The Sick Term Infant Flashcards
Where is a central line inserted into a sick neonate?
- Umbilicus
How do very sick babies lie differently from healthy term babies?
- Sick babies lie flat
- Healthy babies flex arms and legs
Trisomy 18 (Edward’s Syndrome) causes babies to not survive past what age?
1 year
Why can labour make a baby acidotic?
Contractions cause hypoxia to baby
=> hypoxia can cause baby to be acidotic
What does the APGAR score stand for?
Appearance (skin colour) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiration
What elements of history should be assessed in a newborn examination, especially if a baby appears unwell?
- Maternal – PMH, pregnancy issues, drugs, infection
- Infant – foetal growth, anomaly, delivery, resuscitation
What should you inspect in a newborn examination?
- Tone (lying flat/flexed)
- Arousal (is baby alert and looking for food?)
- Colour (baby only appears totally blue if sats <80%)
Pink = Good, Blue = worse, White = BAD
WHat is a normal heart rate and respiratory rate when assessing a neonates vital signs?
HR - 120-150 (up to 160 if preterm)
RR - 40-60
Why are babys at risk of apnoea?
Their immature respiratory system forgets to breath or “give up” if put under too much pressure
HOw do neonatal seizures appear?
- subtle
- lip smacking/ eye rolling
What type of vomit would indicate serious problems in a newborn baby?
Bilious vomit (green colour)
- milk is undigested
- indicates bowel obstruction
How are the airway and breathing of a newborn managed if they are ill?
- Neutral position (instead of head tilt chin lift)
- Non-invasive/ invasive ventilation
How can a newborn be resuscitated if they are hypovolaemic?
- Babies have 80ml of blood per kilo
=> 100ml blood loss would be significant - fluids or blood can be used for resus
- consider adding inotropes if baby is not maintaining BP
What is therapeutic cooling used for?
- used to cool baby’s head after birth
- if they have been exposed to hypoxia during labour
- to prevent brain injury and certain types of cerebral palsy
What are the main categories of causes of the sick baby?
- Pregnancy/birth related
- Metabolic
- Infection
- Congenital Anomalies
What types of infection can be acquired by the baby antenatally, perinatally and postnatally?
- Antenatal (usually bacterial - e.g. Mother carries Group B Strep)
- Perinatal (usually viral - e.g. enterovirus, herpes (if mother has genital herpes))
- Postnatal (usually fungal)
What can predispose to infection in the newborn baby
- prolonged prelabour rupture of membranes (=> open to infection)
- Infection carried by mother (Group B Strep, Genital Herpes)
At what sites on the body can a newborn baby develop infection?
Blood stream - bacteraemia/septicaemia CNS - meningitis Respiratory - pneumonia GU – UTI Skin Bone GI - necrotising enterocolitis
What bacterial infections are common in newborn babies?
Group B Streptococcus E. Coli Listeria (RARE) Staphylococcus aureus Staph epidermidis (usually hospital acquired from procedures)
What viral infections are common in newborn babies?
Cytomegalovirus
Parvovirus
Herpes viruses
Enteroviruses
What condition in newborns is characterised by Multi organ damage due to tissue hypoxia and a poor Apgar score?
hypoxic ischaemic encephalopathy
What is Transient Tachypnoea of the Newborn?
- fluid not cleared from lungs
- production of lung fluid meant to stop at birth (sometimes baby is not ready for this => C-section)
- Crying helps to clear lung fluid
- BUT if baby is unprepared then cells continue to produce fluid
What sign of Transient Tachypnoea of the newborn is seen on CXR?
Fluid in Horizontal fissure
Babies born with heart failure usually develop this within the womb before being born. TRUE/FALSE?
TRUE
HOw do babies who are born with heart failure appear on examination?
- oedematous
- SOB due to pleural effusions
- hepatomegaly
- ascites
What can cause hydrops foetalis (foetal heart failure)?
- rhesus disease
- chromosomal abnormalities
What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?
- high pulmonary pressure due to poor fluid removal
- blood diverted from lungs
- blood not getting oxygenated
=> baby becomes cyanotic and acidotic
What congenital heart diseases can present in newborn babies?
- Tetralogy of Fallot
- Transposition of the Great Vessels
- Coarctation of the Aorta
- Total Anomalous pulmonary venous drainage (TAPVD)
=> 4 pulmonary veins drain to systemic venous circulation - Hypoplastic left heart
What congenital respiratory diseases can present in newborns and be identified on a CXR?
Tracheoesophageal fistula:
- feeding tube curls up in pouch at back of baby’s throat
- No gastric bubble on CXR
- Not usually recognised until 8-12 hours after birth
- Baby drools due to saliva build up in pouch
- often bring milk straight back up as it sits in pouch and cannot be swallowed properly
Diaphragmatic Hernia:
- loops of bowel in lung fields on CXR
- pulmonary hypertension co-occurs
- If known before birth then baby is delivered at specialist centre in case of need for ECLS
What CNS abnormality in newborns requires immediate surgery and what are the complications of this?
Spina Bifida
- if open must be closed within 24 hours
- operation can often cause hydrocephalus
=> Baby needs VP shunt
What is Potters syndrome and what other condition may this lead to?
Potters = bilateral renal agenesis
=> lack of urine production in utero
=> baby cant practise breathing by swallowing amniotic fluid
=> Baby develops Pulmonary Hypoplasia (this is often fatal)
Why may a baby be born with a low blood sugar?
related to reduced “reserves” - Low Weight/SGA
OR related to maternal disease - diabetes
