Neonatology Flashcards
symptoms of sepsis in neonates
Baby pyrexia or hypothermia Poor feeding Lethargy or irritable Early jaundice Tachypnoea Hypo or hyperglycaemia Floppy Asymptomatic
risk factors for neonatal sepsis (3)
PROM - membrane rupture
Maternal pyrexia
Maternal GBS carriage
management of presumed sepsis?
- Admit NNU
- (FBC, CRP, blood cultures) and blood gas
- CXR, LP
- fluid management to treat acidosis
- monitor vital signs
antibiotics for sepsis?
1st line?
2nd line?
- what do you add when there is abdominal concerns?
IV penicillin and gentamicin 1st line
- line IV vancomycin and gentamicin
metronidazole
most common organism causing sepsis?
Group B Streptococcus E. coli Listeria Coag-neg Staphylococci (if lines in situ) Haemophilus influenzae
GBS sepsis early onset vs late onset ?
complications (3)
Early onset – birth to 1 week
Late onset or recurrence – up to 3 months
- Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock
congenital infection - TORCH screen
Toxoplasmosis Other (rubella, chicken pox, syphilis) Rubella (MMR virus) Cytomegalovirus HSV - acyclovir
congenital infection may result in (presentation) ?
IUGR (growth restriction), brain calcifications, neuro development delay, visual impairment, recurrent infections
rubella rash?
purple papular nodule rash
blue berry muffin rash
signs of respiratory distress?
- most common cause?
Grunting - expiring against partially close epiglottis! ,
- tachypnoea, oxygen requirement, normal gases
- subcostal recessions!
- TTN - Delay in clearance of foetal lung fluids
- can also be caused from caesarian sections
Management of TTN?
Supportive, antibiotics, fluids, O2, airway support
- usually settles
signs in TTN - child XR
WET lungs- fluid in horizontal fisher
Meconium aspiration
fist stool passed by newborn - caused by stress during labour
- inhaled into lungs
- increased risk of pneumothorax, chemical pneumonitis
- reduces surfactant, chest infections
risk factors for Meconium aspiration
Post term dates, maternal diabetes, maternal hypertension, difficult labour
symptoms of Meconium aspiration
Cyanosis, increased work of breathing, grunting, apnoea, floppiness
Investigations of Meconium aspiration?
Blood gas, septic screen, CXR
CXR signs of Meconium aspiration?
- flattened diaphragm - hyperinflation of the chest
- patchy areas of collapse
treatment of Meconium aspiration?
endotracheal tube - suction below cords
- airway support - ventilation and intubation
- fluids and anti b’s IV
- surfactant
- NO or ECmO
some babies with Meconium aspiration GO ON TO DEVELOP?
PPHN
- right to left shunt across PFO/PDA
Investigation of the “blue baby” (8)
Examination and history Sepsis screen Blood gas and blood glucose CXR Pulse oximetry ECG Echo (hyperoxia test)
the 5 T’s of congenital heart disease
- the other 2?
truncus arteriosus TGA Tricuspid arteriosus TOF TAPVD
- Hypoplastic Left heart syndrome
- pul atresia
Hypoglycaemia - management?
- Monitor blood glucose
- Start iv 10% glucose
- Increase fluids
- Increase glucose concentration (central iv access)
- Glucagon
- Hydrocortisone
islet cell hyperplasia affects?
- babies from diabetic mothers
- blood glucose drops
Hypothermia - if babies are unable to maintain temperature, what are some of the reasons why?
hot cot-incubator
- sepsis screen and antibiotics
- congenital hypothyroidism
- monitor blood glucose
Birth asphyxia is what?
lack of oxygen at or around both - leads to multi organ dysfunction
Causes of Birth asphyxia? (6)
- Placental problem - abruption
- Long, difficult delivery
- Umbilical cord prolapse
- Infection
- Neonatal airway problem
- Neonatal anaemia
Stages of birth asphyxia - first
within minutes
cell damage occurs with lack of blood flow and O2
Stages of birth asphyxia - second
- Reperfusion injury
- Can last days or weeks
toxins are released from damaged cells
what brain injury occurs secondary to birth asphyxia?
Hypoxic Ischaemic encephalopathy
- cord blood gasses - blood gas after delovery
- low tone, reduced conscious levels, seizures
Management of Hypoxic Ischaemic encephalopathy
Therapeutic hypothermia - 33-34 - improves neuro outcome
- treat seizures
- fluid restriction
- monitor renal and liver failure
- resp support
- cardiovascular support
Surgical problems - give some examples? (5)
- Oesphageal atresia/fistula
- Duodenal atresia and other GI atresias - polyhydramunous
- Causes of failure to pass stool
- Abdominal wall defects
- Diaphragmatic hernia
causes of failure to pass stool in new borns?
- Large bowel atresia
- Imperforate anus
+/- fistula - Hirschsprungs disease
- Meconium plug
- Meconium ileus
think cystic fibrosis - CFDR- reduced sodium and water - thick meconium
congenital diaphragmatic hernia ?
- what sex is it more common in?
defect in diaphragm, bowel contents herniate up into the chest
- males
- 90% are on the left
congenital diaphragmatic hernia.. consequences?
- Usually pulmonary hypoplasia
- Intubation at birth
- mortality associated
Neonatal Abstinence Syndrome (NAS) - what are the most common substances?
Opioids (methadone, heroin)
Benzodiazepines
Cocaine
Amphetamines
Neonatal Abstinence Syndrome (NAS)- give some examples of material co-morbidity?
smoking, alcohol, BBV, ill health
Monitoring and Treatment of Neonatal Abstinence Syndrome (NAS)?
Finnegan scores
Urine toxicology
Comfort (e.g. swaddling)
Morphine - isolated opioid use
Phenobarbitone - polydrug abuse
What are some features of finnegans score?
CNS distrubance - high pitch cries
- sleeping problems
- tremor
- high tone
- AUTONOMIC
- temp instability
- yawning, sneezing, sweating
GI
- diarrhoea
First line treatment for neonatal seizure
Phenobarbitone
- CNS depressant
RR sign of resp rate?
> 60
