what is early onset infection
signs early onset infection
respiratory distress, apnoea, temperature instability
what is late onset infection
> 48h after birth. from the infants environment
what organism most common in late onset
staph epidermidis (coag negative staph)
signs of neonatal meningitis
bulging fontanelle, hyperextension of neck and back (opisothotonus), late signs
what % women carry group B strep
10-30%
in colonised mothers what are the risk factors for group B
prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant
in colonised mothers what are the risk factors for group B
prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant
signs early onset infection
respiratory distress, apnoea, temperature instability
what is late onset infection
> 48h after birth. from the infants environment
predictive signs for severe illness in infant
seizures, stiff limbs, cyanosis, capa refill >3s, difficulty feeding, t 60, lethargy, grunting, t >37.5
signs of neonatal meningitis
bulging fontanelle, hyperextension of neck and back (opisothotonus), late signs
what % women carry group B strep
10-30%
if conjunctivitis is purulent discharge swelling of eyelids at 1-2 weeks
chlamydia trachomatis- give erythromycin for 2 weeks
in colonised mothers what are the risk factors for group B
prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant
symptoms of hypoglycaemia in the neonate
jittery, irritable, apnoea, lethargy, drowsy, seizures
management early onset infection
benzylpenicillin + gentamicin for 10-14 days
management late onset infection
flucloxacillin + gentamicin
predictive signs for severe illness in infant
seizures, stiff limbs, cyanosis, capa refill >3s, difficulty feeding, t 60, lethargy, grunting, t >37.5
how should high concentration glucose be administered
central venous line- to avoid extravasation into the tissue which can cause necrosis and reactive hypoglycaemia
if there is a delay in IV glucose in hypoglycaemia what can be given
glucagon or hydrocortisone
if conjunctivitis is purulent discharge swelling of eyelids at 1-2 weeks
chlamydia trachomatis- give erythromycin for 2 weeks
when is hypoglycaemia likely
IUGR, preterm, born to mother with diabetes, large for dates baby, hypothermic, polycythaemia, ill
symptoms of hypoglycaemia in the neonate
jittery, irritable, apnoea, lethargy, drowsy, seizures
how can hypoglycaemia be prevented
early and frequent milk feeding
complications of kernicterus
CP, LD, deafness
when do you need to give IV glucose in hypoglycaemia
asymptomatic and 2 low readings (
causes of jaundice
rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, congenital infection- sepsis
if there is a delay in IV glucose in hypoglycaemia what can be given
glucagon or hydrocortisone
why do so many newborns become jaundiced
release Hb from breakdown red cells due to high Hb conc at birth; red cell life span shorter than in adults; bilirubin metabolism more immature
causes of jaundice >2 weeks
unconjugated- physiological, breast milk, infection, hypothyroid, haemolysis, high GI obstruction. conjugated- bile duct obstruction, neonatal hep. biliary atresia
can free bilirubin cross the BBB
yes as it is fat soluble
acute symptoms kernicterus
lethargy, poor feeding, irritability, incr muscle tone- opisthotonus, seizures, coma
complications of kernicterus
CP, LD, deafness
what level bilirubin do infants become clinically jaundiced
> 80 umol/l
causes of jaundice
rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, congenital infection- sepsis
how can you confirm rhesus haemolytic disease
direct coombs test
causes of jaundice 24h-2 weeks
physiological, breast milk jaundice, dehydration, infection, haemolysis, bruising, polycythaemia, crigler najer
causes of jaundice >2 weeks
unconjugated- physiological, breast milk, infection, hypothyroid, haemolysis, high GI obstruction. conjugated- bile duct obstruction, neonatal hep. biliary atresia
which infants are more susceptible from damage from jaundice so require intervention quicker
preterms
what can exacerbate jaundice
poor milk intake and dehydration
management jaundice
phototherapy, exchange transfusion,
what does phototherapy do in jaundice
converts unconjugated bilirubin into water soluble pigment to be excreted in the urine
complications phototherapy in jaundice
temperature instability, macular rash, bronze discolouration of the skin
what can you give in rhesus haem disease or ABO incompatibility
IvIG
what are the signs conjugated hyperbilirubinaemia
dark urine, pale stools, hepatomegaly, poor weight gain
what is exchange transfusion
give via umbilical vein, take away via umbilical artery
complications exchange transfusion
decr pulse, apnoea, decr platelets, decr glucose, decr Na, decr Hb
what is resp distress syndrome
due to a deficiency in alveolar surfactant leading to alveolar collapse resp failure
what does hypoxia lead to in RDS
decr cardiac output, hypotension, acidosis and renal failure
what are the signs of respiratory distress
tachypnoea (>60/min); expiratory grunting, laboured breathing and nasal flaring, cyanosis
infants at risk of RDS
pre term, maternal diabetes, males, 2nd twin, Csection
prevention of RDS
betamethasone or dexamethasone to all women 23-35 weeks if expecting to deliver pre term
pulmonary causes RDS
transient tachypnoea of the newborn, meconium aspiration, pneumonia, pneumothorax, milk aspiration, persistent pulmonary hypertension of the newborn
non pulmonary causes RDS
congenital heart disease, metabolic acidosis, severe anaemia, intracranial birth trauma/encephalopathy, sepsis
what is transient tachypnoea of the newborn
due to excess lung fluid. usually resolves within 24h. more common after C section
what is meconium aspiration
meconium passed in utero leading to meconium stained amniotic fluid. usually pre birth. sign of fetal distress (hypoxia). rarer in pre term.
treatment mec aspiration
surfactant, ventilation, inhaled NO, antibiotics
risk factors for pneumonia in the neonate
prolonged rupture of membranes, chorioamniotis, low birthweight
risk factors pneumothorax in the neonate
spontaneous in 2% births, can be secondary to mec aspiration, RDS, complication of ventilation
when does haemorrhagic disease of the newborn happen
2-7 days postpartum
cause of haemorrhagic disease of the newborn
no enteric bacteria to make vitamin K
tests in haemorrhagic disease of the newborn
PT and PTT incr, platelets no difference
prevention haemorrhagic disease of the newborn
vit k 1mg IM or 2 doses oral phytomenadione. repeat in
treatment haemorrhagic disease of the newborn
plasma and vit K for active bleeding
when should term babies get back to their birth weight
all lose weight in first week. by day 7-10. in pre terms- day 14
potential problems with breastfeeding
latching on, cracked nipples, breast engorgement, intestinal hurry
potential problems with bottle feeding
incorrect reconstitution, allergy, inadequate sterilisation
what is tested for in the Guthrie screening
at 5-8 days. maple syrup urine disease, CF, congenital hypothyroidism, PKU, MCADD, sickle cell
what happens in HIE
perinatal asphyxia- gas exchange impaired or stops, cardioresp depression. hypoxia, hypercarbia, metabolic acidosis
causes HIE
failure gas exchange across the placenta- excessive uterine contractions, placental abruption, ruptured uterus; interrupted umbilical blood flow- compressed cord; inadequate maternal perfusion; compromised fetus- anaemia, IUGR; failure to breathe
signs mild HIE
irritable, responds excessively to stimulation, impaired feeding
signs moderate HIE
abnormal tone and movement, cant feed, seizures
signs severe HIE
no normal spontaneous movement or response to pain, hypo and hypertonia. seizures, multi organ failure
management HIE
resp support, record EEG, treat seizures, fluid restriction, vol and inotrope support, monitor BM and electrolytes
prognosis HIE
mild- complete recovery. severe- mortality 30-40%, >80% of survivors- neurodevelopmental disability
what can congenital rubella cause
18 weeks damage to the fetus is minimal
which is the commonest congenital infection
CMV
what are the features of CMV
hepatosplenomegaly, petechiae, neurodevelopmental disability
clinical manifestations toxoplasmosis
retinopathy, cerebral calfication, hydrocephalus
what can appear in congenital syphillis
rash on soles of feet and hands
what is erythema toxicum
neonatal urticaria. rash appears 2-3d. white pin point papules at centre of erythematous base. lesions concentrated on the trunk. goes in 24h
what can retinopathy of prematurity lead to
retinal detachment, fibrosis, blindness
risk factors for retinopathy of prem
prem, low birthweight. screen if
signs of IVH
seizures, bulging fontanelle, cerebral irritability. do ultrasound and CT
complications IVH
IQ decr, CP, hydrocephalus
what can decr the risk of IVH in prems
delayed cord clamping
what happens to pulmonary vascular resistance with the first breath
falls, rush of blood to lungs
what helps promote adult circulation (lungs)
inhaled NO
complications of mechanical ventilation neonates
pneumothorax, pulmonary haemorrhage, bronchopulmonary dysplasia, emphysema, pneumona; upper airway obsrruction; PDA, incr ICP, IVH, RoP
causes of neonatal seizures
HIE, infection, ICH, structural CNS lesions, metabolic (decr glucose, decr Ca, Na up or down, decr Mg)
treatment neonatal seizures
first line-phenobarbital. 2nd line phenytoin
why would the red reflex be absent
cataract, retinoblastoma
causes of apnoeic attacks
resp centre immaturity, aspiration, heart failure, infection, PaO2 decr, glucose decr, Ca decr, seizures, PDA, temp up or down, exhaustion, airways obstruction
what is NEC
inflammatory bowel necrosis
what is the main risk factor for NEC
prem. otherss- weigh
signs NEC
mild- abdominal distension. blood and mucus PR. severe- sudden distension, tenderness, shock, DIC, mucosal sloughing.
what is pathogneumonic for NEC
pneumatosis intestinalis (gas in gut wall seen on x ray)
treatment nec
stop oral feeding, culture faeces, crossmatch, give antibios- cefotaxime + vancomycin. laparotomy if progressive distension perforation
prophylaxis of nec
expressed breast milk, probiotics, oral antibiotics
presentation biliary atresia
jaundice, yellow urine, pale stools. biliary tree occlusion by angiopathy at week 3. splenomegaly. cholestasis
management biliary atresia
surgery- Kasai procedure and intestinal limb to drain bile from porta hepatis. if operation is late- cirrhosis. will need liver transplant in first year of life
