Recognising Sick Babies

Question 1

What are the risk factors for meconium aspiration syndrome?

Answer 1

• Term and post-term

- Hypoxia in labour

Question 2

How should meconium aspiration be managed?

Answer 2

• Take care with resuscitation
• Suction under direct supervision only
• If crying and breathing, observe for RDS symptoms over 12 hours

Question 3

What may cause grunting?

Answer 3

• TTN
• Hypothermia
• Sepsis

Question 4

What may cause nasal flaring and recessions?

Answer 4

• TTN and RDS

- Obstructed airway

Question 5

What may cause tachypnoea?

Answer 5

• TTN and RDS
• Pneumonia
• Congenital heart disease
• Metabolic acidosis

Question 6

What is TTN?

Answer 6

• Transient Tachypnoea of the Newborn

- ‘Wet lungs’ usually following a CS

Question 7

What are the symptoms of TTN?

Answer 7

• Rapid, difficult breathing
• Grunting
• Nasal flaring
• Recessions
• Cyanosis

Question 8

What is the management for TTN?

Answer 8

• Infection screen to exclude pneumonia
• ?Antibiotic therapy
• Usually resolves itself

Question 9

What is RDS?

Answer 9

• Respiratory Distress Syndrome

- Lack of endogenous surfactant so lungs struggle to inflate

Question 10

What are the risk factors for RDS?

Answer 10

• Prematurity
• Babies delivered by CS
• Monozygotic twins
• Hypoxia
• Infants of diabetic mothers

Question 11

What is the treatment for RDS?

Answer 11

• Antenatal corticosteroids
• Artificial surfactant given to babies at risk (or routinely at <28/40)
• Oxygen with ventilation if needed

Question 12

How is artificial surfactant administered?

Answer 12

• Injected into lungs using endotracheal tube

- Made from pig fat - discuss with Muslims/ Jews/ Vegans (may accept as not being ingested)

Question 13

What are the symptoms of RDS?

Answer 13

• Recessions
• Grunting
• Tachypnoea/ Apnoea
• Nasal flaring
• Cyanosis

Question 14

What does an unusual colour indicate?

Answer 14

• Cyanosis with breathing (congenital heart problems)
• Cyanosis and apnoea (investigate cause)
• Grey (shocked and very sick babies)
• Jaundice (suspect infection if pathological)

Question 15

What is mild hypothermia?

Answer 15

36.0-36.4

skin to skin, hat, feeding, obs x 2

Question 16

What is moderate hypothermia?

Answer 16

32.0-35.9

warming, feeding, BMs, paed referral

Question 17

What is severe hypothermia?

Answer 17

<32.0

Neonatal emergency

Question 18

What are some possible causes of hypotonia?

Answer 18

• Prematurity
• Down’s syndrome
• Cerebral injury
• Hypoglycaemia
• Infection
• Maternal drugs
• Congenital conditions

Question 19

If the baby is persistently crying, what may this indicate?

Answer 19

• Can be normal
• Hunger
• Wind/colic
• Pain??

Question 20

What other symptoms will present if the baby is in pain?

Answer 20

• Grimace
• Avoidance of moving
• Cries when disturbed/ handled

Question 21

If the baby has a high-pitched cry, what may this indicate?

Answer 21

• Hypoglycaemia
• Mild encephalopathy
• Cri du Chat

Question 22

What are some causes of neonatal seizures/fits?

Answer 22

• Encephalopathy
• Haemorrhage or oedema
• Infection
• Errors of metabolism
• Drug withdrawal
• Toxins

Question 23

Name some anti-convulsants

Answer 23

• Phenobarbital
• Clonazepam
• Diazepam
• Phenytoin

Question 24

What is HIE?

Answer 24

• Hypoxic-Ischaemic Encephalopathy
• Brain injury caused by lack of oxygen
• Mild (grade 1), Moderate (grade 2) or Severe (grade 3)

Question 25

What is encephalopathy?

Answer 25

Functioning of the brain is affected by an agent or condition (e.g. toxins, infections)

Question 26

How is HIE treated?

Answer 26

Therapeutic hypothermia (cool to 33-35 for max. 72 hrs)