the sick term infant

Question 1

how long is the neonatal period?

Answer 1

first 28 days of life

Question 2

what are the normal vital signs for a neonate?

Answer 2

resp rate 40-60/min
HR 120-140/min
cap refill 2-3s
sa O2 95%+

Question 3

what should you assess in clinical assessment of a neonate?

Answer 3

resp rate, respiratory effort, HR, cap refill, colour, saO2, BP, look for jaundice, tone, seizures, poor feeding & bilious vomit

Question 4

how does sepsis present in neonates?

Answer 4

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

Question 5

what are the common sites of infection in neonates?

Answer 5

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

Question 6

what are the 2 most common bacterial infections in neonates?

Answer 6

group B strep
E. coli

Question 7

what are the antibiotics of choice for neonates?

Answer 7

benzylpenicillin (gram + & - cover) & gentamicin (additional gram - cover)

cefotaxime is an alternative

Question 8

what are the common viral infections in neonates?

Answer 8

Cytomegalovirus
Parvovirus
Herpes viruses
Enteroviruses

Question 9

what are the congenital symptoms of syphilis?

Answer 9

are bone abnormalities, anaemia, hepatosplenomegaly, eye problems, jaundice, meningitis, rashes

Question 10

when should you treat syphilis in pregnancy to reduce congenital infection?

Answer 10

30 days prior to delivery

Question 11

what are the clinical signs of respiratory distress?

Answer 11

Tachypnoea
Recession
Grunting
Blue, low saturations

Question 12

describe transient tachpnoea of the newborn (TTN)

Answer 12

Most common in term infants delivered by C section
Due to delay in clearing lung fluid
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
Resolves over the first 24 hours of life

Question 13

what causes neonatal pneumothorax?

Answer 13

can occur spontaneously
or due to meconium, infections, resuscitation or surfactant deficiency

can be managed conservatively or with chest drain insertion

Question 14

what are some associations with RDS in neonates?

Answer 14

intrauterine growth restriction (IUGR), Maternal diabetes, infection, birth asphyxia, multiple birth, premature rupture of membranes (PROM), Meconium aspiration

Question 15

what is the CXR appearance of RDS?

Answer 15

ground glass and air bronchograms (dark air filled bronchi made visible by white alveoli)

Question 16

describe meconium aspiration syndrome (MAS)

Answer 16

MAS usually occurs following signs of foetal distress
Foetus makes gasps and inhales liquor with meconium in it
Meconium can 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

(baby secretes meconium whilst still in utero and inhales it)

Question 17

describe hypoxic ischaemic encephalopathy

Answer 17

Multi organ damage (Brain, kidneys, liver, gut) due to tissue hypoxia
can be due to placental failure, cord prolapse, uterine rupture or other major event
Poor Apgar scores – active resuscitation required
Neurodevelopmental sequelae - variable prognosis
Therapeutic hypothermia improves neurodevelopmental outcomes

Question 18

what causes heart failure in neonates?

Answer 18

rhesus disease, chromosomal, failure to adapt to postnatal life

Question 19

what are the presentations of cardiac disease in neonates?

Answer 19

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

Question 20

what are the critical congenital cardiac diseases?

Answer 20

Tetralogy of Fallot (most common)
Transposition of great arteries
Coarctation of the aorta
Total anomalous pulmonary venous drainage (TAPVD)
Hypoplastic heart

Question 21

what are the presentations of inborn errors of metabolism?

Answer 21

acidosis, hypoglycaemia & sepsis (also galactosaemia but not screened for)

Question 22

what scoring system is used for neonatal abstinence syndrome (NAS)?

Answer 22

modified finnegan score (measures opiate withdrawal), 2 scores of 8 or more is considered withdrawal

Question 23

what are the possible consequences of neonatal opiate withdrawal and how can it be managed?

Answer 23

seizures (also diarrhoea and irritability) - can be managed by swaddling to calm, breastfeeding from mother which will stop withdrawals as opiates can travel through breast milk, medication when 3 scores >8 in 4 hours (drug of choice is oral morphine solution)