Sick term infant Flashcards
What are the criteria for an APGAR score and how many points per criteria?
- At what time intervals is Apgar performed?
- A normal score is what?
Heart rate- 2 Respiratory effort- 2 Tone- 2 colour- 2 Response- 2 Total- 10 i.e. Appearance, Pulse, Grimace, Activity, Respiration
- at 1 min, 5 mins and 10 mins after birth
- about 8/10
components of a newborn clinical assessment?
- Hx (2)
- inspection (3)
- vital signs (2)
-maternal: PMH, pre issues, drugs, infection risk
Infant: foetal growth, foetal anomaly, delivery, resuscitation
- tone, level of arousal, colour
- HR and Resp rate
State findings on examination of a newborn (8)
-state 3 ways newborns are physiologically different from adults
- Resp rate- 40-60/min + periodic breathing normal
- work of breathing- resp effort
- HR- 120-140 per min (worry if under 100)
- Cap refill 2-3s
- BP- unreliable, preserve BP till last minute
- Colour- pink/blue/white
- SaO2- 95%
- Other: jaundice, low tone, seizures, poor feeding, BILIOUS VOMIT
-have higher HR and Resp rate and lower BP
Describe initial management of the newborn (3)
Temperature
ABCDE
antibiotics (hard to determine sepsis in newborn)
+ remember to check blood glucose, common for babies to be hypo
Ongoing management of the newborn includes what 3 features?
diagnostic work-up
further: ventilation, drugs, specific therapy, surgery, transfer
care of the family
define the term neonate?
name the 4 major causes of neonatal illness?
-baby in the first 28 days if life
-Pregnancy/brith related
congenital abnormalities
metabolic
infection- big one
the 3 time points at which neonatal infection can occur & examples?
-name the 4 commonest sites of neonatal infection
-Antenatal e.g. mother had chickenpox
Perinatal e.g. group B strep picked up during delivery
postnatal e.g. common cold leading to bronchiolitis (+apnoea)
-Blood stream- bacteraemia/septicaemia CNS- meningitis resp- pneumonia GU-UTIs \+ GI (necrotising enterocolitis)
Presentation of neonatal meningitis?
Pre diagnosis management?
non-specifically unwell:
grumpy/raised temp/?raised fontanelle
LP, bloods, urine, give antibiotics
Name the 5 bacteria that most commonly effect neonates ad the features of these
Group B strep
-can present either early or late
early- first few hours, tend to have pneumonia
late- up to 3 months old, ned to have meningitis
E.coli
-tends to cause UTI
Listeria
-cover when giving antibiotics blind
Staph aureus
-abscesses
Staph epidermis
-might get sepsis, usually a commensal and caught due to iatrogenic intervention
Name the 4 main infecting viruses in neonates
- complications that occur from infection during pregnancy?
- name the viral screening used in neonates?
Cytomegalovirus Parvovirus Herpes viruses Enteroviruses \+HIV
-microcephaly, developmental delay, small for dates
-TORCH screening: toxoplasmosis other rubella cytomegalovirus herpes
what is hypoxic ischaemic encephalopathy?
- signs?
- prognosis?
multi organ damage due to issue hypoxia
-poor apgar score (need resus)
pale, floppy, fitting baby
-neurodevelopmental sequel, likely to suffer from cerebral palsy if low cord pH
Name the 2 common resp conditions in the newborn
- causes?
- investigation?
Transient tachypnoea of the newborn (TTN)
- occurs in big babies born by C-section, babies get stressed in delivery and reabsorb fluid from the lungs
- see hazy lung fields on X-ray
Pneumothorax
- occurs silently in 5% of babies
- dont need an X-ray to confirm dx, insert tiny chest drain
Name the 2 common cardiac conditions in the newborn?
-causes?
Hydrops foetalis
i. e. neonatal heart failure
- rhesus disease or chromosomal abnormality
Persistent pulmonary hypertension of the newborn
-there is a failure to adapt to post natal life, difficult to oxygenate thesis babies
cardiac congenital disease:
-name the 5 main abnormalities and describe
Tetralogy of fallot consists of 4 abnormalities (a ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, an overriding aorta)
Transposition of the great arteries
Coarctation of the aorta
(check femoral pulses)
total anomalous pulmonary venous drainage (TAPVD)
Hypoplastic heart
Respiratory congenital disease
-name the 2 more common respiratory abnormalities and describe them
Trachea-oesophageal fistula
oesophageal atresia, babies will vomit and and NG tubes abbot be inserted
Diaphragmatic hernia
gut develops in the chest cavity and so can get hypo plastic lungs
and to bag these babies when they are born
bowel sounds audible on chest auscultation
