Paediatric and Neonatal Health

Question 1

What does an epidural contain?

Answer 1

Bupivacaine - LA
Fentanyl - opioid

Question 2

How is an epidural adminstered?

Answer 2

A needle is inserted into the epidural space around the spine, a catheter is then inserted, and the needle is removed. The catheter is stuck to the back with a clear plaster to allow monitoring of the site.

Question 3

What can epidurals cause?

Answer 3

Numbness from the infusion site down

Hypotension

Nausesa (opioid)

Loss of bladder control

Headache

Reduced pushing during birth

Risk of nerve damage

Question 4

How is hypotension from epidural treated?

Answer 4

IV fluids.
Ensure it is not mixed up with epidural.

Question 5

How is loss of bladder control due to epidural managed.

Answer 5

Catheter

Question 6

What is important to consider when mother with epidural experiences a headache?

Answer 6

Is it due to the epidural or a haemorrhage caused by strain and trauma.

Question 7

What can be used if the mother is struggling to push due to epidural?

Answer 7

Suction or forceps

Question 8

Why is giving an epidural via IV (or any incorrect route) a never event?

Answer 8

If an epidural is given intravenously, it would mean a local anaesthetic and high dose of opioid would go straight into the blood stream, which would cause extreme sedation and respiratory depression, and even death.

Question 9

What is done to prevent administration of epidurals via the incorrect route?

Answer 9

Epidurals bags are stored separately from IV bags in a locked cupboard.

Epidural bags are a different colour (usually bright yellow) instead of clear.

Epidural bags must state “for epidural use only”.

Epidural bags only connect to a certain epidural syringe/line.

The infusion is usually written on a separate epidural infusion chart to ensure no further pain relief is given

Question 10

What is given to all babies shortly after they are born and why?

Answer 10

Vitamin K injection to prevent haemorhagic disease of the newborn (HDN).

Question 11

What is HDN?

Answer 11

A rare but serious bleeding disorder which occurs due to babies’ low vitamin K stores which prevent production of vitamin K dependent clotting factors.

Question 12

What are some symptoms of HDN?

Answer 12

Spontaneous bleeding
Nose bleeds
Prolonged jaundice after 2 weeks
Pale stools
Dark urine

Question 13

What is the NHS vaccine/immunisation schedule?

Answer 13

8 weeks:
6-in1
Rotavirus
MenB

16 weeks:
6-in-1
MenB

1 year:
HiB/MenC
MMR
Pneumococal
MenB

2-11 years:
Live attenuated influenza vaccine (LAIV) or inactivated if in a clinical risk group.

3 years 4 months:
DTaP/IPV
MMR

12/13 years:
HPV

14 years:
Td/IPV
MenACWY

Question 14

What is included in the 6-in1 vaccine?

Answer 14

Diphtheria
Hepatitis B
Haemophilus influenza type B (HiB)
Polio
Tetanus
Whooping coufg

Question 15

What is included in the DtaP/IPV jab?

Answer 15

Diptheria
Tetanus
Pertussis
Polio

Question 16

What is included in the MMR jab?

Answer 16

Measles
Mumps
Rubella

Question 17

What are some points to make to a parent worried about vaccinating their child?

Answer 17

They protect the baby, and everyone around them , from dangerous diseases, and if enough people have them, it can eradicate them.

They undergo rigorous safety testing.

They don’t overload or weaken the immune system.

They don’t contain mercury or any ingredients that cause harm.

They don’t cause autism - this has been debunked, the paper was rescinded, and the doctor who made the claim can no longer practice.

Question 18

What can childhood immunisation cause?

Answer 18

Fever
Headache
Sore arm

Give paracetamol