Term admissions to ICU Flashcards
What is the most common cause of sepsis in neonates?
Group B strep
E. coli
Listeria
What are the complications of group B strep sepsis?
MEningitis
DIC
Pneumonia and resp collapse
Hypotension and shock
What are the risk factors for sepsis in neonates?
Prolonged rupture of membranes
Maternal pyrexia
Maternal group B strep carriage
What are the signs and symptoms of sepsis in neonates?
Pyrexia or hypothermia Poor feeding Lethargy Early jaundice Hypo/hyperglycaemia Asymptomatic
What is the management of sepsis in neonates?
Admit
Partial sepsis screen- FBC, CRP, culture and blood gas
Consider CXR and LP
IV penicillin and gentamicin
-add metronidazole if surgical/abdo concerns
Fluid management, treat acidosis
What is the most common reason for NNU admission?
Resp distress
What are the causes of respiratory distress?
Sepsis
Transient tachypnoea of newborn
Meconium aspiration
What is transient tachypnoea of newborn?
Self limiti g common condition in 1st few hours
Delay in clearance of foetal lungs
What are the features of transient tachypnoea of newborn?
Grunting
Tachypnoea
Normal gases
What is the management of transient tachypnoea of newborn?
CXR
Supportive- fluids, O2, airway
antibiotics
What are the risk factors for meconium aspiration?
Post dates
Maternal DM or hypertension
Difficult labour
What are the features of meconium aspiration?
Cyanosis Increased work of breathing Grunting Apnoea Floppy
What investigations should be done for meconium aspiration?
Blood gas
Sepsis
screen
CXR
What is the management of meconium aspiration?
Suction below cords
Airway support
Fluids and IV antibitocs
Surfactant- meconium deactivates normal surfactant
What investigations should be done for a blue baby?
Exam and history Sepsis screen Blood gas and blood glucose CXR Pulse ox ECG Echo
What is a characteristic pulse ox of cardiac defect?
Always <100%, as can never be 100 due to venous mixing
What are the cardiac defect differentials?
Transposition of great vessels Tetralogy of Fallot Total anomalous pulmonary venous drainage Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia
What is the management of hypoglycaemia?
Monitor
Enteral feeds
IV 10% glucose
Resistant- glucagon, steroids
What are the common causes of hypoglycaemia?
Maternal DM
Intraauterine growth restriction
What is the management of hypothermia?
Incubator
Sepss screen and antibiotics
Thyroid function
Monitor glucose
What are the causes of birth asphyxia?
Placental Long, difficult delivery Umbilical cord prolapse infection Neonatal airway problem Neonatal anaemia
What are the 3 types of birth asphyxia?
Mild
Moderate
Sever
What are the 2 stages of birth asphyxia?
Acute-CEll damage, happens in minutes
Reperfusion injury- can last days to weeks, due to toxins released from damaged cells
What is the management of birth asphyxia?
Supprot- fluid resus, monitor, cardiac and rest support, treat any seizures
Theraputic hypothermia, esp in moderate
What are the common surgical problems of the neonate?
Oesophageal atresia Duodenal atresia Failure to pass stool Abdo wall defect Diaohragmatic hernia
What are the common causes of failure to pass stool?
Constipation Large bowel atresia Imperforate anus Hirschsprungs disease Meconium ileus
When and where are diaphragmatic hernias normally?
Males > females
Left 90%
What is the management of diaphragmatic hernia?
Intubation and hernia
Surgery
