Term Admisssions Flashcards
What are the categories of term admissions?
- Sepsis
- Respiratory problems
- Cardiac problems
- Hypoglycaemia
- Hypothermia
- Jaundice
- Birth asphyxia
- Surgical problems
What are the symptoms of sepsis in a neonate?
- Baby pyrexia or hypothermia
- Poor feeding
- Lethargy
- Early jaundice
- Hypoglycaemia
- Hyperglycaemia
- Asymptomatic
What are the risk factors for sepsis in neonates?
- Premature rupture of membranes
- Maternal pyrexia
- Maternal GBS carriage
How is presumed sepsis managed?
-Admit NNU
-Partial septic screen (FBC, CRP, blood cultures) and blood gas
-Consider CXR, LP
IV penicillin and gentamicin 1st line
-2nd line iv vancomycin and gentamicin
-Add metronidazole if surgical/abdominal concerns
-Fluid management and treat acidosis
-Monitor vital signs and support respiratory and cardiovascular systems as required
What are the commonest organisms implicated in neonatal sepsis?
- Group B streptococci
- E.coli
- Listeria
- Coagulase negative staphylococci (if lines in situ)
- Haemophilus influenzae
When does group B streptococcus sepsis occur?
- Early onset – birth to 1 week
- Late onset or recurrence – up to 3 months
How may babies with GBS sepsis present?
Non-specific symptoms
What are the possible complications of GBS sepsis?
- Meningitis
- DIC
- Pneumonia
- Respiratory collapse
- Hypotension
- Shock
What is the prognosis of GBS sepsis?
4 to 30% mortality
What may congenital infection result in?
- IUGR
- Brain calcifications
- Neurodevelopmental delay
- Visual impairment
- Recurrent infections
- Other
Give examples of congenital infections.
- Toxoplasmosis
- Rubella
- Cytomegalovirus
- Herpes
What may cause respiratory distress?
- Sepsis
- Transient tachypnoea of the newborn
- Meconium aspiration
How does transient tachypnoea of the new-born present?
Usually within the first few hours
- Grunting
- Tachypnoea
- Oxygen requirement
- Normal blood gases
What is the pathophysiology of transient tachypnoea of the new-born?
Delay in clearance of foetal lung fluids
What is the management of transient tachypnoea of the new-born?
- Self-limiting and common
- Supportive management
- Antibiotics
- Fluids
- O2
- Airway support
What is meconium aspiration?
Meconium is inhaled into the lungs
What are the risk factors for meconium aspiration?
- Post dates (aged placenta)
- Maternal diabetes
- Maternal hypertension
- Difficult labour
What are the symptoms of meconium aspiration?
- Cyanosis
- Increased work of breathing
- Grunting
- Apnoea
- Floppiness
How is meconium aspiration investigated?
- Blood gas
- Septic screen
- CXR
How is meconium aspiration treated?
- Suction below cords
- Airway support including intubation and ventilation
- IV fluids and antibiotics
- Surfactant
- NO or ECMO
What is the prognosis of meconium aspiration?
- Most do well
- Some develop PPHN
- There is a associated mortality
When does cyanosis occur?
Cyanosis occurs when there is more than 5g/dl of deoxyhaemoglobin
How is the ‘blue baby’ investigated?
- Examination and history
- Sepsis screen
- Blood gas and blood glucose
- CXR
- Pulse oximetry
- ECG
- ECHO
- Hyperoxia test
What is the differential cardiac diagnosis for the blue baby?
- Transposition of the great arteries
- Teratology of fallots
- TAPVD
- Hypoplastic left heart syndrome
- Tricuspid atresia
- Truncus arteriosus
- Pulmonary atresia
What is the treatment for hypoglycaemia?
- If requires admission to NNU may still manage with enteral feeds
- Monitor blood glucose
- Start iv 10% glucose
- Increase fluids
- Increase glucose concentration (central iv access)
- Glucagon
- Hydrocortisone
How should hypothermia be managed?
- If unable to maintain temperature on PNW admit and place in incubator
- Sepsis screen and antibiotics
- Consider checking thyroid function
- Monitor blood glucose
What may sever jaundice require?
- In severe jaundice may require admission for intensive phototherapy and/or exchange transfusion
- Incubator and IV fluids may also be required
What is birth asphyxia?
Lack of oxygen at or around the birth which leads to multi-organ dysfunction
What are the causes if birth asphyxia?
- Placental problem
- Long, difficult delivery
- Umbilical cord prolapse
- Infection
- Neonatal airway problem
- Neonatal anaemia
What is the first stage of birth asphyxia?
- Occurs within minutes without O2
- Cell damage occurs with lack of blood flow and O2
What is the second stage of birth asphyxia?
- Reperfusion injury
- Can last days or weeks
- Toxins are released from damaged cells
What are the degrees of hypoxic ischaemic encephalopathy?
- Mild
- Moderate
- Severe
How is birth asphyxia managed?
- Supportive
- Fluid restriction (avoid cerebral oedema)
- Monitor for renal and liver failure
- -Respiratory support
- Cardiac support
- Treat seizures
- Therapeutic hypothermia (cooling): improves outcomes especially in the moderate group
What surgical problems may babies be admitted with?
- Oesophageal atresia/fistula
- Duodenal atresia and other GI atresias
- Causes of failure to pass stool
- Abdominal wall defects
- Diaphragmatic hernia
What causes of failure to pass stool are there?
- Constipation
- Large bowel atresia
- Imperforate anus +/- fistula
- Hirschsprungs disease
- Meconium ileus (think CF)
What abdominal wall defects can occur?
- Exomphalos
- Gastroschisis
What is the epidemiology of diaphragmatic hernias?
- 1 in 2500 births
- 90% on left
- M>F
- Can be syndromic
How are diaphragmatic hernias managed?
- Intubation at birth
- Respiratory support
- Surgery
- (ECMO)
What do diaphragmatic hernias usually present with?
Pulmonary hypoplasia
