Sick Newborns

Question 1

Why do they get subcostal recession?

Answer 1

increased elasticity of the chest can cause breathing into the spine

Question 2

What does grunting signifiy?

Answer 2

Breathing against a closed glottis

Question 3

What does billious vomiting signify?

Answer 3

green - shows bowel obstruction

Question 4

What is done for hypoxic brain injury?

Answer 4

cool cap to prevent neurodevelopmental disorder in the future

Question 5

What bacterial infections are children at risk of?

Answer 5

group B strep, e.coli, listeria, staph A and staph epi

Question 6

What viral infections are children most at risk of?

Answer 6

HIV, Hep, parovirus, herpes, enteroviruses

Question 7

What causes transient tachyopnoea of the newborn?

Answer 7

TTN = incomplete expulsion of the fluid from the lung mainly due to CS. Should resolve within 24hr-72 hrs

Question 8

What are the signs of TTN?

Answer 8

hyperinflation of the lungs with perfusion on CXR, diaphragmatic flattening

Question 9

What is hydrops foetalis?

Answer 9

presence of fluid where it shouldnt be e.g. ascites, pericardial, pleural effusion

Question 10

What is hydrops foetalis associated with?

Answer 10

Rhesus

Question 11

What is potter’s disease?

Answer 11

This is when there is no development of the kidneys - therefore failure to produce amniotic fluid. There will be failed lung and alveoli development as well as musculature underdevelopment and contractures. This is not compatible with life

Question 12

What is hypoglycaemia of the newborn associated with?

Answer 12

decreased reserves (LBW or SGA)
Due to maternal disease = diabetes causing hyperinsulinaemia (foetal macrosomnia)

Question 13

in a pre-term baby is the need to heat higher or lower?

Answer 13

higher due to the increased SA:vol, decreased subcut fat, decreased mobility and decrease BMR

Question 14

What can be done to keep a preterm baby warm?

Answer 14

Place in plastic bag (still wet) and under a heater. can also incubate, heater mattress

Question 15

What is the difference between early and late sepsis?

Answer 15

Early = acquired before/during delivery
Late = acquired after delivery (community)

Question 16

What organisms may be causative in early sepsis?

Answer 16

GB strep, gram negatives

Question 17

What organisms may be causative in late sepsis?

Answer 17

staph epidermidis, gram negatives, staph aureus

Question 18

What are some factors that put a pre-term baby at risk of infection?

Answer 18

immature immune system, indwelling lines and ports and the intensive care environment in general

Question 19

What is NRDS?

Answer 19

neonatal respiratory distress syndrome - when there is deficiency of pulmonary surfactant in the lungs and the lungs themselves are immature - this is due to pre-term birth

Question 20

How common is NRDS?

Answer 20

Very - 75% of neonates born before 29 weeks and 10% of neonates born after 32 weeks

Question 21

How will NRDS present?

Answer 21

Grunting, cyanosis, intercostal recession, nasal flaring, tachypnoea

Question 22

When will NRDS present?

Answer 22

from start but will reach worst at 2-4 days

Question 23

How do you manage NRDS?

Answer 23

give maternal steroid if think will be pre-term, surfactant and ventilation

Question 24

What is patent ductus arteriosus?

Answer 24

this is when the ductus arteriosus (connecting the pulmonary artery and aorta) remains patent after birth - causing an decrease in the oxygenation of the blood.

Question 25

How will patent ductus arteriosus present?

Answer 25

asymptomatic in the early stages but will show increased work of breathing, poor weight gain and may have signs of congested heart failure

Question 26

What are the types of intraventricular haemorrhage?

Answer 26

1 and 2 = 20% will have neurodevelopmental delay, 10% mortality rate
3 and 4 = 80% will have neurodevelopmental delay, 50% mortality rate

Question 27

What is necrotising colitis?

Answer 27

When a portion of the bowel dies

Question 28

Wha does necrotising colitis present with?

Answer 28

poor feeding, bloating, vomiting bile and blood in stool