Sick Infants Flashcards
What is the time period for classifying a new baby as a neonate?
Up to 28 days
What are the components of the APGAR score?
Appearance Pulse Grimace Activity Respirations
What is a normal APGAR score?
8 or 10
How is appearance scored on APGAR?
Blue or pale = 0
Blue in extremities = 1
No cyanosis = 2
How is pulse scored on APGAR?
Absent = 0
Less than 100 = 1
More than 100 = 2
How is grimace scored on APGAR?
No response = 0
Feeble cry when stimulated = 1
Cry or pull away when stimulated = 2
How is activity scored on APGAR?
No activity = 0
Some flexion = 1
Flexed arms and legs that resist extension = 2
How is respiration scored on APGAR?
No respiration = 0
Weak, irregular, gasping = 1
Strong cry = 2
What is a normal respiratory rate for a neonate?
40-60 breaths/min
What are the 4 main causes/groups of causes of a sick term infant?
Congenital abnormality
Metabolic disorder
Birth-related
Infection
List the main bacterial infections that affect neonates
Group B Strep. E. coli Listeria Staph. aureus Staph. epidermidis
List the main viral infections that affect neonates
Cytomegalovirus
Parovirus
Herpes virus
Enterovirus
What is hydrops foetalis?
Accumulation of fluid in at least 2 compartments (ascites, pleural effusion etc.)
When is a baby classed as preterm?
Born before 37 weeks gestation
When is a baby classed as post-term?
Born after 42 weeks gestation
List some risk factors for preterm birth
Smoking, alcohol, drugs Poor socioeconomic status/poverty Complications, maternal disease Twin pregnancy Teenage mother IVF conception
What are the physiological differences between a preterm and term infant?
Get colder quicker
Fragile lungs
Less effective breathing
Little reserve
The cord should be clamped immediately in a preterm baby. True/False?
False
Can wait a minute to allow placental transfusion if baby is OK and can be kept warm
How can a neonate be kept warm?
Wrap clothes
Plastic bag under a radiant heater
Skin-skin care
Prewarmed incubator
List the main medical concerns in a preterm infant
Hypothermia Sepsis Undernutrition Respiratory distress Patent ductus arteriosus Interventricular haemorrhage Necrotising enterocolitis
How does hypothermia lead to hypoxia?
Increased metabolism decreases O2 supply
How does hypothermia lead to hypoglycaemia?
Increased metabolism increases glucose uptake and usage of glycogen stores
How does hypothermia lead to respiratory distress?
Brown fat metabolism causes release of fatty acids which decreases surfactant production, requiring more work for breathing
For preterm infants, gestational correction is done for plotting growth charts. How is gestation corrected?
Number of weeks early = 40 weeks minus gestational age
What is the pathophysiology behind respiratory distress syndrome?
Surfactant deficiency causes alveolar collapse and decreased residual capacity, requiring more effort to breathe
List clinical features of respiratory distress syndrome in neonates
Tachypnoea Grunting Intercostal recession Nasal flaring Cyanosis
How is neonatal respiratory distress managed?
Steroid
Surfactant
Ventilation (invasive/non-invasive)
When does intraventricular haemorrhage occur typically in neonates?
First day of life
Insult is present by 72 hours
What is the most common neonatal surgical emergency?
Necrotising enterocolitis
List clinical features of necrotising enterocolitis
Lethargy
Gastric residue
Bloody stool
Sepsis
List long-term complications of premature birth
Neurodevelopmental dysfunction
Growth issues
Chronic medical conditions
