The Sick Term Baby Flashcards
What are some gross examples of why a term baby might be admitted to the neonatal unit?
- sepsis
- respiratory problems
- cardiac problems
- hypoglycaemia
- hypothermia
- jaundice
- birth asphyxia
- surgical problems
What are symptoms of sepsis in babies?
- labile temperature (may be hyper- or hypo-thermic
- lethargy
- poor feeding
- early jaundice
- hyper-hypo glycaemia
- asymptomatic
What are risk factors for neonatal sepsis?
- maternal pyrexia
- maternal group B strep carriage
- prolonged rupture of membranes >18hrs (PROM)
How would you manage presumed sepsis?
- admit to NNU
- partial septic screen i.e. FBC, CRP, blood cultures
- blood gases
- consider chest X ray or lumber puncture
What would be first line antibiotic treatment for neonatal sepsis?
IV penicillin and gentamicin
What would be second line treatment for neonatal sepsis?
IV vancomycin and gentamicin
What antibiotic should you add if there are surgical/ abdominal concerns in neonatal sepsis?
metronidazole
What are the 5 most common causes of neonatal sepsis?
- group B strep***
- E.coli
- listeria
- coag-neg staph
- haemophilus influenzae
What are 4 congenital infections a child may have? What complications can arise from this?
- ToRCH organisms
- IUGR
- brain calcifications
- neurodevelopmental delay
- visual impairment
- recurrent infections
What are 3 respiratory causes of admission to NNU?
- sepsis
- TTN - transient tachypnoea of the newborn
- meconium aspiration
What is TTN and how does it present?
- baby breathes very fast and usually lasts for first few hours of life then resolves
- grunting, tachypnoea, oxygen requirement, normal gases
How would TTN be managed?
- supportive
- antibiotics
- fluids
- O2
- airway support
What is thought to be the reason for TTN?
delayed clearing of fluid from the lungs
What do we mean by meconium aspiration?
foetal faeces is passed in utero and the bay aspirates it by accident
What are risk factors for meconium aspiration?
- post dates
- maternal diabetes
- maternal hypertension
- difficult labour
What are symptoms and signs of meconium aspiration?
- cyanosis
- increased work of breathing
- grunting
- apnoea
- floppiness
- meconium stained amniotic fluid
What investigations would be carried out in to meconium aspiration?
- blood gas
- septic screen
- chest x ray
What treatment is there for meconium aspiration?
- suction below cords
- airway support-intubation and ventilation
- fluids and antibiotics IV
- surfactant
- inhaled NO
How would you investigate the ‘blue baby’?
- examination and history
- sepsis screen
- blood gas and blood glucose
- chest x ray
- pulse oximetry
- ECG
- echocardiogram
How would you treat the ‘blue baby’?
- ABC
- inotropes as required
- fluid resus
- resp support
- prostin (prostaglandin E2)
- NO
- cardiology referral
How would you manage hypoglycaemia in the newborn and when would you watch for it particularly?
- diabetic mother
- monitor blood glucose
- sart IV 10% glucose
- increase fluids
- increase glucose concentration
- glucagon
- hydrocortisone
What should you do if the baby is hypothermic?
- admit to NNU and place in incubator
- sepsis screen and antibiotics
- consider checking thyroid function
- monitor blood glucose
What is birth asphyxia?
lack of oxygen at or around birth leading to multi organ dysfunction
What can cause birth asphyxia?
- placental problem
- long, difficult delivery
- umbilical cord prolapse
- infection
- neontal airway problem
- neontal anaemia
What are the 2 stages of birth asphyxia?
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
What is a condition reflecting the sequelae of birth asphyxia?
hypoxic ischaemic encephalopathy
Describe the general process behind hypoxic ischaemic encephalopathy.
- 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
How would you manage hypoxic ischaemic encephalopathy?
- therapeutic hypothermia
- treat seizures
- fluid restriction
- monitor for renal and liver failure
- resp and cardiac support
What are some causes of failure to pass stool?
- constipation
- large bowel atresia
- imperforate anus
- hirschsprung’s disease
- meconium ileus (suggestive of CF)