Sick Term Infant

Question 1

the apgar scoring stands for appearance (skin colour), pulse, grimace (reflex irritability), activity (muscle tone) and respiration - what would give a score of 0, 1 or 2 in those categories?

Answer 1

appearance

• 0 = blue or pale
• 1 = blue in extremities / body pink
• 2 = no cyanosis

pulse

• 0 = absent
• 1 = <100
• 2 >100

grimace

• 0 = no response
• 1 = grimace / feeble cry when stimulated
• 2 = cry or pull away when stimulated

activity

• 0 = none
• 1 = some flexion
• 2 = flexed arms and legs that resist extension

respiration

• 0 = absent
• 1 = weak, irregular, gasping
• 2 = strong cry

Question 2

what is the normal respiratory rate for a newborn?

Answer 2

40-60 / minute

Question 3

what is the normal heart rate for a newborn?

Answer 3

120-140 / minute

Question 4

what is the normal SaO2 levels for a newborn?

Answer 4

95%

Question 5

what is the initial management for a sick term infant?

Answer 5

temperature

airway and breathing - oxygen?

circulation - fluids, inotropes?

metabolic homeostasis - glucose management, acid base balance correction?

antibiotics

Question 6

what is the ongoing management for a sick term infant?

Answer 6

diagnostic work up

further support - ventilation, drugs, specific therapy (eg therapeutic cooling), surgery or transfer?

care of family

Question 7

what bacterium are likely to cause infection in term infant?

Answer 7

group B strep 
e. coli 
listeria myocytogenes 
staph aureus 
staph epidermis

Question 8

what viruses are likely to cause infection in term infant?

Answer 8

cytomegalovirus
parvovirus
herpes virus
enterovirus

Question 9

what is hypoxic ischaemic encephalopathy?

Answer 9

multi organ damage due to tissue hypoxia

Question 10

how is hypoxic ischaemic encephalopathy diagnosed and treated?

Answer 10

poor apgar scores

requires active resuscitation

*variable neurodevelopmental prognosis

Question 11

what pregnancy / birth related respiratory problems can arise in term infant?

Answer 11

transient tachypnoea of the newborn (TTN)

pneumothorax - spontaneous vs 2o active resuscitation

Question 12

what pregnancy / birth related cardiac problems can arise in term infant?

Answer 12

heart failure due to hydrops foetalis (caused by rhesus disease or can be chromosomal)

failure to adapt to postnatal life due to PPHN

Question 13

what are the symptoms of hydrops foetalis?

Answer 13

severe abdominal swelling

swollen liver

Question 14

what congenital diseases can cause cardiac problems in term infant?

Answer 14

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

Question 15

what congenital diseases can cause respiratory problems in term infant?

Answer 15

tracheo-oesophageal fistula

diaphragmatic hernia

Question 16

what neurological congenital anomalies can occur?

Answer 16

microecphaly

spina bifida

Question 17

what renal congenital anomalies can occur?

Answer 17

potters syndrome

Question 18

what muscular congenital anomalies can occur?

Answer 18

myotonic dystrophy

Question 19

what metabolic diseases can occur in term infant?

Answer 19

hypoglycaemia

• related to reduced reserves
• related to maternal disease

acidosis
- inborn error of metabolism