Sick Term Infant

Question 1

how can a baby’s condition after birth be assessed?

Answer 1

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

Question 2

features of agpar score worth 0?

Answer 2

no respiration
no pulse
no muscle tone
no response
pale or blue colour

Question 3

what agpar features are worth 1?

Answer 3

weak, irregular gasping breath
pulse <100
some flexion (tone)
some grimace/feeble cry when stimulated
blue extremities but body is pink

Question 4

what agpar features are worth 2?

Answer 4

strong cry (resp)
pulse >100
flexed arms and legs that resist extension
cry or pull away when stimulated
no cyanosis

Question 5

important history in neonatal examination?

Answer 5

maternal - PMH, pregnancy issues, drugs, infection risk (including STIs)
infant - foetal growth, foetal abnormality, delivery, resuscitation

Question 6

normal neonatal HR?

Answer 6

110-160

- might be very slightly lower in larger babies while at rest

Question 7

normal findings on newborn clinical assessment?

Answer 7

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)

Question 8

other things to be aware of on neonatal examination?

Answer 8

jaundice
low tone (flopy)
seizures
poor feeding
bilious vomit

Question 9

initial management of sick term infant?

Answer 9

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

Question 10

ongoing management of sick term infant?

Answer 10

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

Question 11

main cause of infection at each stage of gestation?

Answer 11

antenatal = bacterial
perinatal = viral
postnatal = fungal

Question 12

sites of infection?

Answer 12

blood stream (bacteraemia/septicaemia)
CNS/meninges (meningitis)
resp system (pneumonia)
GU (UTI)
others (skin, bone, GI etc)

Question 13

what types of bacteria cause infection in sick term infant?

Answer 13

group B strep (very quick and aggressive)
E coli
listeria monocytogenes
staph aureus
staph epidermidis

Question 14

viral causes of infection in sick term infant?

Answer 14

CMV
parovirus
herpes viruses
enteroviruses
others (HIV, syphilis, TORCH etc)

Question 15

what is hypoxic ischaemic encephalopathy?

Answer 15

multi organ damage due to tissue hypoxia during pregnancy/birth
poor agpar score
neurodevelopmental problems
requires active resuscitation

Question 16

2 examples of respiratory problems in sick term baby?

Answer 16

transient tachypnoea of the newborn

pneumothorax (can be spontaneous or due to active resuscitation)

Question 17

2 examples of cardiac problems in term infant?

Answer 17

heart failure (e.g hydrops foetalis - due to rhesus disease or chromosomal)
failure to adapt to postnatal life (PPHN)

Question 18

types of congenital heart disease in term infant?

Answer 18

tetralogy of fallot
transposition of great arteries
coarctation of aorta
TAPVD
hypoplastic heart

Question 19

types of congenital resp disease in term infants?

Answer 19

tracheo-oesophageal fistula

diaphragmatic hernia

Question 20

other congenital abnormalities?

Answer 20

neuro - microcephaly, spina bifida
renal - potter’s syndrome (renal agenesis)
MSK - myotonic dystrophy

Question 21

types of metabolic disease in term infant?

Answer 21

hypoglycaemia (reduced reserves, maternal disease or more complex disorder)
acidosis (inborn error of metabolism)