What are the main types of neonatal emergency?
Sepsis Birth asphyxia Respiratory distress Abdo emergency Duct-dependent cardiac issues
What are common clinical respiratory symptoms in the neonate?
apnoea
gasping
recession
What are the main features of APGAR examination?
Appearance Pulse Grimace Activity Respiration
What are the 3 main causes of neonatal sepsis?
Congenital infection
Early onset sepsis
Late onset sepsis
What constitutes congenital infection?
Present at birth
Usually infection is direct from mother
What is early onset sepsis?
Onset between birth and 1 week old
infection comes from the birth canal
What is late onset sepsis?
onset after 1 week old
Maternal or external source of infection
Bacterial causes of neonatal sepsis:
Group B streptococcus
Listeria
Gram -ve
(present in the genital tract)
Which antibiotics are used to treat neonatal sepsis?
Penicillin/Gentamicin
Cefotaxime/ampicillin
Investigations performed for suspected Dx of neonatal sepsis?
blood cultures
FBC (particularly WCC and platelets)
What are the clinical signs that may indicate neonatal sepsis?
(non-specific)
Fever or hypothermia poor feeding vomiting pallor tachypnoea drowsy irritability
What features may be present on a CXR for a septic neonate?
poor aeration
increased lung markings
What is the broad management of neonatal sepsis?
Resuscitate
Antibiotics
(Supportive care) ventilation, fluid rescus. coagulopathy, ionotropes
Conditions that are associated with increased risk of birth asphyxia:
IUGR Prematurity Abnormal CTG Abnormal fatal blood gas difficult delivery
What does intrapartum asphyxia increase your is of?
Cerebral palsy
What are the early signs of birth asphyxia?
acute bradycardia or asystole at delivery
What is the late presentation of birth asphyxia?
hypoxic ischemic encephalopathy
What are the 3 grades of hypoxic ischemic encephalopathy and what do they mean?
Grade 1: irritability, poor feeding
Grade 2: fits, bad feeding, hypertonia
Grade 3: floppy, intractable seizures, apnoea
What observations can be found by ultrasound in asphyxia?
periventricular flare
cystic leukomalacia
(white matter brain injury)
What observations can be found by CT/MRI in asphyxia?
swollen basal ganglia
enhancement of white matter
What is the time window during which effects of asphyxia are reversible?
< 6hr of injury
What metabolic intervention could minimise tissue injury following asphyxia?
Cooling of baby
to ~35C
What the alternative DDx for respiratory distress ?
Respiratory distress syndrome Pneumothorax Abdominal emergency Cardiac malformation Pneumonia
What are predictors of respiratory distress syndrome?
Prematurity Asphyxia Cold stress Diabetic mum lower segment C-section (LCSC)
What is the specific clinical sign of respiratory distress syndrome?
Recession
use of accessory muscles
How do alveoli function between breaths in RDS?
Alveoli fully collapse between breaths, requiring massive breaths during each inspiration to-reinflate the alveoli
What are the 4 pathophysiological components of RDS?
Weak chest wall
excess lung liquid
no blood-air approx.
surfactant delivery
What the radiological features observed on a CXR for RDS?
poor expansion
air bronchograms
ground glass appearance
What are the predictive conditions for meconium aspiration syndrome?
post-term baby
asphyxia
Predictors of abdominal emergencies inc;
other congenital malformations
polyhydramnios
What are the clinical features of an abdominal emergency?
specific: abdo distension, bilious vomiting, obvious loops
non-specific: poor feeding, vomiting, pallor, tachypnoea, drowsy, irritability
Type of abdominal emergency include?
NEC Malrotation Volvulus gastroschisis meconium ileum Hirshprung's diseases
What is volvulus?
intestine twists around itself and its mesentery
What is gastrochiasis?
congenital defect in which baby’s intestine extend outside body cavity through hole in or near umbilicus
What is Hirshprung’s disease?
Congenital defect in which the nerves in the intestine are missing
Constipation is the predominant symptom
What are the main types of duct-dependent heart defects?
pulmonary atresia critical pulmonary stenosis Critical coarctation Transposition of the great arteries Hypoplastic left ventricle
What does tetralogy of Fallot include?
VSD
Right ventricular hypertrophy
pulmonary artery stenosis
overriding aorta
What are the specific clinical features for duct-dependent heart defects?
minimal recession for cyanosis
absent femoral pulses
What are the non-specific clinical features for duct-dependent heart defects?
poor feeding, vomiting, pallor, cyanosis, tachypnoea, sleepiness, irritability
What investigations should be done to confirm duct-dependent heart defects?
echocardiogram
CXR
What is the broad aetiology of neonatal emergencies?
an unpreparedness for birth and extra-uterine life
What is a risk factor for transient tachypnoea of the newborn?
C-section
What is transient tachypnoea of the newborn?
common respiratory distress disorder in newborn
Symptoms usually start within the first hours after birth
thought to result from delayed absorption of foetal lung fluid.
It is a self-limiting condition.
Risk factors include prematurity, cesarean section, and male sex
What is intusseception?
invagination of one portion of bowel into the lumen of the adjacent bowel
most commonly around the ileo-caecal region.
usually affects infants at 6-18mo
M>F
What are the clinical features of intusseception?
- paroxysmal abdominal colic pain
- during paroxysm the infant will characteristically draw their knees up and turn pale
- vomiting
- bloodstained stool: ‘red-currant jelly’ - is a late sign
- sausage-shaped mass in RUQ
What investigation is performed for intusseception?
USS
may show target-like mass
What are the clinical features common to respiratory stress in the neonate?
- tachypnoea
- intercostal recession
- expiratory grunting
- cyanosis
What is the classical CXR for respiratory distress/surfactant deficiency in the newborn?
ground glass appearance
indistinct heart border
What is the management of respiratory distress/surfactant deficiency?
- maternal corticosteroids to induce foetal lung maturation (during pregnancy)
- oxygen
- assisted ventilation
- exogenous surfactant given via ET tube