the sick newborn

Question 1

what is the definition of neonatal?

Answer 1

first 28 days of life

Question 2

what does APGAR stand for?

Answer 2

Appearance
Pulse
Grimace
Activity
Respiration

Question 3

what can a low APGAR score indicate?

Answer 3

a poor outcome

Question 4

what are typical vital signs for a term new born?

Answer 4

RR (40-60)
HR (120-140)
cap refill (2-3 seconds)
colour
O2 Sat (>95% after first 10/20mins)

Question 5

what is involved in the initial management of a new born?

Answer 5

temp control
airway/breathing support (+/- O2)
circulation (if needed fluids and inotropic drugs)
metabolic homeostasis (if needed glucose management)
Abx

Question 6

what can cause a sick baby?

Answer 6

pregnancy/birth related
congenital anomalies
metabolic
infection

Question 7

how does sepsis present in newborns?

Answer 7

Quiet
Poor feeding
Floppy
Tachypnoea
Apnoea
Tachycardia
Bradycardia
Temperature instability –high or low
(All non specific)

Question 8

what are possible sites of infection in a new born?

Answer 8

Blood stream - bacteraemia/septicaemia
CNS - meningitis
Respiratory - pneumonia
Gastrointestinal – Necrotising Entero Colitis
Urinary – UTI

Question 9

what are the antibiotics of choice for treating a new born?

Answer 9

Benzylpenicillin
-Gram +ve and Gram –ve cover
Gentamicin
-Additional Gram –ve cover
cefotaxime is an alternative

Question 10

what are the common viral infections in newborns?

Answer 10

Cytomegalovirus
Parvovirus
Herpes viruses
Enteroviruses

Question 11

what are the classical signs of respiratory distress?

Answer 11

Tachypnoea
Recession
Grunting
Blue, low saturations

Question 12

what is transient tachypnoea of the newborn (TTN)

Answer 12

a delay in clearing lung fluid

Question 13

what is the clearance of lung fluid dependent on?

Answer 13

active epithelial Na channels (activated by adrenaline)

Question 14

what does a CXR in TTN show?

Answer 14

fluid in the horizontal fissure

Question 15

What causes RDS?

Answer 15

a surfactant deficiency

Question 16

what is RDS associated with?

Answer 16

IUGR, Maternal diabetes, Infection, birth asphyxia, multiple birth, PROM and meconium aspiration

Question 17

how does RDS present on a CXR?

Answer 17

ground glass appearance and air bronchograms

Question 18

how is RDS treated?

Answer 18

with respiratory support and surfactant replacement

Question 19

what causes meconium aspiration syndrome (MAS)

Answer 19

foetus gasps and inhales liquor with meconium in it

Question 20

when does MAS usually occur?

Answer 20

after foetal distress

Question 21

what can MAS cause?

Answer 21

airway obstruction, inflammation, surfactant dysfunction
Ranges from mild respiratory distress to very sick babies
MAS in severe form linked with asphyxia and persistent pulmonary hypertension

Question 22

what is hypoxic ischaemic encephalopathy?

Answer 22

multiple organ damage due to tissue hypoxia

Question 23

how can HIE be caused?

Answer 23

placental failure, cord prolapse, rupture or other major event

Question 24

how can HIE be treated

Answer 24

theraputic hypothermia

Question 25

what are some common cardiac presentations in newborns?

Answer 25

Tachypnoea ; but may not have much in the way of signs of respiratory distress Cyanosis - usually not responsive to oxygen Murmur Femoral pulses maybe weak or absent Circulatory collapse (Antenatal or syndromic; T21 for example)

Question 26

does cyanosis in congenital heart diseases usually respond to oxygen?

Answer 26

No

Question 27

name some critical congenital cardiac diseases

Answer 27

Tetralogy of Fallot Transposition of great arteries Coarctation of the aorta TAPVD Hypoplastic heart

Question 28

is hypoglycaemia associated with poor outcomes?

Answer 28

yes if prolonged and symptomatic

Question 29

what is the threshold for hypoglycaemia in a newborn?

Answer 29

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