neonatology Flashcards
how does a neonate present with sepsis?
Baby pyrexia or hypothermia Poor feeding Lethargy or irritable Early jaundice Tachypnoea Hypo or hyperglycaemia Floppy Asymptomatic
RF for a baby to present with Sepsis?
PROM
Maternal pyrexia
Maternal GBS carriage
management of presumed sepsis in neonate?
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
commonest causes of neonatal sepsis
group B strep e.coli Listeria Coat-neg staphylococci (I lines in situ) Haemophilus influenzae
group b strep sepsis?
how does it present?
Early onset – birth to 1 week
Late onset or recurrence – up to 3 months
Symptoms – may be non specific
May have no risk factors
ccx of group b strep sepsis?
Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock
what is done in TORCH screen? screen for congenital infection (infection acquired in the uterus by baby from mum)
(T)oxoplasmosis, (O)ther Agents, (R)ubella (C)ytomegalovirus (H)erpes Simplex.
what can TORCH result in>
Intrauterine growth restriction (IUGR), brain calcifications, neurodevelopmental delay, visual impairment, recurrent infections
signs u can see in congenital infection in a baby?
blueberry muffins rash- purple papullary rash–Rubella
microcephalous deafness heart defects\splenomegaly bone abnormalities rash intrauterine growth restriction anaemia neutropenia thrombocytopenia hepatomegaly\jaundiced hepatitis pneumitis cataracts microphthalmia retinites intracerbral calcification hydrocephalus
commonest reason for NUU admission
Resp distress (RDS)
causes of RDS?
Sepsis
TTN – transient tachypnoea of the newborn
Meconium aspiration
what is TTN?
symtoms?
pathophysiology?
Management?
Self limiting and common
Presents within 1st few hours of life
Grunting,
tachypnoea,
oxygen requirement, normal gases
Pathophysiology
Delay in clearance of foetal lung fluids
management: Supportive, antibiotics, fluids, O2, airway support
What is meconium aspiration?
Meconium is inhaled into the lungs
sx of meconium aspiration
Cyanosis, Increased work of breathing, grunting, apnoea, floppiness
RF for meconium aspiration
Post dates,
maternal diabetes,
maternal hypertension,
difficult labour
ix for meconium
Blood gas, septic screen, CXR
how does TTN present on Xray?
- fluid in horizontal fissure
- wet lung
- prominent vascular marking
Treatment of Meconium aspiration?
suction below cords
airway support- intubation and ventilation
fluids and abx
surfactant
NO or ECMO
Prognosis of meconium aspiration?
Most do well
some develop PPHN
there is associated mortality
most likely causes of the ‘blue baby’ medical emergency
sepsis and respiratory causes more common than cardiac
Investigation of the “blue baby”
Examination and history Sepsis screen Blood gas and blood glucose CXR Pulse oximetry ECG Echo (hyperoxia test)
what are the cardiac ddx for the blue baby?
TGA Tetralogy of Fallots TAPVD Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia
what are the 5ts for cyanotic congenital cardiac disease (can cause blue baby)
Truncus Arteriosus TGA Tricuspid Atresia ToF TAPVD
Hypoglycaemia RF?
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
what do if baby is hypothermia
If unable to maintain temperature on PNW admit and place in incubator
Sepsis screen and antibiotics
Consider checking thyroid function
Monitor blood glucose
jaundiced baby management?
In severe jaundice may require admission for intensive phototherapy and/or exchange transfusion
Incubator and IV fluids may be required
what is birth asphyxia?
Lack of oxygen at or around birth leads to multiorgan dysfunction
what can cause birth asphyxia?
Placental problem Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia
what are the 2 stages of asphyxia?
1st: Within minutes
Cell damage occurs with lack of blood flow and O2
2nd:
Reperfusion injury
Can last days or week.
Toxins are released from damaged cells
management of birth asphyxia?
Cardiac support
Fluid restriction (avoid cerebral oedema)
Monitor for renal and liver failure
Respiratory support
Treat seizures
neonatal surgical problems?
Oesphageal atresia/fistula Duodenal atresia and other GI atresias Causes of failure to pass stool Abdominal wall defects Diaphragmatic hernia
causes of failure to pass stool?
Large bowel atresia
Imperforate anus
+/- fistula
Hirschsprungs disease
Meconium plug
Meconium ileus
think cystic fibrosis
Diaphragmatic hernia features?
1 in 2500 births 90% on left Male > female Can be syndromic Usually pulmonary hypoplasia Intubation at birth Respiratory support Surgery (ECMO)
what is Neonatal Abstinence Syndrome (NAS)
Withdrawal from physically addictive substances taken by the mother in pregnancy Opioids (methadone, heroin) Benzodiazepines Cocaine Amphetamines
how to monte/diagnose NAS?
Finnegan Scores
Urine toxicology
treatment for NAS?
Comfort (e.g. swaddling)
Morphine
Phenobarbitone
ccc of birth asphyxia>
Hypoxic-ischemic encephalopathy
cooling improves outcomes
RR>60 or signs of respiratory distress are a common reason for admission- causes can be mild (TTN) or severe (MAS, sepsis)
.
