The Sick Term Infant

Question 1

When is the neonatal period?

Answer 1

Between birth and 28 days

Question 2

When might a neonate become unwell?

Answer 2

• At delivery
• First few hours of life
• First few days
• Up to 28 days

Question 3

Outline the 5 components of the Apgar score.

Answer 3

• Heart rate
• Resp. effort
• Tone
• Colour
• Response
• Total

Question 4

What is the total amount of points you can score in Apgar?

Answer 4

10

Question 5

What are the different categories of Apgar able to score?

Answer 5

0, 1 or 2

Question 6

What should be asked in a neonatal exam with regards to history?

Answer 6

Maternal hx – PMH (incl. thyroid disease), pregnancy issues, drugs, infection risks

Infant – fetal growth, fetal anomaly, delivery, resuscitation

Question 7

What 3 things should you cover in inspection during neonatal exam?

Answer 7

• Tone.
• Level of arousal.
• Colour.

Question 8

What vital signs should you check during a neonatal exam?

Answer 8

• Heart rate.

* Respiratory rate.

Question 9

What is the normal range of resp rate for a newborn baby?

Answer 9

40-60 breaths per minute

Question 10

Should you always measure baby BP during a neonatal exam?

Answer 10

NO - only if the baby is sick

Question 11

What should SaO2 be?

Answer 11

95% or above

Question 12

What type of vomit is important to ask about?

Answer 12

Billous

Question 13

If a baby has in infection, think when could this have been acquired ….

Answer 13

• Antenatal.
• Perinatal.
• Postnatal.

Question 14

Who gets UTI’s more in the first few months of life?

Answer 14

Boys

Question 15

Give 5 examples of bacterial infections which more commonly affect neonates.

Answer 15

• Group B Streptococcus. (v dangerous – reason we use benzylpenicillin and gent)
• E. coli.
• Listeria myocytogenes.
• Staphylococcus aureus.
• Staph epidermidis.

Question 16

Give examples of viral (+ other) infections that commonly affect newborns?

Answer 16

• Cytomegalovirus.
• Parovirus.
• Herpes virus.
• Enteroviruses.
• Others: toxoplasma gondii, HIV, syphilis – Treponema pallidum, TORCH.

Question 17

What is Hypoxic Ischaemic Encephalopathy?

Answer 17

Multi-organ damage due to tissue hypoxia

Question 18

What is required if a baby has a poor Apgar score?

Answer 18

Active resuscitation is required.

Question 19

Transient tachypnoea of the newborn is more common with what type of birth?

Answer 19

Elective c section

Question 20

What does heart failure of the newborn occur due to?

Answer 20

Hydrops foetalis – rhesus disease, chromosomal

Question 21

What will a baby with heart failure be born like?

Answer 21

Baby will be born anaemic and oedematous

Swollen liver + severe abdo swelling

Question 22

What cardiac problem does failure to adapt to postnatal life lead to?

Answer 22

Persistent Pulmonary Hypertension of the Newborn (PPHN).

Question 23

What congenital cardiac problems should you be aware of?

Answer 23

• Tetralogy of Fallot.
• Transposition of great arteries.
• Coarctation of the aorta.
• TAPVD.
• Hypoplastic heart

Question 24

Name 2 congenital resp dieses of the newborn.

Answer 24

• Tracheo-oesophageal fistula

* Diaphragmatic hernia

Question 25

What may hypoglycaemia of the newborn be related to?

Answer 25

• Reduced ‘reserves’ – LBW/SGA.
• Related to maternal disease – IDM.
• Evidence of more complex metabolic disorder.

Question 26

If a baby is acidotic. What may this be evidence of?

Answer 26

An inborn error of metabolism