the sick new born Flashcards
what is the definition for a term infant?
babies born at 37 weeks gestation and above
what is neonatal period?
the first 28 days in life
what would be taken in a history to clinically assess a neonate?
Maternal:
- PMH
- pregnancy issues
- drugs
- infection risks
Fetal:
- fetal growth
- fetal anomaly
- delivery
- resuscitation
what would be inspected in a clinical assessment of a neonate?
- tone
- level of arousal
- colour
what vital signs are taken in a clinical assessment of a neonate?
- heart rate, perfusion
- respiratory rate
- cap refill
- SaO2
what scoring system is used to assess neonates quickly after birth?
-Apgar score
when is Apgar score done?
usually scored at 1 minute and then at 5 minutes and sometimes longer if necessary
what is measured in Apgar soring?
Appearance (skin colour) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiration
what is normal RR in a newborn baby?
40-60 breaths/minute
what is a normal HR in a newborn baby?
120-140 bpm
whart is a normal capillary refill time in babies?
2-3 seconds
what is a normal SaO2 in a baby?
95%
what occurs to SaO2 in babies when born?
-O2 sats will gradually increase and don’t reach above 90% until about 10 minutes old
what is the normal temperature for babies?
36.5- 37.4 degrees Celcius
what is initial management of newborns?
- temperature (36.5-37.4)
- assess and support baby’s breathing
- circulation may need supporting using fluids and in very unwell babies use inotroped
- metabolic homeostasis must be established (glucose management, acid-base balance correction)
- antibiotics if infection
what usually causes antenatal infection?
-bacterial infection
what usually causes perinatal infection in babies?
-viral infection
what usually causes postnatal infections in babies?
-fungal infection
how does sepsis present in a newborn baby?
- quiet
- poor feeding
- tachypnoea
- apnoea
- tachycardia
- bradycardia
- temperature instability
where can infection present in neonates?
- blood stream
- CNS
- respiratory
- GU
others:
- skin
- bone
- GI
what is an example of a blood stream infection?
-bacteraemia/ septicaemia
what is an example of a CNS infection?
-meningitis
what bacterial infection is common in mums and what is done to pick it up early?
-group B strep
screening progamme in place for pregnant women
when is staphilococcus aureus infection usually seen in neonates?
-when IV fluids used and needles
what are some common bacterial infections seen in neonates?
- group B streptococus
- E.coli
- staphylococcus aureus
- staph epidermis
- staph capitis
- Klebsiella Oxytoca
- Listeria monocytogenes
what is first line antibiotic choice for neonatal sepsis?
Benzylpenicillin and gentamicin
what is the most common bacteria in neonatal sepsis?
Group B strep
what are some examples of viruses that may affect a neonate?
- cytomegalovirus
- parvovirus
- herpes viruses
- enteroviruses
Other:
- syphilis
- toxoplasma gondii
- HIV
- TORCH
what are some examples of viruses that may affect a neonate?
- cytomegalovirus
- parvovirus
- herpes viruses
- enteroviruses
Other:
- syphilis
- toxoplasma gondii
- HIV
- TORCH
what causes syphilis?
-Treponema Pallidum readily crossing the placenta
when are babies at highest risk of catching syphilis?
-when mum has early stage syphilis (infection within last 2 years)
what can reduce a mother passing on syphilis to her neonate?
-if treatment is given 30 days prior to delivery
what are some pregnancy/birth related respiratory pathologies?
- TTN
- pneumothorax
- meconium aspiration
- RDS
- birth asphyxia
what are some clinical signs of respiratory distress?
- tachypnoea
- subcostal and intercostal recession
- grunting
- blue
- low sats
who is TTN (transient tachypnoea of the newborn) usually seen in?
-in term infants delivered by caesarean section
what is transient tachypnoea of the newborn (TTN)?
-a breathing disorder seen shortly after birth due to delay in clearing lung fluid
how is lung fluid cleared out in a healthy newborn?
-usually clears into interstitium and then in to lymphatic system
what does the clearing out of lung fluid depend on ?
-dependant on active Na channels, activated by adrenaline
how long does it take for transient tachypnoea of the newborn to resolve?
-resolves over the first 24 hours of life
what would a CXR of a neonate with transient tachypnoea of the newborn (TTN) show?
-CXR shows fluid in horizontal fissure
what causes a pneumothorax to occur in a neonate?
-can occur spontaneously
secondary to:
- resus
- infection
- meconium
- surfactant deficiency
what causes respiratory distress syndrome?
-surfactant deficiency
who is RDS more common in?
-preterm infants
what is RDS associated with?
- IUGR
- maternal diabetes
- infection
- birth asphyxia
- multiple birth
- PROM
- meconium aspiration
how does RDS appear on a CXR?
-ground glass appearance
what is treatment for respiratory distress syndrome??
-respiratory support and surfactant replacement
who is meconium aspiration syndrome more common in?
-more common in later gestation
what is meconium aspiration syndrome?
-when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery
what can meconium aspiration syndrome cause?
- airway obstruction
- inflammation
- surfactant dysfunction
what is hypoxic ischaemic encephalopathy?
-multi organ tissue damage due to tissue hypoxia
