SICK NEWBORN

Question 1

Neonate

Answer 1

0 to 28 days of birth

Question 2

At birth all healthy newborns are active with a strong cry T/F

Answer 2

True

Question 3

Newborns with abnormal manifestations of one or more of the following signs are described as unwell
Or
Vital signs in a new born

Answer 3

Colour
Activity
Temperature
Respiration
Heart rate
Blood sugar
Urine output
Nature of bowel movements
Signs of distress (pain)

Question 4

Causes of a sick newborn

Answer 4

Birth asphyxia
Prematurity
Neonatal infections
Congenital malformations
Birth injury
Maternal sedation or analgesia during labour
Metabolic (hypoglycemia, hypocalcemia)

Question 5

Symptoms of a sick newborn

Answer 5

Weak cry or inability to cry
Difficulty breathing or recurrent apnoea
Reduced spontaneous movements or being very floppy
Refusal of feeds
Vomiting
Abdominal distension
Convulsions
Blood in stools
Reduced urine output

Question 6

Signs seen in a sick newborn

Answer 6

Raised temperature (>37.5 axillary
Low temperature (<36.5 axillary
Pallor
Cyanosis
Jaundice
Bradycardia (<100bpm
Tachycardia (>160pbm
Heart murmurs
Respiratory distress (>60bpm, chest indrawing
Respiratory rate <20bpm
Apnoea
Abdominal distention
Drowsiness or unconsciousness
Seizures
Tenderness on any part of the body

Question 7

Normal heart rate in neonates

Answer 7

100-160

Question 8

Investigations to be done in a sick newborn

Answer 8

FBC
RBS
BUE/Cr
Blood cultures
Urine culture
Swab of any lesions for culture and sensitivity
Chest X-ray
Plain abdominal X-ray, erect and supine
CSF biochemistry, culture and sensitivity

Question 9

Treatment objectives in a sick newborn

Answer 9

To diagnose and treat underlying cause
To identify and urgently correct hypoglycaemia
To prevent permanent organ damage

Question 10

Non-pharmacological interventions ina sick newborn

Answer 10

Establish airway, ensure breathing and adequate circulation (ABC)
Keep baby warm either wrapped in dry clothes or in an incubator

Question 11

Oxygen therapy in neonates

Answer 11

Oxygen by face mask or nasal prongs 1-2L/min if available, maintain saturation between 92-95%

Question 12

Maintenance fluid in the newborn

Answer 12

On day of delivery:
Dextrose 10%, IV, 2 drops/minute/kg (60 ml/kg/ day

After day 1:
Normal Saline 0.18% with Dextrose 10% (60-150 ml/kg/day

Question 13

Treatment for neonates having seizures

Answer 13

Phenobarbitone, IV/IM,
10 mg/kg stat. then 5 mg/kg 12 hourly

Question 14

Treatment regimen for sepsis (other than cord sepsis) in the newborn

Answer 14

Ampicillin, IM/IV
And
Gentamicin, IM/IV

or

Ampicillin, IM/IV,
And
Cefotaxime

Question 15

Ampicillin dose in neonates

Answer 15

Ampicillin, IM/IV,
Neonates
> 7 days of age; 50 mg/kg 8 hourly for 5-7 days
< 7 days of age; 50 mg/kg 12 hourly for 5-7 days

Question 16

Gentamicin dose in neonates

Answer 16

Gentamicin, IM/IV, 4 mg/kg daily for 7 days (irrespective of age after birth)

Question 17

Ceotaxime dose in neonates

Answer 17

Cefotaxime, IV, 25-50 mg/kg 8 hourly for 7 days (irrespective of age after birth)

Question 18

Antibiotic regimen for treatment of cord sepsis

Answer 18

Cloxacillin
and
Gentamicin

Question 19

Gentamicin dose for treatment of cord sepsis

Answer 19

Gentamicin, IM/IV, 4 mg/kg 24 hourly for 7 days (irrespective of age
after birth)

Question 20

Dose of metronidazole for bowel related sepsis in the neonate

Answer 20

Metronidazole, IV (over 20–30 minutes)
Neonate
> 34 weeks corrected gestational age; 15 mg/kg as a single loading
dose followed after 8 hours by 7.5 mg/kg every 8 hours
26-34 weeks corrected gestational age; 15 mg/kg as a single loading
dose followed after 12 hours by 7.5 mg/kg every 12 hours
< 26 weeks corrected gestational age; 15 mg/kg as a single loading dose followed after 24 hours by 7.5 mg/kg daily

Question 20

Dose of amipicillin for neonatal bowel related sepsis

Answer 20

Ampicillin, IM/IV,
Neonates
> 7 days of age; 50 mg/kg 8 hourly for 5-7 days
< 7 days of age; 50 mg/kg 12 hourly for 5-7 days

Question 20

Dose of gentamicin for neonatal bowel related sepsis

Answer 20

Gentamicin, IM/IV, 4 mg/kg daily for 7 days (irrespective of age after birth)