Neonatology Flashcards
What is neonatal sepsis
infection in the neonatal period (first 28 days) results in significant morbidity and mortality (10%)
what are common causative organism of neonatal sepsis
** Group B streptococcus (GBS) **
Escherichia coli (e. coli)
Listeria
Klebsiella
Staphylococcus aureus
what are RF for neonate sepsis
- Vaginal GBS colonisation
- GBS sepsis in a previous baby
- Maternal sepsis, chorioamnionitis or fever > 38ºC
- Prematurity (less than 37 weeks)
- Early (premature) rupture of membrane
- Prolonged rupture of membranes (PROM)
how does neonatal sepsis present
Respiratory distress
fever
tachycardia
Apnoea
Reduced tone and activity
jaundice
Vomiting
poor feeding
what are red flag symptoms of neonatal sepsis
- Confirmed or suspected sepsis in the mother
- Signs of shock
- Seizures
- Term baby needing mechanical ventilation
- Respiratory distress starting more than 4 hours after birth
- Presumed sepsis in another baby in a multiple pregnancy
what is the management for suspected neonatal sepsis if there is ONE risk factor or clinical feature
monitor the observations and clinical condition for at least 12 hours
what is the management for suspected neonatal sepsis if there is TWO or more risk factor or clinical feature
start antibiotics
what is the management for suspected neonatal sepsis if there is ONE red flag sign
start Abx
how soon should Abx be started in neonatal sepsis
within 1 hr of decsion
when should blood cultures be taken in neonatal sepsis
before antibiotics are given
also baseline FBC and CRP
LP if meningitis suspected
what is 1st line Abx of neonatal sepsis and the alterantive
benzylpenicillin with gentamycin
alt = third generation cephalosporin (e.g. cefotaxime)
What is the ongoing management of neonatal sepsis
- Check the CRP again at 24 hours
- Check the blood culture results at 36 hours
- Check the CRP again at 5 days if they are still on treatment
- Consider performing a LP if any of the CRP results are more than 10.
When can Abx be considered being stopped in neonatal sepsis
- at 48 hours if clinically well, the blood cultures are negative and both CRP results are less than 10
or
- at 5/10 day if clinically well, the lumbar puncture and blood cultures are negative and the CRP has returned to normal
what are steps of neonatal resuscitation
- Dry baby and maintain temperature
- Assess tone, respiratory rate, heart rate
- If gasping or not breathing give 5 inflation breaths*
- Reassess (chest movements)
- If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
what score is used to assess newborns health after birth
APGAR Score
appearance:
pulse
grimace = reflex irritability
activity = tone
respiration
taken at 1 min and 5 mins
what can prolonged hypoxia lead to
hypoxic-ischaemic encephalopathy (HIE)
in severe hypoxia situations what management can be considered
IV drugs and intubation
therapeutic hypothermia with active cooling.
what is benefit of delayed cord clmaping
improved haemoglobin, iron stores and blood pressure and a reduction in intraventricular haemorrhage and necrotising enterocolitis.
what is downside to delayed cord clamping
increase in neonatal jaundice, potentially requiring more phototherapy
how long should cord clamping be delayed in uncompromised neonates
at least 1 min
what is respiratory distress syndrome
affects premature neonates, born before the lungs start producing adequate surfactant
common <32 weeks
mortality ~40%
what is pathophysiology of RDS
Inadequate surfactant leads to high surface tension within alveoli.
= lung collapse = more difficult for lungs and alveoli to expand
= inadequate gaseous exchange
what are blood gas results of RDS
hypoxia, hypercapnia (high CO2)
what are chest XRay results of RDS
“ground-glass” appearance
what are features of RDS
tachypnoea, intercostal recession, expiratory grunting and cyanosis
how is RDS managed before labor
mother given antenatal steroids (dexamethasone) to increase production of surfactant with suspect or confirmed preterm labour
how is a neonate with RDS managed
- intubation and ventilation
- Endotracheal surfactant (artificial surfactant by trach tube
- Continuous positive airway pressure (CPAP
- Supplementary oxygen 91-95% o2 stat
what are short term complications of RDS
- Pneumothorax
- Infection
- Apnoea
- Intraventricular haemorrhage
- Pulmonary haemorrhage
- Necrotising enterocolitis
what are long term complications of RDS
- Chronic lung disease of prematurity
- Retinopathy of prematurity
- Neurological, hearing and visual impairment
what is Hypoxic-Ischaemic Encephalopathy
occurs in neonates as a result of hypoxia during birth.
When should HIE be suspected in neonates
- when there are events that could lead to hypoxia during the perinatal or intrapartum period
- acidosis (pH < 7) on the umbilical artery blood gas
- poor Apgar scores
- features of mild, moderate or severe HIE (see below)
- evidence of multi organ failure.
what causes HIE
- Maternal shock
- Intrapartum haemorrhage
- Prolapsed cord, causing compression of the cord during birth
- Nuchal cord, where the cord is wrapped around the neck of the baby
what is the grading system of HIE
Sarnat Staging
what is mild in Sarnat Staging
Poor feeding, generally irritability and hyper-alert
Resolves within 24 hours
Normal prognosis
what is moderate in Sarnat Staging
- Poor feeding, lethargic, hypotonic and seizures
- Can take weeks to resolve
- Up to 40% develop cerebral palsy
what is severe in Sarnat Staging
- Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes
- Up to 50% mortality
- Up to 90% develop cerebral palsy
how is HIE managed
supportive care with neonatal resuscitation
ventilation
circulatory support
nutrition
acid base balance
treatment of seizures.
Therapeutic hypothermia
what is Therapeutic hypothermia
actively cooling the core temperature of the baby to reduce the inflammation and neurone loss after the acute hypoxic injury
what is the temperate aim of Therapeutic hypothermia and for how long
between 33 and 34°C, measured using a rectal probe for 72 hours
baby is gradually warmed to a normal temperature over 6 hours
What is Jaundice
abnormally high levels of bilirubin in the blood
what do RBC contain
unconjugated bilirubin
