Neonatology 2- Term admissions Flashcards
what are risk factors for neonatal sepsis?
prolonged rupture of membranes (>18-24hrs)
maternal pyrexia
maternal group B strep carriage
what is the presentation of sepsis in a neonate?
pyrexia or hypothermia poor feeding lethargy or irritable early jaundice tachypnoea hypo or hyperglycaemia floppy asymptomatic
what is first line treatment of presumed sepsis in a neonate?
IV penicillin and gentamicin
what is second line treatment of presumed sepsis in a neonate?
IV vancomycin and gentamicin
what are the most common causative organisms of sepsis in neonates?
group B streptococcus escherichia coli listeria monocytogenes coagulase-negative staphylococci haemophillus influenza
list possible complications of group B strep sepsis in neonates.
meningitis DIC pneumonia respiratory collapse hypotension and shock
congenital infections such as ToRCH can result in what complications?
IUGR intracerebral calcifications, hydrocephalus neurodevelopment delay, microcephaly visual and auditory impairment recurrent infections splenomegaly bone abnormalities rash anaemia, neutropenia, thrombocytopenia hepatomegaly, jaundice, hepatitis pneumonitis
what is the pathophysiology of transient tachypnoea of the newborn?
delay in clearance of foetal lung fluids
what is the management for transient tachypnoea of the newborn?
supportive
antibiotics
fluids
02 airway support
when does transient tachypnoea of the newborn present?
within the fist few hours of life
what are the risk factors of meconium aspiration?
past dates
maternal diabetes
maternal hypertension
difficult labour
what are the symptoms of meconium aspiration?
cyanosis increased work of breathing grunting apnoea floppiness
what is the management for meconium aspiration?
suction below cord
airways support - intubation and ventilation
fluids (IV)
antibiotics (IV)
surfactant
nitric oxide or ECMO (extracorporeal membrane oxygenation)
what is a possible complication of meconium aspiration?
persistent pulmonary hypertension of the newborn
a baby is taken into the A and E who is blue at the lips.
what investigations would you carry out?
Hx and examination sepsis screen blood gas and blood glucose CXR pulse oximetry ECG echo
a neonate is admitted to the NNU with hypoglycaemia. what management would you give?
start IV 10% glucose
fluids
glucagon
hydrocortisone
how is neonatal jaundice managed?
phototherapy
if severe - exchange transfusion
what are causes of birth asphyxia?
placental problem long, difficult delivery umbilical cord prolapse infection neonatal airway problem neonatal anaemia
what are the 2 stages of birth asphyxia?
1st;
- within minutes without oxygen
- cell damage occurs with lack of blood flow and oxygen
2nd;
- re-perfusion injury
- can last days/weeks
- toxins are release from damaged cells
list causes of a neonate unable to pass stool.
constipation large bwoel atresia imperforate anus +/- fistula hirschsprungs disease meconium ileus (think cystic fibrosis)
what side is a diaphragmatic hernia most common?
left (90%)
how is a diaphragmatic hernia in a newborn managed?
intubation at birth
respiratory support
ECMO
surgery
in what gender is a diaphragmatic hernia most common?
boys > girls
what score is used to monitor neonatal abstinence syndrome?
Finnegan scores
how is neonatal abstinence syndrome managed?
comfort e.g. swaddling
morphine
phenobarbitone - if morphine not sufficient or substance wasn’t opioid
a mother who is a known alcoholic gives birth to a baby boy.
how would you assess if the baby has neonatal abstinence syndrome?
urine toxicology
what developmental abnormality is associated with diaphragmatic hernia in neonates?
pulmonary hypoplasia
what are differential diagnoses of the ‘blue baby’ ?
truncus arteriosus Transportation of the great arteries tricuspid atresia tetralogy of fallot total anomalous pulmonary venous drainage
what is the presentation of hypoxic ischaemic encephalopathy ?
floppy decreased / absent primitive reflexes seizures altered consciousness acidosis
what is the management for hypoxic ischaemic encephalopathy?
therapeutic hypothermia supportive; - respiratory - cardiac - seizures fluid restriction monitor renal and liver failure
what puts a newborn at greater risk for GI atresia’s?
polyhydramnios in utero
