the sick newborn Flashcards
what is the definition of neonatal?
first 28 days of life
what does APGAR stand for?
Appearance
Pulse
Grimace
Activity
Respiration
what can a low APGAR score indicate?
a poor outcome
what are typical vital signs for a term new born?
RR (40-60)
HR (120-140)
cap refill (2-3 seconds)
colour
O2 Sat (>95% after first 10/20mins)
what is involved in the initial management of a new born?
temp control
airway/breathing support (+/- O2)
circulation (if needed fluids and inotropic drugs)
metabolic homeostasis (if needed glucose management)
Abx
what can cause a sick baby?
pregnancy/birth related
congenital anomalies
metabolic
infection
how does sepsis present in newborns?
Quiet
Poor feeding
Floppy
Tachypnoea
Apnoea
Tachycardia
Bradycardia
Temperature instability –high or low
(All non specific)
what are possible sites of infection in a new born?
Blood stream - bacteraemia/septicaemia
CNS - meningitis
Respiratory - pneumonia
Gastrointestinal – Necrotising Entero Colitis
Urinary – UTI
what are the antibiotics of choice for treating a new born?
Benzylpenicillin
-Gram +ve and Gram –ve cover
Gentamicin
-Additional Gram –ve cover
cefotaxime is an alternative
what are the common viral infections in newborns?
Cytomegalovirus
Parvovirus
Herpes viruses
Enteroviruses
what are the classical signs of respiratory distress?
Tachypnoea
Recession
Grunting
Blue, low saturations
what is transient tachypnoea of the newborn (TTN)
a delay in clearing lung fluid
what is the clearance of lung fluid dependent on?
active epithelial Na channels (activated by adrenaline)
what does a CXR in TTN show?
fluid in the horizontal fissure
What causes RDS?
a surfactant deficiency
what is RDS associated with?
IUGR, Maternal diabetes, Infection, birth asphyxia, multiple birth, PROM and meconium aspiration
how does RDS present on a CXR?
ground glass appearance and air bronchograms
how is RDS treated?
with respiratory support and surfactant replacement
what causes meconium aspiration syndrome (MAS)
foetus gasps and inhales liquor with meconium in it
when does MAS usually occur?
after foetal distress
what can MAS cause?
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
what is hypoxic ischaemic encephalopathy?
multiple organ damage due to tissue hypoxia
how can HIE be caused?
placental failure, cord prolapse, rupture or other major event
how can HIE be treated
theraputic hypothermia
what are some common cardiac presentations in newborns?
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)
does cyanosis in congenital heart diseases usually respond to oxygen?
No
name some critical congenital cardiac diseases
Tetralogy of Fallot
Transposition of great arteries
Coarctation of the aorta
TAPVD
Hypoplastic heart
is hypoglycaemia associated with poor outcomes?
yes if prolonged and symptomatic
what is the threshold for hypoglycaemia in a newborn?
<2.6
