Sick Term Infants Flashcards
What structure is commonly used to give IV access in babies?
The umbilicus
How long dies it take for babies to become sick?
Not long at all = babies can become sick very quickly at any time from birth up until 28 days
When is the neonatal period?
From birth to 27 days
When do infections tend to present in babies?
Soon after delivery
What are the categories of the Apgar score?
Appearance (skin colour) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiration
What Apgar score indicates a healthy baby?
Aiming for score of 2 in each category to give a total of 10
What Apgar score do stillborns normally have?
A score of 0
What should a baby’s pulse be?
Greater than 100 = term babies should be between 120-140 bpm, preterm babies should be up to 160 bpm
What makes up the history of a newborn clinical assessment?
Maternal = PMH, pregnancy issues, drugs, infection risks Infant = foetal growth and anomaly, delivery, resuscitation
What should be inspected in a newborn clinical assessment?
Tone, colour, level of arousal, work of breathing, heart rate, respiratory rate, capillary refill, oxygen saturation
What should the normal vital signs be in babies?
Respiratory rate = 40-60 bpm
Capillary refill = 2-3s
SaO2 = 95%
When may a baby develop apnoea?
When they are just beginning to become unwell
How do seizures present in babies?
They are subtle = apnoea, lip smacking, eye rolling, cycling of limbs
What are some signs that may indicate an unwell baby in a newborn clinical assessment?
Jaundice, low tone (floppy), seizures, poor feeding, bilious vomit
What temperature should babies be kept at?
Between 36.5-37.4 degrees
What makes up the initial management of a baby after delivery?
Temperature, airways and breathing, circulation (fluids, inotropes), antibiotics, metabolic homeostasis (glucose management, acid-base balance)
When should antibiotics be given to a sick baby?
Until infection is completely ruled out
What is the blood volume of babies?
80ml/kilo
What makes up the ongoing management of babies after delivery?
Diagnostic work up
Further support = ventilation, drugs, specific therapy, surgery, transfer to specialist centre
Care of family
What is therapeutic hypothermia?
Cooling of baby to 33.5 degrees for 72 hrs = used to treat neurological ischaemia (protective against cerebral palsy)
What are the main categories of causes of a sick baby?
Congenital abnormalities, metabolic, infection, pregnancy/birth related
When may infection occur in a baby?
Antenatal = bacterial (Group B strep) Perinatal = viral (enterovirus, herpes) Postnatal = bacterial (staph)
Where are some sites of infection in babies?
Bloodstream = bacteraemia/septicaemia CNS = meningitis Respiratory = pneumonia GU = UTI (more common in boys up to 28 days) Others = skin (around umbilicus), bone (osteomyelitis), necrotising enterocolitis
What are some common bacterial causes of infection in babies?
Group B strep (most common), E.coli, listeria myocytogenes (rare), staph aureus, staph, epidermidis (babies who’ve undergone operations)
What are some viral causes of infection in babies?
Cytomegalovirus, parovirus, herpes, enterovirus
What are some rarer cause of infection in babies?
Toxoplasma gondii, HIV, syphilis, TORCH
What is hypoxic ischaemic encephalopathy?
Multi-organ damage due to tissue hypoxia = affects brain. kidneys and liver
What are some features of hypoxic ischaemic encephalopathy?
Poor Apgar scores = active resuscitation required
Neurodevelopmental sequeli = variable prognosis
How is hypoxic ischaemic encephalopathy treated?
Therapeutic hypothermia
What causes transient tachypnoea of the newborn?
Fluid in lungs not being cleared as production of lung fluid hasn’t been stopped
What does transient tachypnoea of the newborn look like on an x-ray?
Fluid in the horizontal fissures of the lung
How common are pneumothoraxes in babies?
Very common = most babies aren’t unwell and it resolves without intervention
What causes heart failure in babies?
Hydrops foetalis = may be due to rhesus disease (linked with maternal anaemia) or be chromosomal
How may hydrops foetalis present?
Baby will have swollen liver, ascites/severe abdominal swelling and pleural effusions
What are some congenital cardiac abnormalities found in babies that may cause sickness?
Tetralogy of Fallot, coarctation of the aorta, TAPVD, hypoplastic heart, transposition of great vessels
When do cardiac abnormalities tend to present in babies?
Usually 2-3 days after birth
What are some congenital respiratory disease in babies?
Tracheo-oesophageal fistula (baby turns blue after swallowing)
Diaphragmatic hernia
What is Potter’s syndrome?
Rare renal congenital disease = causes renal agenesis
What are some neurological congenital diseases of the baby?
Microcephaly, spina bifida
What is myotonic dystrophy?
Muscular congenital disease = presents with transient myotonia in baby
What are some metabolic diseases that cause babies to become unwell?
Hypoglycaemia = related to reduced reserves or maternal diabetes Acidosis = inborn error of metabolism
What may hypoglycaemia be a sign of?
May be evidence of a more complex metabolic disorder
