Sick Term Infant Flashcards
how can a baby’s condition after birth be assessed?
agpar score each of following given score of 0, 1 or 2 - heart rate - resp rate - tone - responsiveness - colour score out of 10 - 8+ = normal
features of agpar score worth 0?
no respiration no pulse no muscle tone no response pale or blue colour
what agpar features are worth 1?
weak, irregular gasping breath pulse <100 some flexion (tone) some grimace/feeble cry when stimulated blue extremities but body is pink
what agpar features are worth 2?
strong cry (resp) pulse >100 flexed arms and legs that resist extension cry or pull away when stimulated no cyanosis
important history in neonatal examination?
maternal - PMH, pregnancy issues, drugs, infection risk (including STIs)
infant - foetal growth, foetal abnormality, delivery, resuscitation
normal neonatal HR?
110-160
- might be very slightly lower in larger babies while at rest
normal findings on newborn clinical assessment?
resp rate: 40-60/min (may be low in sepsis etc)
work of breathing/resp effort
HR: 120-140/min
cap refill: 2-3 secs
BP: difficult to measure
colour: pink
SaO2: 95% (blood flow will be changing in fist few mins of life from foetal>adult circulation so may be a bit lower for 5-10 mins)
other things to be aware of on neonatal examination?
jaundice low tone (flopy) seizures poor feeding bilious vomit
initial management of sick term infant?
temp is main initial problem (should be 36.5 - 37.4)
airway and breathing (gently support with positioning/ventilation/oxygen)
circulation (can give fluids/blood/intropes if problem with BP)
metabolic homeostasis (manage glucose with infusion if needed and correct acid-base balance)
antibiotics if septic
ongoing management of sick term infant?
diagnostic work up further support with - ventilation - drugs - specific therapy (e.g therapeutic cooling can be used in acidotic babies to prevent cerebral palsy) - surgery if needed - transfer if needed care for the family
main cause of infection at each stage of gestation?
antenatal = bacterial perinatal = viral postnatal = fungal
sites of infection?
blood stream (bacteraemia/septicaemia) CNS/meninges (meningitis) resp system (pneumonia) GU (UTI) others (skin, bone, GI etc)
what types of bacteria cause infection in sick term infant?
group B strep (very quick and aggressive) E coli listeria monocytogenes staph aureus staph epidermidis
viral causes of infection in sick term infant?
CMV parovirus herpes viruses enteroviruses others (HIV, syphilis, TORCH etc)
what is hypoxic ischaemic encephalopathy?
multi organ damage due to tissue hypoxia during pregnancy/birth
poor agpar score
neurodevelopmental problems
requires active resuscitation