Term Admissions to NNU Flashcards
What are the symptoms of sepsis?
Baby pyrexia or hypothermia, poor feeding, lethargy, early jaundice, tachypnoea, hypo/ hyperglycaemia, floppy and asymptomatic
What are the risk factors for sepsis in term babies?
PROM, maternal pyrexia and maternal GBS carriage
What is the management for sepsis?
Admit NNU, partial septic screen + blood gas, consider CXR + LP, IV penicillin and gentamicin 1st line, 2nd line is IV vancomycin and gentamicin, add metronidazole if surgical/ abdominal concerns, fluid management and treat acidosis
What are the commonest causes of neonatal sepsis?
Group B strep
E. coli
Listeria
Coag-neg staphylococcus
Haemophilus influenza
Describe GBS sepsis
Early onset - birth to 1 week
Late onset or recurrence - up to 3 months
Symptoms may not be specific and may have no risk factors
What are the complications of GBS sepsis?
Meningitis, DIC, pneumonia, respiratory collapse, hypotension and shock
What is congenital infection?
Infections acquired trans placentally or in utero
TORCH - toxoplasmosis, other, rubella, CMV and HSV
What can congenital infection result in?
IUGR, brain calcifications, neurodevelopmental delay, visual impairment and recurrent infections
What are some signs and symptoms of a neonate with congenital infection?
Hydrocephalus, cataracts, retinitis, pneumonitis, anaemia, jaundice, hepatitis, thrombocytopenia, microcephalus, heart defects, splenomegaly, bone abnormalities and rash (blueberry muffin rash in rubella)
Describe TTN - transient tachypnoea of the newborn
Self limiting and common
Presents within 1st few hours of life
Grunting, tachypnoea, oxygen requirement and normal gases
Delay in clearance of the foetal lung fluids
Support, antibiotics, fluids, O2 and airway support
How is TTN diagnosed?
CXR - wet lungs with prominent vascular markings
Fluid in horizontal fissure
What is Meconium aspiration?
Meconium is inhaled into the lungs
Occurs due to stress on the baby
Risk factors are post-dates, maternal diabetes, HTN and difficult labour
Blood gas, septic screen and X-ray
What are the symptoms of meconium aspiration?
Cyanosis, increased work of breathing, grunting, apnoea and floppiness
What does meconium aspiration look on X-ray?
Areas of over inflation and collapse
Flattened diaphragm can be seen
What is the treatment for meconium aspiration?
Suction below cords, intubation + ventilation, fluids, antibiotics, surfactant and NO + ECMO if severe
Most do well but some develop PPHN
What are some cardiac conditions seen in newborns for NNU?
Most cardiac murmur of no consequence does not need admitted
Blue baby - needs urgent treatment
Resp and sepsis is more common in NNU
What is involved in the investigation of the blue baby?
Exam, history, sepsis screen, blood gas, blood glucose, CXR, pulse oximetry, ECG and Echo
What are differential diagnoses for the blue baby?
5 Ts - truncus arteriosus, TGA, tricuspid atresia, ToF and TAPVD
Describe management of hypoglycaemia
Monitor blood glucose, start IV 10% glucose, increase fluids, increase glucose concentration, glucagon and hydrocortisone
May still manage with enteral feeds
What is the investigations and management for hypothermia?
Septic screen and antibiotics given
Consider checking thyroid function
Monitor blood glucose
Place in incubator
What is the management for jaundice?
Intensive phototherapy and/ or exchange transfusion
Incubator and IV fluids may be required
What is birth asphyxia?
Lack of oxygen at or around birth leads to multiorgan dysfunction
Causes are placental problem, long/ difficult delivery, umbilical cord prolapse, infection, neonatal airway problem and neonatal anaemia
What are the stages of birth asphyxia?
1st - within minutes - cell damage occurs with lack of blood flow and O2
2nd - reperfusion injury - can lasts days or weeks where toxins are released from damaged cells
What can happen secondary to birth asphyxia?
Hypoxic ischaemic encephalopathy
What is the management of hypoxic ischaemic encephalopathy?
Fluid restriction, supportive (organ failure), treat seizures and therapeutic hypothermia
What are some surgical problems seen in NNU?
Oesophageal atresia/ fistula, duodenal atresia, causes of failure to pass stool, abdominal wall defects and diaphragmatic hernia
What are some causes of failure to pass stool?
Large bowel atresia, imperforate anus (possible fistula), Hirschsprung’s disease (failure of neuro-migration so can’t perform peristalsis), meconium plug and meconium ileus (think CF)
Describe a diaphragmatic hernia
90% are left and more males
Can be syndromic
Usually pulmonary hypoplasia
Intubation at birth and respiratory support
Surgery
What is neonatal abstinence syndrome (NAS)
Withdrawal from physically addictive substances taken by the mother during pregnancy - opioids, benzodiazepines, cocaine and amphetamines
What is the management and diagnosis of NAS?
Finnegan score and urine toxicology
What is the treatment for NAS?
Comfort - swaddling
Morphine and phenobarbitone
