Sick Term Infant Flashcards

1
Q

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

A
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
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2
Q

features of agpar score worth 0?

A
no respiration
no pulse
no muscle tone
no response
pale or blue colour
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3
Q

what agpar features are worth 1?

A
weak, irregular gasping breath
pulse <100
some flexion (tone)
some grimace/feeble cry when stimulated
blue extremities but body is pink
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4
Q

what agpar features are worth 2?

A
strong cry (resp)
pulse >100
flexed arms and legs that resist extension
cry or pull away when stimulated
no cyanosis
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5
Q

important history in neonatal examination?

A

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

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6
Q

normal neonatal HR?

A

110-160

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

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7
Q

normal findings on newborn clinical assessment?

A

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)

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8
Q

other things to be aware of on neonatal examination?

A
jaundice
low tone (flopy)
seizures
poor feeding
bilious vomit
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9
Q

initial management of sick term infant?

A

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

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10
Q

ongoing management of sick term infant?

A
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
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11
Q

main cause of infection at each stage of gestation?

A
antenatal = bacterial
perinatal = viral
postnatal = fungal
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12
Q

sites of infection?

A
blood stream (bacteraemia/septicaemia)
CNS/meninges (meningitis)
resp system (pneumonia)
GU (UTI)
others (skin, bone, GI etc)
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13
Q

what types of bacteria cause infection in sick term infant?

A
group B strep (very quick and aggressive)
E coli
listeria monocytogenes
staph aureus
staph epidermidis
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14
Q

viral causes of infection in sick term infant?

A
CMV
parovirus
herpes viruses
enteroviruses
others (HIV, syphilis, TORCH etc)
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15
Q

what is hypoxic ischaemic encephalopathy?

A

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

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16
Q

2 examples of respiratory problems in sick term baby?

A

transient tachypnoea of the newborn

pneumothorax (can be spontaneous or due to active resuscitation)

17
Q

2 examples of cardiac problems in term infant?

A
heart failure (e.g hydrops foetalis - due to rhesus disease or chromosomal)
failure to adapt to postnatal life (PPHN)
18
Q

types of congenital heart disease in term infant?

A
tetralogy of fallot
transposition of great arteries
coarctation of aorta
TAPVD
hypoplastic heart
19
Q

types of congenital resp disease in term infants?

A

tracheo-oesophageal fistula

diaphragmatic hernia

20
Q

other congenital abnormalities?

A

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

21
Q

types of metabolic disease in term infant?

A

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