The Sick newborn Flashcards
Clinical Assessment?
Respiratory rate: 40 – 60 / minute
Work of breathing / respiratory effort
HR: 120 - 140 / minute
Cap refill 2 - 3 seconds
Colour – pink/blue/white
SaO2 95% or above
BP ?
Others – jaundice, low tone (floppy), seizures, poor feeding, bilious vomit
Initial Management?
Temperature control (crucial as baby gets hypoglyceamic if gets cold)
Airway and breathing
Airway support +/- oxygen
Circulation
Fluids
Inotropic drugs
Metabolic homeostasis
Glucose management
Acid-base balance - is correction required
Antibiotics
Ongoing Management?
- Diagnostic work-up
- Further support
- Ventilation
- Drugs
- Specific therapy e.g. therapeutic cooling
- Surgery
- Transfer
- Care of family
How does sepsis present?
Non-specific
Quiet
Poor feeding
Floppy
Tachypnoea
Apnoea
Tachycardia
Bradycardia
Temperature instability –high or low (baby tends to be cold when they have sepsis)
Sites of infection?
Blood stream - bacteraemia (Bac in the blood stream) /septicaemia (When bacteraemia gets abnormal and gets high)
CNS - meningitis
Respiratory - pneumonia
Gastrointestinal – Necrotising Entero Colitis
Urinary – UTI
Others:
Skin
Bone
Bacterial Infections?
Group B Streptococcus
E. Coli
Staphylococcus aureus
Antibiotic Choice?
Benzylpenicillin – Gram positive cover – bactericidal
Gentamicin – broad Gram negative cover – bactericidal
Viral infections?
Cytomegalovirus
The term TORCH screen?
Toxoplasma, Others (syphillis, HepB), Rubella, CMV and Herpes
Syphilis?
- Highest risk when woman has early stage syphilis (infection within last 2 years)
- Treatment 30 days prior to delivery for reducing congenital infection
What are the Pregnancy/Birth Related Pathologies?
Respiratory – Transient Tachypnoea of Newborn/Pneumothorax/Meconium aspiration/Respiratory Distress Syndrome
Birth Asphyxia- lack of oxygen and blood flow to the brain
Circulatory- Persistent Pulmonary Hypertension/Foetal anaemia
Clinical signs of respiratory distress?
Tachypnoea
Recession
Grunting
Blue, low saturations
Transient Tachypnoea of the Newborn (TTN)?
- the most common cause of Tachypnoea
- Most common in term infants delivered by Caesarean section
- Due to delay in clearing lung fluid (fluid in the lungs does not clear away)
- Lung fluid usually clears into interstitium and then to lymphatic system
- Dependant on active **epithelial Na channels **– activated by adrenaline
- CXR shows fluid in the horizontal fissure
*Fluid goes into interstitm and then blood stream with first gasp of the air. The Na channel doesn’t shot down and more fluid produces after birth
Pneumothorax
- spontaneously
- Due to meconium/ infection/resuscitation/surfactant deficiency
- Conservative management vs chest drain insertion
Respiratory distress syndrome?
- Surfactant deficiency can occur in term infants
- Much more common in preterm infants
- Associated with
-IUGR (not growth enough in the womb),
-Maternal diabetes
-infection
-birth asphyxia (lack of O2 and blood to the brain)
-Meconium aspiration - CXR – Ground glass appearance
- Mx- is with respiratory support and surfactant replacement
Meconium Aspiration Syndrome (MAS)?
- When the baby pass the stools in the womb and amniotic and breathes it in during distress delivery, (fetal distress sign).
- Common (up to 20% of term deliveries, rare in preterm)
- Meconium can cause airway obstruction, inflammation, surfactant dysfunction
- MAS in severe form linked with asphyxia and persistent pulmonary hypertension
Hydrops Fetalis is one of the causes of baby’s heart failure. what is it??
- Hydrops fetalis is severe swelling (edema) from too much fluid leaves the baby’s bloodstream and goes into the tissues like liver
As a result of - rhesus disease
- chromosomal
What is the another heart failure cause aprat from hydrops fetalis?
Failure to adapt to postnatal life - persistent pulmonary hypertension of the newborn (PPHN)
Cardiac Presentations?
- 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
Critical Congenital Cardiac diseases?
- Tetralogy of Fallot
- Transposition of great arteries
- Coarctation of the aorta (a part of the aorta is narrower than usual)
- TAPVD-Total Anomalous Pulmonary Venous Drainage is where “the four pulmonary veins do not drain into the left atrium but instead drain via unique pathways into the right atrium or systemic veins”
- Hypoplastic heart (incomplete LV)
Give a disease example for each of the following:
Neurological
Renal
Muscular
Neurological: Microcephaly, Spina bifida
Renal: Potters syndrome
Muscular: Myotonic dystrophy
Why baby can have hypoglycaemia and Acidosis?
- Hypoglycaemia
- Reduced to ‘reserves’ - LBW/SGA (Low Birth Weight/ Small at Gestational Age)
- Related to maternal disease - IDM (Infant of a Diabetic Mother)
- Evidence of more complex metabolic disorder
- Acidosis - inborn error of metabolism
