The Sick Term Baby

Question 1

What are some gross examples of why a term baby might be admitted to the neonatal unit?

Answer 1

• sepsis
• respiratory problems
• cardiac problems
• hypoglycaemia
• hypothermia
• jaundice
• birth asphyxia
• surgical problems

Question 2

What are symptoms of sepsis in babies?

Answer 2

• labile temperature (may be hyper- or hypo-thermic
• lethargy
• poor feeding
• early jaundice
• hyper-hypo glycaemia
• asymptomatic

Question 3

What are risk factors for neonatal sepsis?

Answer 3

• maternal pyrexia
• maternal group B strep carriage
• prolonged rupture of membranes >18hrs (PROM)

Question 4

How would you manage presumed sepsis?

Answer 4

• admit to NNU
• partial septic screen i.e. FBC, CRP, blood cultures
• blood gases
• consider chest X ray or lumber puncture

Question 5

What would be first line antibiotic treatment for neonatal sepsis?

Answer 5

IV penicillin and gentamicin

Question 6

What would be second line treatment for neonatal sepsis?

Answer 6

IV vancomycin and gentamicin

Question 7

What antibiotic should you add if there are surgical/ abdominal concerns in neonatal sepsis?

Answer 7

metronidazole

Question 8

What are the 5 most common causes of neonatal sepsis?

Answer 8

• group B strep***
• E.coli
• listeria
• coag-neg staph
• haemophilus influenzae

Question 9

What are 4 congenital infections a child may have? What complications can arise from this?

Answer 9

• ToRCH organisms
• IUGR
• brain calcifications
• neurodevelopmental delay
• visual impairment
• recurrent infections

Question 10

What are 3 respiratory causes of admission to NNU?

Answer 10

• sepsis
• TTN - transient tachypnoea of the newborn
• meconium aspiration

Question 11

What is TTN and how does it present?

Answer 11

• baby breathes very fast and usually lasts for first few hours of life then resolves
• grunting, tachypnoea, oxygen requirement, normal gases

Question 12

How would TTN be managed?

Answer 12

• supportive
• antibiotics
• fluids
• O2
• airway support

Question 13

What is thought to be the reason for TTN?

Answer 13

delayed clearing of fluid from the lungs

Question 14

What do we mean by meconium aspiration?

Answer 14

foetal faeces is passed in utero and the bay aspirates it by accident

Question 15

What are risk factors for meconium aspiration?

Answer 15

• post dates
• maternal diabetes
• maternal hypertension
• difficult labour

Question 16

What are symptoms and signs of meconium aspiration?

Answer 16

• cyanosis
• increased work of breathing
• grunting
• apnoea
• floppiness
• meconium stained amniotic fluid

Question 17

What investigations would be carried out in to meconium aspiration?

Answer 17

• blood gas
• septic screen
• chest x ray

Question 18

What treatment is there for meconium aspiration?

Answer 18

• suction below cords
• airway support-intubation and ventilation
• fluids and antibiotics IV
• surfactant
• inhaled NO

Question 19

How would you investigate the ‘blue baby’?

Answer 19

• examination and history
• sepsis screen
• blood gas and blood glucose
• chest x ray
• pulse oximetry
• ECG
• echocardiogram

Question 20

How would you treat the ‘blue baby’?

Answer 20

• ABC
• inotropes as required
• fluid resus
• resp support
• prostin (prostaglandin E2)
• NO
• cardiology referral

Question 21

How would you manage hypoglycaemia in the newborn and when would you watch for it particularly?

Answer 21

• diabetic mother
• monitor blood glucose
• sart IV 10% glucose
• increase fluids
• increase glucose concentration
• glucagon
• hydrocortisone

Question 22

What should you do if the baby is hypothermic?

Answer 22

• admit to NNU and place in incubator
• sepsis screen and antibiotics
• consider checking thyroid function
• monitor blood glucose

Question 23

What is birth asphyxia?

Answer 23

lack of oxygen at or around birth leading to multi organ dysfunction

Question 24

What can cause birth asphyxia?

Answer 24

• placental problem
• long, difficult delivery
• umbilical cord prolapse
• infection
• neontal airway problem
• neontal anaemia

Question 25

What are the 2 stages of birth asphyxia?

Answer 25

1st

• within minutes without O2
• cell damage occurs with lack of blood flow and O2

2nd

• reperfusion injury
• can last days or weeks
• toxins are released from damaged cells

Question 26

What is a condition reflecting the sequelae of birth asphyxia?

Answer 26

hypoxic ischaemic encephalopathy

Question 27

Describe the general process behind hypoxic ischaemic encephalopathy.

Answer 27

• primary phase where you get acute injury and primary energy failure occurs within minutes to hours
• latent phase in which reperfusion occurs over 6-15 hours
• secondary phase where you get delayed injury and second energy failure which happens in hours to days

Question 28

How would you manage hypoxic ischaemic encephalopathy?

Answer 28

• therapeutic hypothermia
• treat seizures
• fluid restriction
• monitor for renal and liver failure
• resp and cardiac support

Question 29

What are some causes of failure to pass stool?

Answer 29

• constipation
• large bowel atresia
• imperforate anus
• hirschsprung’s disease
• meconium ileus (suggestive of CF)