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Appreciating Complex Midwifery Care > Recognising the Sick Neonate > Flashcards

Recognising the Sick Neonate Flashcards

1
Q

What should be routinely be assessed on a baby?

A
  • ABC
  • Colour and temp
  • Behaviour
  • Vomiting/ Elimination
  • Feeding
  • Physical signs (skin)
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2
Q

What is the most common cause of Meconium Aspiration Syndrome?

A

Stress

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3
Q

What is the difference in care for babies that are breathing/not breathing after MAS?

A

Breathing = observe for signs of RDS over next 12 hours (mec obs)
Not breathing = Check for meconium, suction under direct supervision

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4
Q

What are the most common causes of grunting?

A
  • Hypothermia

- Septicaemia

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5
Q

What are the most common causes of nasal flaring and recessions?

A
  • TTN
  • RDS
  • Obstructed airway
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6
Q

What are the most common causes of tachypnoea?

A
  • TTN
  • RDS
  • Pneumonia
  • Congenital heart disease
  • Metabolic acidosis
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7
Q

What is TTN?

A

Transient Tachypnoea of the Newborn

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8
Q

What is RDS?

A

Respiratory Distress Syndrome

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9
Q

What are the symptoms of TTN?

A
  • ‘Wet lungs’
  • Rapid, difficult breathing
  • Grunting
  • Cyanosis
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10
Q

What causes ‘wet lungs’?

A

Most common in a CS because the fluid is not forced out of the lungs like it would be in a SVD

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11
Q

What is the management for a baby with TTN?

A
  • Refer to paed
  • Infection screen to exclude pneumonia
  • X-ray to exclude other problems
  • Antibiotic therapy?
  • NNU
  • Usually resolves itself
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12
Q

What causes RDS?

A

Deficiency of surfactant

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13
Q

What factors increase the risk of RDS?

A
  • Preterm
  • Perinatal hypoxia
  • Infants of diabetic mothers
  • Pre-labour LSCS
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14
Q

What factors decrease the risk of RDS?

A
  • Stress in utero and narcotic addiction

- Steroids to mothers at risk of pre-term delivery

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15
Q

What are the signs of RDS?

A
  • Tachpnoea/ increased RR
  • Grunting
  • Nasal flaring
  • Sternal/ intercostal recessions
  • Peripheral/ central cyanosis
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16
Q

What is the treatment for RDS?

A
  • Surfactant via ET tube
  • Oxygen with ventilation if needed
  • Maintain temperature
  • Biochemical balance
  • Nutrition
  • NICU
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17
Q

What does cyanosis when breathing indicate?

A

Congenital heart problems

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18
Q

What does cyanosis with apnoea indicate?

A

Investigate cause

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19
Q

What does grey colouring indicate?

A

Shocked and very sick babies

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20
Q

What does Jaundice indicate?

A

Infection if pathological

21
Q

What is mild Hypothermia?

A
  • 36.0-36.4
  • Skin to skin and hat
  • Ensure baby has fed
  • Full set of obs and repeat after 1 hr
  • Refer if worried
22
Q

What is moderate Hypothermia?

A
  • 32.0-35.9
  • Follow trust policy for warming and feeding
  • Check blood sugar level
  • Paediatric referral
23
Q

What is severe Hypothermia?

A
  • <32.0

- Paediatric emergency

24
Q

What may contribute to sickness in Hypothermic babies?

A
  • Sepsis
  • Underfeeding/ Hypoglycaemia
  • Intercranial bleeding
  • Baby must be warmed slowly if true Hypothermia
25
Q

What are some concerning behaviours of a baby?

A
  • Hypotonia (floppy)
  • Hypertonia (tense) and clenched fists
  • Not moving when awake
  • Persistent failure to attach to breast
  • Persistent head retraction
26
Q

What are the common causes of Hypotonia?

A
  • Down’s syndrome
  • Cerebral injury
  • Hypoglycaemia/ Hyponatraemia
  • Infection
  • Maternal drugs crossing the placenta
  • Congenital conditions
27
Q

What is Hyponatraemia?

A

Decreased sodium concentration

28
Q

When is Hypotonia expected?

A

In babies <34/40

29
Q

What should be considered if a baby consistently cries?

A
  • Hunger
  • Wind/colic
  • Important to understand that some babies do cry alot
30
Q

What are some signs that a baby is in pain?

A
  • Grimace
  • Avoidance of moving
  • Cries when disturbed/ handled
31
Q

What should be considered if a baby has a shrill, high-pitched cry?

A
  • Mild encephalopathy

- Cri du Chat (chromosomal condition)

32
Q

What eye movements are abnormal?

A

Eye rolling or crossing

33
Q

Describe neonatal fits

A
  • Brief jerking/ twitching of a single limb
  • Sometimes very rapid
  • Momentary changes in respiration, eye movement, drooling or lip smacking
34
Q

What are some common causes of neonatal fits?

A
  • Encephalopathy
  • Cerebral haemorrhage/ oedema from trauma
  • Infection
  • Metabolic disorders
  • Structural abnormalities in the brain
  • Drug withdrawal
  • Toxins
35
Q

Give 4 examples of anti-convulsants

A
  1. Phenobarbital
  2. Clonazepam
  3. Diazepam
  4. Phenytoin
36
Q

What are 2 common neurological problems?

A
  1. Intracranial haemorrhage - resulting from birth injury/ perinatal asphyxia (subdural, intraventricular, subarachnoid)
  2. Hypoxic-Ischaemic Encephalopathy syndrome - graded into mild (grade 1), moderate (grade 2) and severe (grade 3)
37
Q

What is therapeutic Hypothermia and why is it used?

A
  • Protects brain following severe perinatal asphyxia

- Cool within 6 hours of birth to 33-35 for 72 hrs and then warm up slowly

38
Q

What should be considered if a baby does not demand feeds?

A
  • Affected by maternal medication/ drugs?

- Jaundice

39
Q

What should be considered if a baby is too tired to suck?

A
  • Preterm?
  • Prolonged crying or disturbance?
  • Underfed or sick?
40
Q

What are the signs of dehydration?

A
  • Dry mouth
  • Dry, wrinkled, inelastic skin
  • Little darker urine and infrequent stools
  • Sunken fontanelle and eyes
  • Tachycardia, hypotension and greyish pallor
  • Excessive weight loss
41
Q

When is vomiting common and why?

A

In 1st 2 weeks due to posseting, oesophageal reflux or swallowed blood at birth

42
Q

What is posseting?

A

Bringing up milk after a feed

43
Q

When should a baby be referred for vomiting?

A
  • Persistent
  • Not keeping down any milk
  • Contains bile (obstruction or cerebral problem)
  • Combined with diarrhoea (gastroenteritis)
44
Q

What are the obvious signs of infection?

A
  • Eyes
  • Paronychia
  • Mastitis
  • Rashes
  • Umbilical
  • Thrush
  • Cuts/ abrasions
  • Unpleasant smell
45
Q

What is Paronychia?

A

Infection under the nails

46
Q

When should a woman be screened for Group B Strep?

A
  • Prev. baby with GBS
  • Discovery of GBS through bacteriology investigation during pregnancy
  • Preterm birth
  • Prolonged ROM
  • Suspected maternal infection
  • Pyrexia
47
Q

What does IAP stand for?

A

Intrapartum Antibiotic Prophylaxis

48
Q

When should IAP be given for GBS?

A
  • Prev. GBS pregnancy
  • Current GBS pregnancy
  • Pyrexia in labour
49
Q

What IAP is used for GBS?

A

3g Benzylpenicillin at beginning of labour and then 1.5g Benzylpenicillin every 4 hrs

Appreciating Complex Midwifery Care (14 decks)

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