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REPRODUCTION & GYNAECOLOGY > The Sick Term Infant > Flashcards

The Sick Term Infant Flashcards

1
Q

Where is a central line inserted into a sick neonate?

A
  • Umbilicus
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2
Q

How do very sick babies lie differently from healthy term babies?

A
  • Sick babies lie flat

- Healthy babies flex arms and legs

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3
Q

Trisomy 18 (Edward’s Syndrome) causes babies to not survive past what age?

A

1 year

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4
Q

Why can labour make a baby acidotic?

A

Contractions cause hypoxia to baby

=> hypoxia can cause baby to be acidotic

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5
Q

What does the APGAR score stand for?

A 
Appearance (skin colour)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
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6
Q

What elements of history should be assessed in a newborn examination, especially if a baby appears unwell?

A
  • Maternal – PMH, pregnancy issues, drugs, infection

- Infant – foetal growth, anomaly, delivery, resuscitation

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7
Q

What should you inspect in a newborn examination?

A
  • 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
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8
Q

WHat is a normal heart rate and respiratory rate when assessing a neonates vital signs?

A

HR - 120-150 (up to 160 if preterm)

RR - 40-60

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9
Q

Why are babys at risk of apnoea?

A

Their immature respiratory system forgets to breath or “give up” if put under too much pressure

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10
Q

HOw do neonatal seizures appear?

A
  • subtle

- lip smacking/ eye rolling

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11
Q

What type of vomit would indicate serious problems in a newborn baby?

A

Bilious vomit (green colour)

  • milk is undigested
  • indicates bowel obstruction
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12
Q

How are the airway and breathing of a newborn managed if they are ill?

A
  • Neutral position (instead of head tilt chin lift)

- Non-invasive/ invasive ventilation

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13
Q

How can a newborn be resuscitated if they are hypovolaemic?

A
  • 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
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14
Q

What is therapeutic cooling used for?

A
  • 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
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15
Q

What are the main categories of causes of the sick baby?

A
  • Pregnancy/birth related
  • Metabolic
  • Infection
  • Congenital Anomalies
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16
Q

What types of infection can be acquired by the baby antenatally, perinatally and postnatally?

A
  • 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)
17
Q

What can predispose to infection in the newborn baby

A
  • prolonged prelabour rupture of membranes (=> open to infection)
  • Infection carried by mother (Group B Strep, Genital Herpes)
18
Q

At what sites on the body can a newborn baby develop infection?

A 
Blood stream - bacteraemia/septicaemia
CNS - meningitis
Respiratory - pneumonia
GU – UTI
Skin
Bone 
GI - necrotising enterocolitis
19
Q

What bacterial infections are common in newborn babies?

A 
Group B Streptococcus
E. Coli
Listeria (RARE)
Staphylococcus aureus
Staph epidermidis (usually hospital acquired from procedures)
20
Q

What viral infections are common in newborn babies?

A

Cytomegalovirus
Parvovirus
Herpes viruses
Enteroviruses

21
Q

What condition in newborns is characterised by Multi organ damage due to tissue hypoxia and a poor Apgar score?

A

hypoxic ischaemic encephalopathy

22
Q

What is Transient Tachypnoea of the Newborn?

A
  • 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
23
Q

What sign of Transient Tachypnoea of the newborn is seen on CXR?

A

Fluid in Horizontal fissure

24
Q

Babies born with heart failure usually develop this within the womb before being born. TRUE/FALSE?

A

TRUE

25
Q

HOw do babies who are born with heart failure appear on examination?

A
  • oedematous
  • SOB due to pleural effusions
  • hepatomegaly
  • ascites
26
Q

What can cause hydrops foetalis (foetal heart failure)?

A
  • rhesus disease

- chromosomal abnormalities

27
Q

What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?

A
  • high pulmonary pressure due to poor fluid removal
  • blood diverted from lungs
  • blood not getting oxygenated
    => baby becomes cyanotic and acidotic
28
Q

What congenital heart diseases can present in newborn babies?

A
  • 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
29
Q

What congenital respiratory diseases can present in newborns and be identified on a CXR?

A

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
30
Q

What CNS abnormality in newborns requires immediate surgery and what are the complications of this?

A

Spina Bifida
- if open must be closed within 24 hours
- operation can often cause hydrocephalus
=> Baby needs VP shunt

31
Q

What is Potters syndrome and what other condition may this lead to?

A

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)

32
Q

Why may a baby be born with a low blood sugar?

A

related to reduced “reserves” - Low Weight/SGA

OR related to maternal disease - diabetes

REPRODUCTION & GYNAECOLOGY (58 decks)

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