Neonatology Flashcards
Sepsis evaluation and management
Initial response -Call for help -Assess vitals -Primary survey -Concurrent targeted hx -Bedside investigations -Empiric management ->secure airway + O2 ->gain IV access ->fluids +- pressors ->antibiotics Vitals (Red flags) -Fever (may be absent in neonate/immunosuppressed) -Tachycardia -Tachypnoea -Hypoxia -Hypotension (late sign) Primary survey (Red flags) -Altered level of consciousness -Cold shock = pale/cold/mottled skin + slow cap refill -Warm shock = flushed + bounding pulses + fast cap refill -Respiratory distress/grunting -Rash Hx -Delivery room status ->intrapartum tachycardia ->meconium staining ->low APGARs -Risk factors ->premature ->maternal GBS ->maternal fever ->prolonged rupture of membranes ->chorioamnionitis -Symptoms ->apnoeas ->irritability/lethargy ->poor feeding ->vomiting/diarrhoea -Review ->congenital abnormalities ->recent antibiotic use ->urine output (<1mL/kg/hr) Investigations -VBG ->glucose ->lactate >2 ->base excess < -5 -Blood cultures ->1 site is usually sufficient ->anaerobic bottle not needed ->at least 1mL/bottle -FBC ->neutropenia -Urea/creatinine -CRP -Coags ->coagulopathy -Group + hold -mobile CXR -Stabilised ->MSU ->lumbar puncture Management -Airway ->HFNP/CPAP/BiPAP + O2 ->intubate if unconscious -IV access ->10-20mL/kg bolus ->reassess and repeat up to 40mL/kg -Antibiotics ->under 2 months = ben pen + cefotaxime ->over 2 months = cefotaxime + flucloxacillin ->HSV skin lesions = aciclovir -Inotropes if fluids fail ->adrenaline infusion 0.1mcg/kg/min ->transfer to ICU
Jaundice evaluation and management
Hx
- Timing
- >onset before 2 days = haemolysis
- >onset after 3 days = pathological
- Duration ->physiological <2-3 weeks
- Symptoms
- >unwell
- >dark urine/pale stools
- >persistant vomiting
- ABE
- >lethargy to irritability
- >hypotonia to hypertonia
- >poor feeding
- >high pitched cry
- >apnoea/seizure/stupor
- Past
- >premature + delayed cord clamping
- >birth trauma
- >breast feeding/caloric intake
- >birth weight and growth
- Background
- >maternal blood group/viral serology
- >family hx of haemoglobinopathy
Exam
- Vitals
- >febrile
- >haemodynamically stable
- Weight/Length/HC -
Inspect
- >cephalocaudal progression
- >plethora
- >evidence of infection
- Abdo
- >tenderness
- >hepatosplenomegaly
- ABE
- >retrocollis
- >opisthotonus
Investigations
- Unwell
- >VBG
- >blood cultures
- >LP ->urinalysis
- >FBC
- >EUCs
- >LFTs
- >CRP
- Well
- >total bilirubin + conjugated/unconjugated split
- >FBC + differential + film + haemolysis markers
- >blood group + direct coombs
- >urine MCS
- >TFTs
- Conjugated >15% of total
- >septic screen
- >LFTs + hepatitis serology + alpha 1 antitrypsin level
- >abdo ultrasound
- Unconjugated
- >reducing substances
- >G6PD
Management
- Overall
- >seek help for anything but physiological
- >treat underlying cause
- Physiological
- >discharge
- >resolution within 10 days
- >do not seek excessive sunlight
- >maintain adequate hydration/breastfeeding
- >safety net dark urine/pale stools/unwell
- >GP follow up in 24/48 hrs + repeat bili if borderline
- Breast milk jaundice
- >trial ceasing/pumping for 24-48hrs if phototherapy
- >not indication for ceasing breastfeeding
- Photo-theraphy
- >total bilirubin >95th centile photo-therapy normogram
- >maintain hydration + monitor electrolytes
- Exchange transfusion
- >clinical evidence or total bili >95th for ET nomogram
- >adjuvant phototherapy
- >IvIg for isoimmune haemolytic disease
Failure to thrive evaluation and management
Hx
- Breast feeding
- >any difficulties
- >perception of supply/delivery
- >vomiting
- >are they settled when feeding
- >previous experience
- Formula feeding
- >dilution
- >volumes
- Solids
- >timing of introduction
- >meal times pleasant/unpleasant
- >describe feeding times to great detail
- Organic
- >infective symptoms
- >chronic disease
- >persistant diarrhoea/vomiting
- Past
- >antenatal complications
- >birth measurements
- >development
- Social
- >beliefs about food and weight
- >attachement
- >stressors
- >carer mental health
- >access to food and housing
Exam
- Growth
- >WHO <2/CDC >2
- >correct for prematurity until 24 months
- >weight + length/HC
- >consider velocity
- Appearance
- >dehydration
- >malnutrition (wasting/loss of fat stores)
- >signs of abuse
- >observe communication and attachment
- Systems review
- >murmur
- >wheeze/crepitations
- >rash
Investigations
- Consider
- >urinalysis
- >glucose
- >FBC
- >iron
- >EUCs
- >LFTs
- >CMP
- >TSH
- >coeliac screen
Management
- MDT
- >maternal child health nurse
- >GP
- >paediatrician
- >lactation consultant
- >dietician
- >psychologist
- >social worker
- Admit
- >dehydration
- >significant illness
- >abuse
- >extreme social circumstances
- Monitor
- >under 3 months = weekly weighs
- >older = less frequent (avoid fluctuations)
- Expected growth
- >0-3 months = 150g/week
- >3-6 months = 100g/week
- >6-12 months = 75g/week
