Sick term infant Flashcards
What is the neonatal period?
Up to 28 days of life
What are the most common causes of neonatal death?
Prematurity Birth asphyxia and birth trauma Neonatal sepsis Pneumonia Congenital anomalies Neonatal tetanus Diarrhoea
What is incorporated into the apgar score?
HR Resp effort Tone Colour Response
What is the acronym for apgar?
Appearance (skin colour) Pulse Grimace (reflex irritability) Activity (miscue tone) Respiration
What are the normal parameters for a neonatal clinical assessment?
RR; 40-60/min HR; 120-140 bpm Cap refill; 2-3 seconds Colour; pink SaO2; >95%
What should be assessed in a newborn clinical assessment?
RR Work of breathing; resp effort HR CRT BP Colour Sats Jaundice Tone Seizures Feeding Bilious vomit
What is the inital management of a sick term baby?
Temp; 36.5-37.5 Airway and breathing; oxygen? Circulation; fluids, inotropes? Metabolic homeostasis; glucose management, acid base balance Antibiotics
What are the 4 reasons for a sick baby?
Pregnancy or birth related
Congenital anomaly
Infection
Metabolic
When can babies catch infections?
Antenatal
Perinatal
Postnatal
What are the sites of infections in neonates?
Blood stream; bacteraemia CNS; meningitis Resp; pneumonia GU; UTI (more common in boys) Skin bone GI; NEC (preterms)
What are the common bacteria that affect neonates?
GBS E.coli Listeria monocytogenes Staphylococcus aureus Staph epi
What viral infections affect neonates?
CMV Parvovirus Herpes Enterovirus Toxoplasmosis gondii GIV
What is hypoxic ischaemia encephalopathy?
Multi organ damage due to tissue hypoxia
Poor apgar’s; resus required
Neurodevelopmental sequelae; variable prognosis
What are the pregnancy/ birth related resp problems in neonates?
TTN
Pneumothorax; spontaneous vs secondary to active resus
What can be seen on CXR of TTN?
White, streaky lungs with fluid in the horizontal fissure
What are the pregnancy/ birth related cardiac problems in neonates?
Heart failure; hydrops (rhesus or chromosomal)
Failure to adapt; PPHN
What is the mainstay of tx for PPHN?
Nitric oxide
ECMO
What are common congenital cardiac diseases?
ToF Transposition of the great arteries Coarctation of aorta TAPVD Hypoplastic left heart
When will congenital cardiac anomalies present?
2 to 3 days after birth; as the heart adapts to extrauterine life
What are common respiratory congenital diseases?
Tracheoesophageal fistula; blue when feeding
diaphragmatic hernia
What are common neurological congenital anomalies?
Microcephaly
Spina bifida resulting in hydrocephalus
What are common renal congenital anomalies?
Potters syndrome; renal agenesis with pulmonary hypoplasia
What are common muscular congenital anomalies?
Myotonic dystrophy
Why can babies present with hypoglycemia?
Reduced reserves; LBM/ SGA
Maternal diabetes
More complex metabolic disorder
Why can babies present with acidosis?
Birth asphyxia
Inborn error of metabolism
What are the 5 primitive reflexes?
Rooting and sucking (to do with breastfeeding)
Moro (startle)
Tonic neck (when head at one side; arm will stretch out)
Grasp
Stepping
