Recognising the Sick Neonate Flashcards
What should be routinely be assessed on a baby?
- ABC
- Colour and temp
- Behaviour
- Vomiting/ Elimination
- Feeding
- Physical signs (skin)
What is the most common cause of Meconium Aspiration Syndrome?
Stress
What is the difference in care for babies that are breathing/not breathing after MAS?
Breathing = observe for signs of RDS over next 12 hours (mec obs)
Not breathing = Check for meconium, suction under direct supervision
What are the most common causes of grunting?
- Hypothermia
- Septicaemia
What are the most common causes of nasal flaring and recessions?
- TTN
- RDS
- Obstructed airway
What are the most common causes of tachypnoea?
- TTN
- RDS
- Pneumonia
- Congenital heart disease
- Metabolic acidosis
What is TTN?
Transient Tachypnoea of the Newborn
What is RDS?
Respiratory Distress Syndrome
What are the symptoms of TTN?
- ‘Wet lungs’
- Rapid, difficult breathing
- Grunting
- Cyanosis
What causes ‘wet lungs’?
Most common in a CS because the fluid is not forced out of the lungs like it would be in a SVD
What is the management for a baby with TTN?
- Refer to paed
- Infection screen to exclude pneumonia
- X-ray to exclude other problems
- Antibiotic therapy?
- NNU
- Usually resolves itself
What causes RDS?
Deficiency of surfactant
What factors increase the risk of RDS?
- Preterm
- Perinatal hypoxia
- Infants of diabetic mothers
- Pre-labour LSCS
What factors decrease the risk of RDS?
- Stress in utero and narcotic addiction
- Steroids to mothers at risk of pre-term delivery
What are the signs of RDS?
- Tachpnoea/ increased RR
- Grunting
- Nasal flaring
- Sternal/ intercostal recessions
- Peripheral/ central cyanosis
What is the treatment for RDS?
- Surfactant via ET tube
- Oxygen with ventilation if needed
- Maintain temperature
- Biochemical balance
- Nutrition
- NICU
What does cyanosis when breathing indicate?
Congenital heart problems
What does cyanosis with apnoea indicate?
Investigate cause
What does grey colouring indicate?
Shocked and very sick babies
What does Jaundice indicate?
Infection if pathological
What is mild Hypothermia?
- 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
What is moderate Hypothermia?
- 32.0-35.9
- Follow trust policy for warming and feeding
- Check blood sugar level
- Paediatric referral
What is severe Hypothermia?
- <32.0
- Paediatric emergency
What may contribute to sickness in Hypothermic babies?
- Sepsis
- Underfeeding/ Hypoglycaemia
- Intercranial bleeding
- Baby must be warmed slowly if true Hypothermia
What are some concerning behaviours of a baby?
- Hypotonia (floppy)
- Hypertonia (tense) and clenched fists
- Not moving when awake
- Persistent failure to attach to breast
- Persistent head retraction
What are the common causes of Hypotonia?
- Down’s syndrome
- Cerebral injury
- Hypoglycaemia/ Hyponatraemia
- Infection
- Maternal drugs crossing the placenta
- Congenital conditions
What is Hyponatraemia?
Decreased sodium concentration
When is Hypotonia expected?
In babies <34/40
What should be considered if a baby consistently cries?
- Hunger
- Wind/colic
- Important to understand that some babies do cry alot
What are some signs that a baby is in pain?
- Grimace
- Avoidance of moving
- Cries when disturbed/ handled
What should be considered if a baby has a shrill, high-pitched cry?
- Mild encephalopathy
- Cri du Chat (chromosomal condition)
What eye movements are abnormal?
Eye rolling or crossing
Describe neonatal fits
- Brief jerking/ twitching of a single limb
- Sometimes very rapid
- Momentary changes in respiration, eye movement, drooling or lip smacking
What are some common causes of neonatal fits?
- Encephalopathy
- Cerebral haemorrhage/ oedema from trauma
- Infection
- Metabolic disorders
- Structural abnormalities in the brain
- Drug withdrawal
- Toxins
Give 4 examples of anti-convulsants
- Phenobarbital
- Clonazepam
- Diazepam
- Phenytoin
What are 2 common neurological problems?
- Intracranial haemorrhage - resulting from birth injury/ perinatal asphyxia (subdural, intraventricular, subarachnoid)
- Hypoxic-Ischaemic Encephalopathy syndrome - graded into mild (grade 1), moderate (grade 2) and severe (grade 3)
What is therapeutic Hypothermia and why is it used?
- Protects brain following severe perinatal asphyxia
- Cool within 6 hours of birth to 33-35 for 72 hrs and then warm up slowly
What should be considered if a baby does not demand feeds?
- Affected by maternal medication/ drugs?
- Jaundice
What should be considered if a baby is too tired to suck?
- Preterm?
- Prolonged crying or disturbance?
- Underfed or sick?
What are the signs of dehydration?
- Dry mouth
- Dry, wrinkled, inelastic skin
- Little darker urine and infrequent stools
- Sunken fontanelle and eyes
- Tachycardia, hypotension and greyish pallor
- Excessive weight loss
When is vomiting common and why?
In 1st 2 weeks due to posseting, oesophageal reflux or swallowed blood at birth
What is posseting?
Bringing up milk after a feed
When should a baby be referred for vomiting?
- Persistent
- Not keeping down any milk
- Contains bile (obstruction or cerebral problem)
- Combined with diarrhoea (gastroenteritis)
What are the obvious signs of infection?
- Eyes
- Paronychia
- Mastitis
- Rashes
- Umbilical
- Thrush
- Cuts/ abrasions
- Unpleasant smell
What is Paronychia?
Infection under the nails
When should a woman be screened for Group B Strep?
- Prev. baby with GBS
- Discovery of GBS through bacteriology investigation during pregnancy
- Preterm birth
- Prolonged ROM
- Suspected maternal infection
- Pyrexia
What does IAP stand for?
Intrapartum Antibiotic Prophylaxis
When should IAP be given for GBS?
- Prev. GBS pregnancy
- Current GBS pregnancy
- Pyrexia in labour
What IAP is used for GBS?
3g Benzylpenicillin at beginning of labour and then 1.5g Benzylpenicillin every 4 hrs
