Neonatology 2 Flashcards
What are the dates for a term baby?
37-42 weeks
What are the symptoms of sepsis in a newborn?
- Baby pyrexia or hypothermia
- Poor feeding
- Lethargy or irritable
- Early jaundice
- Tachypnoea (RR>60)
- Hypo or hyperglycaemia
- Floppy
- Asymptomatic
What are the risk factors for a term baby developing sepsis?
- PROM (prolonged ruptured membrane: >18 hours of labour)
- Maternal pyrexia
- Maternal GBS (group B strep) carriage
How is presumed sepsis managed in newborns?
- Admit NNU
- Partial septic screen (FBC, CRP, blood cultures) and blood gas
- Consider CXR, LP
- IV penicillin and gentamicin 1st line
- 2nd line iv vancomycin and gentamicin
- Add metronidazole if surgical/abdominal concerns
- Fluid management and treat acidosis
- Monitor vital signs and support respiratory and cardiovascular systems as required
What are the commonest causes of neonatal sepsis?
- *Group B strep* □ Early onset: birth to 1 week □ Late onset or recurrence: up to 3 months □ Symptoms: may be non-specific □ May have no risk factors □ Complications ® Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock □ Prognosis – 4 to 30% mortality - *E. Coli* - Listeria - Coagulase-negative staph. - Haemophilus Influenzae
What are the congenital infections in newborns?
- ToRCH □ Toxoplasmosis (and other including syphilis) □ Rubella □ CMV □ Herpes
What might congenital infections in newborns result in?
□ IUGR (intrauterine growth restriction) □ Brain calcifications □ Neurodevelopmental delay □ Visual impairment □ Recurrent infections
What are the causes of respiratory distress syndrome?
- Sepsis
- TTN – transient tachypnoea of the new-born
- Meconium aspiration
Talk about transient tachypnoea of the new-born
- Self-limiting and common
- Presents within 1st few hours of life
- Clinically
□ Grunting, tachypnoea, oxygen requirement, normal gases - Pathophysiology
□ Delay in clearance of foetal lung fluids - Management
□ Supportive, antibiotics, fluids, O2, airway support
What are the risk factors of meconium aspiration?
□ Postdates (aged placenta)
□ Maternal diabetes
□ Maternal hypertension
□ Difficult labour
What are the symptoms of meuconium aspiration?
□ Cyanosis □ Increased work of breathing □ Grunting □ Apnoea □ Floppiness
What investigations are done for meuconium aspiration?
□ Blood gas
□ Septic screen
□ CXR
What is the treatment for meuconium aspiration?
□ Suction below cords □ Airway support- intubation and ventilation □ Fluids and antibiotics □ Surfactant □ NO or ECMO
What is the prognosis of meuconium aspiration?
□ Most do well
□ Some develop Persistent pulmonary hypertension of the new-born
□ There is an associated mortality
What investigations are done on the “blue baby”?
- Examination and history
- Sepsis screen
- Blood gas and blood glucose
- CXR
- Pulse oximetry
- ECG
- Echo
- (Hypoxia test)
What aree the diferentials for the “blue baby”?
- (1) truncus arteriosus
- (2) TGA
- (3) tricuspid atria
- (4) tetralogy of Fallot’s
- (5) TAPVD
- Hypoplastic left heart syndrome
- Pulmonary atresia
Talk about hypoglycaemia and the new-born
○ If requires admission to NNU may still manage with enteral feeds
○ Monitor blood glucose
○ Start iv 10% glucose
○ Increase fluids
○ Increase glucose concentration (central iv access)
○ Glucagon
○ Hydrocortisone
Talk about hypothermia and the newborn
○ If unable to maintain temperature on PNW admit and place in incubator
○ Sepsis screen and antibiotics
○ Consider checking thyroid function
○ Monitor blood glucose