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Paediatrics 4MB > The Ill Newborn/Neonatal Collapse > Flashcards

The Ill Newborn/Neonatal Collapse Flashcards

1
Q

Define Early Onset Infection

A

Infection <48hrs after birth

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2
Q

What are the causes of early onset infection?

A
  1. Bacteria from the birth canal ascending and invading amniotic fluid with secondary infection of the foetus
  2. Pneumonia and secondary bacteraemia/septicaemia
  3. Congenital viral infections
  4. Early onset Listeria monocytogenes infection
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3
Q

List the risk factors for early onset infection

A
  1. Prolonged or premature rupture of membranes

2. Maternal fever during labour

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4
Q

How does neonatal infection present?

A
  1. Respiratory distress
  2. Temperature instability
  3. Poor feeding
  4. Vomiting
  5. Apnoea and bradycardia
  6. Abdominal distension
  7. Jaundice
  8. Neutropenia
  9. Hypoglycaemia/Hyperglycaemia
  10. Shock
  11. Irritability
  12. Seizures
  13. Lethargy/drowsiness
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5
Q

What investigations would you perform if you suspected neonatal infection?

A
  1. CXR
  2. Septic screen:
    - FBC
    - Blood cultures
    - CRP
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6
Q

How can we manage neonatal infection?

A
  1. IV antibiotics ASAP:
    - Amoxicillin + CefoTAXime
    - Gentamicin for gram negative cover
  2. If confirmed GBS:
    - Benzylpenicillin IV + Gentamicin IV
  3. If cultures and CRP negative and no clinical indicators:
    - Stop antibiotics after 36-48hrs
  4. Blood culture positive or neurological signs:
    - CSF examined and cultured
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7
Q

Define Late Onset Infection

A

Infection >48hrs after birth

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8
Q

What are the sources of late onset infection?

A
  1. Infant’s environment
  2. NICU:
    - Indwelling CVC
    - Invasive procedures
    - Tracheal tubes
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9
Q

What is the most common pathogen associated with late onset infection?

A

Coagulase negative staphylococcus - e.g Staph epidermidis

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10
Q

What are the risks of prolonged broad spectrum antibiotic use in preterm infants?

A

Predisposes to invasive fungal infection

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11
Q

How can we measure the response to therapy in neonatal infection?

A

Serial CRP measurements

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12
Q

How does neonatal meningitis present?

A
  1. Nonspecific signs
  2. Late signs:
    - Bulging fontanelle
    - Hyperextension of the neck and back
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13
Q

How is neonatal meningitis treated?

A

IV Amoxicillin and CefoTAXime and consider gentamicin for gram neg cover

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14
Q

List the complications of neonatal meningitis

A
  1. Cerebral abscess
  2. Ventriculitis
  3. Hydrocephalus
  4. Hearing loss
  5. Neurodevelopmental impairment
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15
Q

When does Group B Streptococcal (GBS) infection present?

A

Can be early or late onset infection

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16
Q

What are the features of early onset GBS disease?

A
  1. Respiratory distress
  2. Pneumonia
  3. Mortality with positive blood or CSF cultures up to 10%
17
Q

How does late onset GBS disease present?

A
  1. Meningitis
  2. Focal infection (occasionally)
  3. Can be developed up to 3mths of age
18
Q

What are the risk factors for developing GBS infection?

A
  1. Preterm
  2. Prolonged rupture of membranes
  3. Maternal fever during labour (>38)
  4. Maternal chorioamnionitis
  5. Previously infected infant
19
Q

How can GBS infection be prevented?

A

Intrapartum antibiotic prophylaxis given to those at risk

20
Q

How is Listeria monocytogenes infection transmitted to the mother?

A

Transmitted in food:

  1. Unpasteurised milk
  2. Soft cheeses
  3. Undercooked poultry
21
Q

How does Listeria infection present in the mother and transmit to the foetus?

A

Presents as mild bacteremia and mild flu-like illness in the mother
Transmits to foetus across placenta

22
Q

List the consequences of maternal infection with Listeria

A
  1. Spontaneous abortion
  2. Preterm delivery
  3. Fetal/neonatal sepsis
23
Q

What are the characteristic features of Listeria infection?

A
  1. Meconium stained liquor
  2. Widespread rash
  3. Septicaemia
  4. Pneumonia
  5. Meningitis
24
Q

What is the mortality rate with Listeria infection?

A

30%

25
Q

What are the common causes of neonatal conjunctivitis?

A
  1. Staphylococcal and Streptococcal organisms
  2. Gonococcal infection
  3. Chlamydia trachomatis infection
26
Q

What are the features of Staph/Strep conjunctivitis and how is it managed?

A 
Features:
 - Discharge
 - Redness of the eye
Management:
 - Clean with saline or water
 - Topical antibiotic eye ointment (Chloramphenicol or Neomycin)
27
Q

What are the features of gonococcal conjunctivitis and how is it managed?

A

Features:
- Purulent discharge (gram stained and cultured URGENTLY)
- Swelling of eyelids (<48hrs after birth)
Management:
- Clean with saline or water
- Immediate 3rd generation cephalosporin IV or penicillin
- Cleanse eye frequently
May lead to permanent loss of vision

28
Q

What are the features of Chlamydia conjunctivitis and how is it managed?

A

Features:
- Purulent discharge (immunofluorescent staining)
- Swelling of eyelids (1-2wks after birth)
Management:
- Clean with saline or water
- Erythromycin PO for 2wks
- Mother and partner checked and treated

29
Q

List the risk factors for Herpes Simplex Virus infection in neonates

A
  1. Infant born to mother with primary genital infection
  2. Recurrent maternal infection
  3. More common in preterm infants
30
Q

How does HSV infection in neonates present?

A
  1. Any time up to 4wks after delivery
  2. Localised herpetic lesions on skin or eye
  3. Encephalitis
  4. Disseminated disease (HIGH MORTALITY)
31
Q

How can we prevent neonatal HSV infection?

A 
Mother with primary genital infection:
 - Elective C-Section
Mother with hx of recurrent genital infections:
 - Deliver vaginally
 - Maternal treatment before delivery
32
Q

How can we prevent vertical transmission of Hepatitis B infection?

A

Give the Hepatitis B vaccine shortly after birth
Complete course of vaccinations during infancy
Check antibody response

33
Q

What are The Sepsis Six?

A 
GIVE THREE:
1. Oxygen
2. Antibiotics
3. Fluids
TAKE THREE:
1. Blood cultures
2. Urine output
3. Lactate
34
Q

List the most common causes of neonatal meningitis/sepsis?

A

Group B Strep
Eschericia coli
Listeria moncytogenes

35
Q

What features will be present in the history of a neonate with sepsis?

A
  1. Fever
  2. Poor feeding
  3. Miserable, irritable, lethargy
  4. History of focal infection
  5. Predisposing conditions
36
Q

List the features that may be present on examination of a neonate with sepsis

A
  1. Fever
  2. Tachycardia, tachypnoea, low BP
  3. Purpuric rash
  4. Shock
  5. Multi-organ failure
37
Q

What are the management priorities in a neonate with sepsis?

A
  1. ANTIBIOTICS without delay
  2. FLUIDS and monitoring of fluid balance
  3. CIRCULATORY SUPPORT - usually inotropic
  4. Beware of DIC - treat clotting derangement with FFP, cryoprecipitate and platelet transfusions

Paediatrics 4MB (22 decks)

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