Term Admissions to NNU Flashcards
What is meant by term?
Babies born >37 weeks gestation
Why is sepsis difficult to diagnose?
Very generic symptoms, only half have a fever
Always consider sepsis to be a diagnosis.
Risk factors for sepsis in neonates?
PROM- premature rupture of membranes
Maternal pyrexia
Maternal group B strep infection
First line antibiotics in neonatal sepsis?
IV penicillin and gentamycin
->2nd line is IV vancomycin and gentamycin
Commonest causes of neonatal sepsis?
Group B streptococcus
E.Coli
What are the congenital infections to consider using the acronym TORCH?
Toxoplasmosis
Other- syphilis, Varicella-Zoster
Rubella
Cytomegalovirus
Herpes simplex virus
What is transient tachypnoea of the newborn (TTN)?
Commonest cause of respiratory distress syndrome in neonates
Common and self-limiting
Features of TTN?
Grunting
Tachypnoea, oxygen requirement
What is the pathophysiology behind TTN?
Delay in clearance of foetal lung fluids
Management of TTN?
Supportive care until fluid clears
What is meconium aspiration?
Aspiration of meconium (first stool, tar-like) into the lung if it is passed during labour
Risk factors for meconium aspiration?
Post due dates
Maternal diabetes
Maternal hypertension
Difficult labour
Symptoms of meconium aspiration?
Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppiness
Investigations is suspecting meconium aspiration?
Blood gas
Septic screen
CXR
There are five main causes of cyanotic heart disease and they can be remembered as the 5 T’s.
Summary below :)
1- truncus arteriosus (number one, one vessel)
- Transposition of the great arteries (number two, two vessels)
- Tricuspid atresia (number three, tricuspid)
- Tetralogy of Fallot (number four, tetra)
- TAPVD- five words
What can happen if there is prolonged hypoglycaemia in neonates?
Brain damage
How can neonatal hypoglycaemia be managed?
Can be managed with additional feeding alone.
Some may need IV 10% glucose and increased fluids
->if still low, glucagon and hydrocortisone may be used
If a child has hypothermia, what must you screen for?
Sepsis
->sepsis doesn’t have a set symptom pattern in young children so need to always have it in the back of our mind
If a baby has a persistently low temperature, what should be considered as a diagnosis?
Congenital hypothyroidism
Birth asphyxia?
Lack of oxygen at or around birth
What can birth asphyxia lead to?
Multiorgan dysfunction
List some of the causes of birth asphyxia.
Placental problem
Long, difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia
Describe the two stages of birth asphyxia.
1st stage- occurs within minutes, cell damage occurs with lack of blood flow and oxygen
2nd stage- reperfusion injury, can last days to weeks, toxins are released from the damaged cells
Which type of brain damage can follow birth asphyxia?
Hypoxic ischaemic encephalopathy
Management of hypoxic ischaemic encephalopathy?
Therapeutic hypothermia (cooling)
Treat seizures
Supportive care
Fluid restriction (to avoid cerebral oedema)
Resp and cardio support
->therapeutic hypothermia improves outcomes, especially in moderate group
Babies expected to pass stool (meconium) within first day of life.
If baby has not passed stool within 2 days, what are some of the potential causes?
Large bowel atresia
Imperforate anus
Hirschsprung’s disease
Meconium plug
Meconium ileus
->anus should always be checked in newborn exam. Cannot assume that because there is stool in nappies, that there is not an imperforate anus as in girls, it can pass out vaginally if not able to go through anus
What is Hirschsprung’s disease?
A birth defect in which nerves are missing from parts of the intestines and poo can get stuck in it
If a baby has a meconium plug, there is usually an underlying disease such as?
Hirschsprung’s disease
Cystic fibrosis
Meconium ileus in particular is indicative of which condition?
Cystic fibrosis
->due to defect in CFTR transport which thickens mucus in cystic fibrosis, thickens meconium too
What are the two common types of abdominal wall defects seen in neonates?
Exomphalos
Gastroschisis
->gut is slowly squeezed back in over time essentially, look up pictures to see difference, exomphalos has protective sac
What happens in a diaphragmatic hernia?
Defect in the formation of the diaphragm meaning bowel contents herniate into chest.
This causes issues with lung development.
Management of diaphragmatic hernia?
Intubation and respiratory support NOT with a mask as gas can distend the bowel and cause further issues
Surgery
->mortality is associated with diaphragmatic hernia, and survivors have long-term impacted lung function
What is neonatal abstinence syndrome?
Withdrawal from physically addictive substances taken by the mother in pregnancy
List some of the things neonates can be in withdrawal from in neonatal abstinence syndrome.
Opioids- methadone, heroin
Benzodiazepines
Cocaine
Amphetamines
How is a diagnosis of neonatal abstinence syndrome made?
Finnegan score
Urine toxicology
->maybe remember the score as being a funny Irish name so maybe it’s a funny Irish person who has addiction issues…idk anything to help
Treatment of neonatal abstinence syndrome?
Comfort e.g. swaddling
Morphine
Phenobarbitone
->phenobarbitone is also first line for neonatal seizures
If suspecting a baby has sepsis, what needs to be commenced within an hour?
Antibiotics
