Sick Neonatal Infants Flashcards
Name some causes of death of neonates…
Pneumonia Prematurity Birth asphyxia and birth trauma Neonatal sepsis Congential anomalies Neonatal tetnus Other conditions Diarrhoes
What maternal history do we want to gain from a sick baby?
PMH
Pregancy issues
Drugs
Infection risks
What foetal history do we want to to get for a sick baby?
Foetal growth
Foetal anomalies
Delivery
Resuscitation?
What do we look for when inspecting a sick baby?
Tone Level of arousal Colour Heart Rate Perfusion Respiratory rate Work of breathing Saturation Jaundice? Seizures? Poor feeding? Bilious vomit?
What is the initial management of a sick baby?
T - temperature
A - airway - head in neutral position; airway obstruction
B - breathing
C - circulation - fluids?
Metabolic homeostasis - glucose management; acid-base balance
Antibiotics - sepsis is always a differential in an unwell baby
What factors can cause babies to get sick?
Pregnancy/birth related
Congenital anomalies
Infection
Metabolic
How does sepsis present?
NON-SPECIFIC
What are common sites of neonatal infection?
Blood stream - bacteraemia/septicaemia CNS - meningitis Respiratory - pneumonia GI - UTI; necrotising enterocolitis Skin Bone
What antibiotic should be given to the infected baby?
BENZYLPENICILLIN
GENTAMICIN
What are the common bacterial pathogens in an infected baby?
GBS
E. Coli
Staph Aureus
Staph Epidermidis
What are the common viral pathogens in neonates?
Cytomegalovirus
Parovirus
Herpes virus
Enteroviruses
What is the cause of transient tachypnoea of the newborn?
Due to delay in clearing lung fluid - most common in caesarean section.
Normally adrenaline causes the interstitial tissue in the lungs to absorb this fluid through Na channels.
What may cause a pneumothorax in the neonate?
Spontaneous
Secondary to - resuscitation; infection; meconium; surfactant deficiency
What is the x-ray appearance of respiratory distress syndrome?
Ground glass appearance
What is meconium aspiration syndrome?
When a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery
What is hypoxic ischaemic encephalopathy?
Multi organ damage due to tissue hypoxia - therapeutic hypothermia is neuroprotective
When does congential heart disease present in the neonate?
A few days after birth
What are causes of hydrops foetalis (heart failure in utero)?
Rhesus disease
Chromosomal abnormalities
Idiopathic
What is persistent pulmonary hypertension of the newborn?
High pulmonary pressure prevents blood from going to the lungs
What are the causes of PPHN?
Prolonged illness
Meconium Aspiration
Diaphragmatic Hernia
What do we use to treat PPHN?
Nitric Oxide - reduces pulmonary pressure
ECMO if case is severe
What are presentations of congenital heart disease?
Tachypnoea - without respiratory distress Cyanosis - may not be responsive to O2 Murmur - not same as PDA Weak femoral pulses Circulatory collapse
When would circulatory collapse become apparent in the neonate?
Once the PDA has closed; there is no route for the blood to flow therefore causing circulatory collapse
What are examples of CHD?
Tetralogy of fallot Transposition of great arteries Coarctation of the aorta Total anomalous pulmonary venous drainage Hypoplastic heart
What are the conditions in tetralogy of fallot?
Ventricular Septal Defect
Overriding Aorta
Right Ventricular Hypertrophy
Pulmonary Stenosis
What are congential respiratory conditions?
Tracheo-oesophageal fistula - commonly occurs with oesophageal atresia
Diaphragmatic hernia
What can describe the term ‘floppy baby’?
Rag doll like
What areas may be affected to cause floppiness?
Cortex Spinal cord Anterior horn cells/motor neurons Neuromuscular junction Muscles
