Paediatrics: neonatal jaundice and neonatal sepsis Flashcards
What does the APGAR score include?
What times is it taken?
APGAR scores taken at 1 and 5 mins. Than every 5 mins thereful until 20 mins have passed if score less than 7.
How to prevent GBS neonatal infection?
IV penicillin G 4 hours before delivery –> complete prophylaxis. Reduce early onset neonatal infection by 60-80%
What is the clinical presentation of early onset neonatal sepsis?
- Respiratory distress (pneumonia)
- Poor perfusion
- Apnoea and bradycardia
- Unstable temperature
- Altered consious state (lethargy/irritability)
- Poor feeding
SS of sepsis in neonate?
Perfusion
Color: pallor/ cyanosis
Chest: tachypnea, crepitations
CVS: tachycardia/bradycardia.
Abdomen: distension (ileus), enlarged liver and spleen
CNS: bulging anterior fontanelle
What is normal oxygen saturation in neonate?
SpO2>95% breathing in room air
Cyanosis when deoxyhaemoglobin >5g/dL: central cyanosis, peripheral cyanosis
What is neonatal sepsis workup?
- CBC: WBC (infection), platelets)
- CRP (requires 2 CRP measurements: as takes 12-24 hours for CRP to increase hence may be normal at 1st measurement): more sensitive than ESR
- Blood culture
- Urine culture
- CSF culture
At what level is lumbar puncture done for neonates?
What are the possible complications? specific to neonate?
Insert LP needle between vertebral bodies: L4-5/L3-4. Spinal cord ends at L1.
Possible complications
* Local trauma to spinal cord
* Bleeding –> haematoma
* Introduce infection
* Cardiopulmonary decompensation during position (specific to neonates who are non compliant and require assistance for positioning)
* Coning (herniation of brain to compress on brainstem) when there is increasde ICP –> unlikely in neonates
What pathogens should empirical antibiotics cover in neonatal sepsis?
organisms from mothers uro genital anal region
Gram+ve: GBS, other streptococcus
Gram-ve: e.coli, klebsieela
Rarely virus
Neonatal sepsis, blood culture shows gram positive cocci in chains, what is most likely pathogen?
GBS
Is GBS carrier state a contraindication to breastfeeding?
Babys body may be colonized and shared the flora with mother in return.
Chance that breastmilk may be colonized, but not necessarily cause infection.
No evidence to exclude breastfeeding for GBS mother.
Most common cause of jaundice in newborn?
Physiologic jaundice
* Immature liver function
* Breakdown of lots of haemoglobin
* Inadequate milk feeds –> increased enteroehepatic circulation
What are pathologic causes of neonatal jaundice?
- Haemolysis: ABO incompatibility (group O mother has naturally occuring anti A and anti B that can damage fetal cells of group A or group B), G6PD deficiency
- Polycythemia/bruises.haematoma
- Hepatic disorders e.g. bile duct obstruction
- Sepsis
- Dehydration
- Prematurity
- Endocrine disorders e.g. hypothyroidism
- Breastmilk jaundice
- Intestinal obstruction
Consequence of severe jaundice
Haemolysis –> unconjugated hyperbilirubinemia
Brain damage –> kernicterus
* Dystonic cerebral palsy
* Hearing loss
What is the history taking for NNJ?
- Gestation at birth, birth weight (preterm more prone to immature liver)
- Prenatal: GDM, IUGR, maternal blood group (hemolysis due to ABO incompatibility)
- Perinatal
- Postnatal
Mode of feeding, adequacy, feeding problem
G6PD screening result (hemolysis)
Systemic symptoms
Family history of severe NNJ/gallstone (haemolytic disorders causing pigment stones)/chronic anemia
Father thal status if mother is also thal positive
What is a noninvasive method for checking jaundice in neonate?
Transcutaneous bilirubinometer –> if high do blood test for total serum bilirubin.
