Sick-term infant Flashcards
Define the neonatal period
0-27days old
What are the warning signs of a sick infant ?
- Not feeding well
- Convulsions
- Drowsy or unconcious
- Movement only when stimulated or no movement at all
- Tachypnoea (>= 60)
- Grunting
- Accessory muscles used
- Raised temp >= 38
- Hypothermia < 35.5
- Central cyanosis
What is the emergency management of a neonate and the treatment given ?
- ABC - use a nasal cannula if O2 sat ≤ 90%, use bag & mask ventilation if aponea, gasping or RR < 20
- IV access
- IV antibiotics - is pyrexia of unknown source give GAM, if suspected menigococcal septicaemia follow meningitis treatment (in preterm lecture)
- If drowsy or convulsing check BG - give IV glucose if needed
- If convulsing - 1st line = phenobarbitol, 2nd line = phenytoin
- Admit & monitor + further investigations if needed
What are the main causes of convulsions or fits in infants ?
- Hypoxic ichaemic encephalopathy (result of perinatal asphyxia)
- CNS infection e.g. meningitis/ encephalitis
- Hypoglycaemia
- Hypocalcaemia
- Itrancranial haemorrhage
Define what hypoxic ischaemic encephalopathy is
This is where the babies O2 supply was interupted at birth, this can then result in neurodevelopmental problems in the future e.g. cerebral palsy
What are the symptoms of hypoxic ischaemic encephalopathy?
- Hyperalert or decreased conciousness
- Irritable
- Eye rolling
- Convulsions/fits
What is the treatment of hypoxic ischaemic encephalopathy?
May need mild hypothermia/cooling treatment & need to be admitted to NICU where they may have ventilation or CPAP
Define hypoglycaemia in neonates
≤ 2.5
What are the symptoms of hypoglycaemia in neonates ?
- Coma or decreased conciousness
- Convulsions
- Transient hypermesis (vomiting)
What is the treatment of hypoglycaemia in neonates ?
IV glucose infusion
Define hypocalcaemia in neonates
< 2.1 (norm is 2.1-2.6)
What are the symptoms of hypocalcaemia in neonates ?
- Convulsion/fits - muscle spasms
- Prolonged QT interval
- Laryngospasm
- Bronchospasm
What is the treatment of hypocalcaemia in neonates ?
- 1st line = Low PO43- + calcium gluconate
- If also have hypomagnesaemia the give IV MgSO4
What are the 4 main serious infections in neonates ?
- Sepsis
- Meningitis
- Pneumonia
- UTI
What are the signs of sepsis in neonates ?
- Seizures
- Stiff limbs
- Cyanosis - looks mottled, blueish or pale
- Cap refill ≥ 3 secs
- Difficulty feeding
- Severe chest indrawing
- Temp ≤ 35.5 or ≥ 37.5
- Movement only when stimulated
- RR ≥ 60
- Lethargy
- Grunting
Sepsis should always be a differential in neonates
In the early neonatal period (<48hrs) what is the most common causative organisms for sepsis ?
E.coli & Group B strep (streptococcus agalactiae)
In late onset sepsis alongside the common ones for early onset what are the other potential causative organisms ?
- Staph. epidermis
- Listeria monocytogenes
- Klebsiella
- Enterococcus
In suspected or confirmed sepsis of a neonate what investigations should be done as an infeciton screen to find the possible source ?
- Blood culture & virology
- CXR
- Lumbar puncture
- Stool sample for virology
- Urine sample for culture & virology
- ENT swabs for culture
What is the management of neonatal sepsis ?
- BUFALO (Abx = GAM)
- then once the cause is found treat as per guidelines
What are the 3 potential causative organsims of neonatal meningitis ?
Think GEL
- Group B strep
- E.coli
- Listeria monocytogenes
What are the signs/symptoms of neonatal meningitis ?
- Irritable
- High pitched abnormal cry
- Lethargy
- Difficulty feeding
- Fever
- Seizures
- Bulging fontanelles
- Apnoea
Note photophobia, stiff neck etc is less common in young kids
How is neonatal meningitis diagnosed ?
Lumbar puncture
What is the treatment of meningitis in young kids < 3months and kids > 3months ?
- If < 3 months tx = cefotaxime + amoxicillin
- If > 3months (upto age of 18) tx = 1st dose cefotazimine followed by once daily ceftriaxone + dexamethasone
What are the signs/symptoms of penumonia in neonates ?
- Malaise
- Poor feeding
- Tachypnoea
- Cyanosis
- Grunting
- Respiratory excessory muscle use
How is penumonia diagnosed in neonates ?
CXR + FBC + blood & sputum cultures
List the causes of pneumonia neonates, infants & school children ?
- Neonates: GBS, E.coli, Klebsiella, Staph aureus
- Infants: Strep pneumoniae, Chlamydia
- School age: Strep pneumoniae, Staph aureus, Gr A strep, Bordetella, Mycoplasma, Legionella
How is the severity of CAP pneumonia determined ?
Using CURB 65
What is the treatment of severe and non-severe CAP in children < 1 and > 1y/o ?
Non severe:
- > 1y/o 1st line = amoxicillin, 2nd line = clarithromycin
- < 1y/o 1st line = co-amoxiclav
Severe:
- 1st line = co-amoxiclav (+ clarithromycin if signs of atypical pneumonia or pertussis)
What is the treatment of HAP/post-op/aspiration penumonia in young children ?
1st line = co-amoxiclav
What are the signs/symptoms of UTI in neonates ?
- Fever
- Vomiting
- Lethargy
- Irritability
- Poor feeding & failure to thrive
- May be abdo pain, loin tenderness and other characterisitc symptoms but less likely in younger children
When is an upper UTI assumed in young children ?
- Assumed if bacteruria & fever ≥ 38
- OR if fever < 38 but have loin pain/tenderness & bacteriuria
When is lower UTI assumed in young children ?
Assumed in all other children who have bacteruria but no systemic symptoms/signs e.g. fever or loin pain
How is UTI diagnosed in young children ?
Clean catch urine for microscopy & culture
What is the treatment of lower UTI in children < 3months and those > 3months ?
- < 3months = Amox + Gent
- > 3months = Trimethroprim or nitrofuratoin
What is the treatment of upper UTI’s in young children ?
- 1st line = Amox + Gent
- 2nd line = Co-amoxiclav
Define what nectrosing enterocolitis (NEC) is
- This is an inflammatory bowel disorder in which the bowel begins to die (necrosis)
- It can then lead to perforation of the bowel which in turn can lead to infection
What is the chief risk factor for NEC development ?
Prematurity
What are the signs/symptoms of NEC ?
- Poor feeding
- Vomiting +/- bile
- Swollen & tender abdomen
- Blood/mucus in the stool
- May present with shock, DIC if severe
- Usually presents in the first 2 weeks of life (& primarily in pre-terms)
How is NEC diagnosed?
Abdo X-ray shows pneumatosis intestinalis (gas within wall of the bowel) - this is pathognomic for it
What is the treatment of NEC?
Antibiotics (IV GAM) with step-down to co-amoxiclav +/- surgery
What are the 2 types of impetigo ?
- Bullous
- Non-bullous
What is the causative organism of impetigo ?
Staph.aureus
What age group of children does non-bullous impetigo usually affect ?
5-15 yr olds
Describe the presentation of non-bullous impetigo
- Starts as tiny pustules or vesicles that evolve rapidly into honey coloured crusted plaques
- Plaques usually on the face around the mouth & nose
- Satellite lesions may occur as it spreads
- May be itchy
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