconium aspiration
how common is TTN
self limiting and commonest cause of resp distress in term neonate
presentation of TTN
presents within 1st few hrs of life
grunting, tachypnoea, oxygen requirement, normal gases
pathophysiology of TTN
delay in clearance of foetal lung fluids
- normally at birth a small amount of fluids are expelled from the mouth, majority is absorbed by lung epithelium (influenced by catecholamines)
management of TTN
supportive
abx - make sure to exclude other serious causes
fluids
O2
airway support
what is associated w/ TTN
C section
lower concentration of catecholamines to help clear lung fluids
absence of physical pressure squeezing on the chest
what is seen here
TTN
- wet lungs
- prominent vascular markings
- horizontal fissure (separating right upper lobe from middle lobw)
what is meconium
first stool passed by a newborn
10% of neonates pass it during labour
risk factors for meconium aspiration
post dates
maternal HT
maternal DM
difficult labour
symptoms of meconium aspiration
cyanosis
increased work of breathing
grunting
apnoea
floppiness
investigations for meconium aspiration
blood gas
septic screen
CXR
why is meconium aspiration important
thick meconium inhaled can cause obstruction and air trapping
increased risk of pneumothorax or air leaks
irritant properties - chemical pneumonitis
reduces effectiveness of surfactant and predisposes to chest infections
why is meconium aspiration important
thick meconium inhaled can cause obstruction and air trapping
increased risk of pneumothorax or air leaks
irritant properties - chemical pneumonitis
reduces effectiveness of surfactant and predisposes to chest infections
what can be seen here
meconium aspiration
- flattened diaphragm
- hyperinflation of the chest
- coarse opacities w/ patchy areas of collapse and areas of overinflation
treatment for meconium aspiration
suction below cords
airway support - intubation and ventilation
fluids and IV abx
surfactant
NO or ECMO
prognosis for meconium aspiration
most do well
some develop PPHN - persistent pulmonary hypertension of the newborn
associated mortality
what happens to the circulation in PPHN
R → L shunt across PFO/PDA
(persistence of foetal circulation)
failure to oxygenate and pulmonary HT
things to remember about cardiac conditions in neonates
- most murmurs aren’t significant and don’t need NNU admission
- blue baby = urgent treatment
- sepsis and resp causes are more common than cardiac
investigation of the blue baby
hx and exam
sepsis screen
blood gas and blood glucose
CXR
pulse oximetry
ECG
echo
hyperoxia test
what is a hyperoxia test
try to differentiate cardiac from resp disease
- administer 100% O2 for short time period
lung disease - improved pp O2 on blood gas
cyanotic heart disease - healthy lungs already oxygenating as much as possible, no difference on blood gas
DDx - cardiac diagnoses for the blue baby
TGA
TOF
TAPVD
hypoplastic L heart syndrome
tricuspid atresia
truncus arteriosus
pulmonary atresia
5 Ts of cyanotic congenital cardiac disease
- Truncus arteriosus (one vessel)
- TGA (2 major vessels are switched)
- TRIcuspid atresia
- TOF (4 defects)
- TAPVD (total anomalous pulmonary venous drainage)
defects in TOF
pulmonary stenosis
VSD
overriding aorta
RVH
