Neonatology (Physiology, prematurity, Common postnatal, term admissions to NNU) Flashcards
what are the Categories of term admissions?
Most term admission would fall into one of these categories
always consider sepsis as a diagnosis
what are the signs and symptoms?
Symptoms and signs are very non-specific:
Baby pyrexia or hypothermia
Poor feeding
Lethargy or irritable
Early jaundice (first 24 hours of life)
Tachypnoea
Hypo or hyperglycaemia
Floppy
Asymptomatic
what are the risk factors for sepsis?
PROM - prolonged rupture of membranes – mothers water broken for over 24 hours before deliver baby – important as potential route for ascending infection
Maternal pyrexia - Mother has a fever around time of delivery
Maternal GBS (group B step) carriage
If baby has 2 risk factors then they get blood tests to make sure there is no signs of infection
what is the management of presumed sepsis?
Admit NNU
Partial septic screen (FBC, CRP, blood cultures) and blood gas
Consider CXR, LP (Babies can have pneumonia or meningitis so may consider CXR or 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?
Infection can be acquired trans placentally (in untero), intrapartum so around time of delivery, or post partum from bacteria in environment
GBS is the commonest cause followed by E. coli of early sepsis
Listeria no longer 3rd commonest cause
what are the clinical features of GBS sepsis?
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
Congenital infection: the causes can be seen below
what may it result in?
•IUGR, brain calcifications, neurodevelopmental delay, visual impairment, recurrent infections
what are the signs and symptoms of a neomate with a congenital ifnection?
Respiratory distress is one of the commonest reasons for admission to NNU
what are the causes?
Sepsis
TTN – transient tachypnoea of the newborn
Meconium aspiration
what is TTN? (Transient tachypnoea of new-born)
Babies with TTN have extra fluid in their lungs or the fluid leaves too slowly. So they must breathe faster and harder to get enough oxygen into the lungs
Self limiting and common
Presents within 1st few hours of life
Pathophysiology - Delay in clearance of foetal lung fluids
how does TTN present and how is it managed?
Clinically - Grunting, tachypnoea, oxygen requirement, normal gases
Management - Supportive, antibiotics (Give antibiotics until exclude more serious conditions like sepsis), fluids, O2, airway support
what is Meconium aspiration?
•Meconium is inhaled into the lungs
Meconium aspiration syndrome occurs when stress (such as infection or low oxygen levels) causes the fetus to take forceful gasps, so that the amniotic fluid containing meconium is breathed (aspirated) in and deposited into the lungs
what are the risk factors for Meconium aspiration??
•Post dates, maternal diabetes, maternal hypertension, difficult labour
what are the symptoms of Meconium aspiration??
•Cyanosis, increased work of breathing, grunting, apnoea, floppiness
what investigations for Meconium aspiration??
•Blood gas, septic screen, CXR
CXR - Flattened diaphragm and over inflation of chest
what is the treatment and prognosis of meconium aspiration?
May Need to suck it out
Meconium reduces natural surfactant in the lungs so we sometimes need to give it
Most unwell babies may need NO (pulmonary vasal dilator)
what cardiac issues may you see in newborns?
- Most cardiac murmurs of no consequence and don’t need admission to NNU
- The “blue baby” – needs urgent treatment
- Remember sepsis and respiratory causes more common than cardiac
what investigaiotns are done for a blue baby?
Consider respiratory causes
Hyperoxia – differentiate between lung and liver disease
what are the differentia cardiac causes for a blue baby?
how should hyoglycaemia be managed?
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
babies are susceptible to drop their temperature at birth
how should hpyothermia be managed?
if babies have low temp then they have to use up their glygogen stores to maintian heat and this makes them more susceptible to hypoglycaemia
Birth asphyxia - what is it and what causes it?
•Lack of oxygen at or around birth leads to multiorgan dysfunction
Causes: Placental problem, Long difficult delivery, Umbilical cord prolapse, Infection, Neonatal airway problem, Neonatal anaemia
Stages of birth asphyxia - there are 2 stages, what are they?
reperfusion - the tissue damage caused when blood supply returns to tissue after a period of ischemia or lack of oxygen
what is Hypoxic Ischaemic encephalopathy and how should it be treated?
Pattern of brain injury that occurs secondary to birth asphyxia
the brain injury caused by oxygen deprivation to the brain, also commonly known as intrapartum asphyxia. The newborn’s body can compensate for brief periods of depleted oxygen, but if the asphyxia lasts too long, brain tissue is destroyed
what are different surgical problems that may occur in newborns?
what are causes of failure to pass stool?
Large bowel atresia
Imperforate anus +/- fistula
Hirschsprungs disease
Meconium plug
Meconium ileus - think cystic fibrosis
what are the 2 common abdominal wall defects?
Exomphalos - a weakness of the baby’s abdominal wall where the umbilical cord joins it. This weakness allows the abdominal contents, mainly the bowel and the liver to protrude outside the abdominal cavity where they are contained in a loose sac that surrounds the umbilical cord
Gastroschisis - a birth defect of the abdominal (belly) wall. The baby’s intestines are found outside of the baby’s body, exiting through a hole beside the belly button. The hole can be small or large and sometimes other organs, such as the stomach and liver, can also be found outside of the baby’s body
what is Diaphragmatic hernia, who does it occur in and how is it managed?
Bowel contents herniates up into the chest and cause problem with lung development
a birth defect where there is a hole in the diaphragm, organs in the abdomen can move through the hole in the diaphragm and upwards into a baby’s chest
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
Maternal co-morbidity (smoking, alcohol, BBV, ill health)
Social & discharge planning
Neonatal Abstinence Syndrome (NAS) - how is the diagnosis made and what is the treatment?
Monitoring/Diagnosis:
- Finnegan Scores
- Urine toxicology
Treatment:
- Comfort (e.g. swaddling)
- Morphine
- Phenobarbitone
take home messages:
Never forget _______ in an unwell neonate
Start antibiotics within _ hour
RR>60 or signs of respiratory distress are a common reason for admission- causes can be mild (TTN) or severe (MAS, sepsis)
A blue baby may have _______ congenital heart disease
Birth asphyxia can lead to ___- early management and cooling improves outcomes
sepsis
1
cyanotic
HIE
