Term Admissions to NNU Flashcards
Symptoms of sepsis in term neonates
Baby pyrexia Hypothermia Poor feeding Lethargy Early jaundice Hypoglycaemia Hyperglycaemia Asymptomatic
Risk factors for sepsis in term neonates
PROM
maternal pyrexia
maternal GBS carriage
Investigations of presumed sepsis
Admit NUU
Partial septic screen (FBC, CRP, blood cultures) and blood gasses
Consider CXR, LP
Treatment of presumed sepsis
IV penicillin and gentamicin 1st line IV vancomycin and gentamycin 2nd line Add metronidazole if surgical/abdominal concerns Fluid management Treat acidosis Monitor vital signs treat CSV and resp systems as required
Commonest causes of neonatal sepsis
- Group B streptococcus
- E coli
- Listeria
- coag-neg staphlycocci (if lines in situ)
- haemophilus influenzae
How long is early onset GBS sepsis?
birth to one week
How long is late onset or recurrence GBS sepsis?
Up to 3 months
Complications of GBS sepsis
Meningitis DIC pneumonia Resp collapse hypotension shock
Prognosis of GBS sepsis
4 - 30% mortality
Congenital infections (ToRCH)
Toxoplasmosis
Rubella
CMV
Herpes
What can congenital infections result in?
IUGR Brain calcifications Neurodevelopment delay Visual impairment Recurrent infections Cataracts / retinitis Pneumonitis Hepatomegaly Jaundice Hepatitis Anaemia Neutropenia Thrombocytopenia Splenomegaly Bone abnormalities Cardiomegaly / PDA Microcephalus Deafness
Causes of respiratory distress
Sepsis
TTN
Meconium aspiration
What does TTN stand for?
Transient tachypnoea of the newborn
When does TTN present?
within 1st few hours of life
Presentation of TTN
Grunting
Tachypnoea
Oxygen requirement
Normal gases
Pathology of TTN
delay in clearance of foetal lung fluids
Treatment of TTN
supportive Ax fluids O2 airway support
What is meconium aspiration?
Meconium is inhaled into the lungs
What is meconium?
Earliest stool of a mammalian infant
Risk factors for meconium aspiration
Post dates (aged placenta)
Maternal DM
Maternal HTN
difficult labour
Symptoms of meconium aspiration
Cyanosis Increased work of breathing grunting apnoea floppiness
Investigations of meconium aspiration
Blood gas
septic screen
CXR
Treatment of meconium aspiration
Suction below cords Airway support - intubation and ventilation Fluids Antibiotics Surfactant NO or ECMO
Prognosis of meconium aspiration
Most do well
Some develop PPHN
There is an associated mortality
What does PPHN stand for?
Persistent pulmonary HTN of the newborn
The _____ baby needs urgent treatment
Blue
What level of deoxyhaemoglobin is there when cyanosis occurs?
> 5g/dl
Investigations of the blue baby
Exam and history sepsis screen blood gas + blood glucose CXR pulse oximetry ECG ECHO (hyperoxia test)
Differential diagnosis of the blue baby
TGA Teratology of fallots TAPVD Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia
Management of hypoglycaemia in NNU
Start IV 10% glucose Increase fluids Increase glucose concentration (central IV access) Glucagon Hydrocortisone
What is an IUGR twin prone to?
Hypoglycaemia
What do you have to monitor in hypothermia?
Sepsis screen
Thyroid function
Blood glucose
Treatment of hypothermia
Incubator
Antibiotics if needed
When would jaundice need admission to NNU?
Severe jaundice for intensive phototherapy and/or exchange transfusion
Incubator and IV fluids may be required
What is birth asphyxia?
Lack of oxygen at or around birth leading to multiorgan dysfunction
Causes of birth asphyxia
Placental problem Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia
Stages of birth asphyxia
1st stage - within minutes without O2 - cell damage occurs with lack of blood flow and O2 2nd stage - reperfusion injury - can last days or weeks - toxins are released from damaged cells
Management of hypoxic ischaemic encephalopathy
Therapeutic hypothermia (cooling) Treat seizures Supportive Fluid restriction (to avoid cerebral oedema) Monitor for renal and liver failure Resp support Cardiac support
Surgical problems in the NNU
Oesophageal atresia/fistula Duodenal atresia and other GI atresias Causes of failure to pass stool Abdominal wall defects Diaphragmatic hernia
Causes of failure to pass stool
Constipation Large bowel atresia imperforate anus +/- fistula Hirschspurngs disease Meconium ileus - think CF
What is meconium ileus?
Meconium ileus is a bowel obstruction that occurs when the meconium in your child’s intestine is even thicker and stickier than normal meconium, creating a blockage in the ileum
What gender gets diaphragmatic hernias?
M > F
Treatment for diaphragmatic hernias
Intubation at birth
resp support
surgery
What sign would indicate a diaphragmatic hernia in a cyanosed baby?
Evidence of bowel sounds on respiratory exam
What occurs alongside congenital diaphragmatic hernia?
Pulmonary hypoplasia
