Sick Term Infant

Question 1

Define term?

Answer 1

37 weeks

Question 2

What is the neonatal period?

Answer 2

Between birth and day 28

Question 3

When might a neonate become unwell?

Answer 3

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

Question 4

Explain the APGAR score

Answer 4

Scored out of 10, with a max of 2 points available for each of; it is done at 1 minute and then 5 minutes post-delivery:
• Appearance (skin colour)
• Pulse 
• Grimace (reflex irritability)
• Activity (muscle tone)
• Respiratory 

ADD IMAGE

NOTE - grimace and activity go hand-in-hand

Question 5

Components of a newborn clinical assessment?

Answer 5

History:
• Maternal - PMH, pregnancy issues, drugs, infection risks
• Infant - foetal growth, foetal anomaly, delivery, resuscitation

Inspection:
• Tone
• Level of arousal
• Colour (pink, blue, white, jaundice)
• Work of breathing / respiratory effort - grunting, recession (intercostal, sternal), tracheal tug, nasal flaring 

Vital signs:
• HR - normally, 120-140 bpm
• RR - normally, 40-60 breaths

NOTE - can also check BP, SaO2 (95%) and cap refill; watch out for poor feeding and bilious vomiting

Question 6

Initial Mx of a sick term infant?

Answer 6

TEMPERATURE CONTROL

Airway and breathing - O2

Circulation - fluids and potentially inotropes

Metabolic homeostasis - glucose and acid-base balance management

Antibiotics - 1st line is benzylpenicillin + gentamicin

Question 7

Ongoing Mx of a sick term infant?

Answer 7

Diagnostic work-up

Further support should be considered:
• Ventilation
• Drugs
• Specific therapy, like therapeutic cooling for birth asphyxiated infants
• Surgery
• Transfer to another centre

Care of the family

Question 8

4 major causes of a sick baby?

Answer 8

1. Pregnancy / birth-related issues
2. Metabolic issues
3. Infection (bacterial, viral, fungal):
   • Antenatal (from the mother)
   • Perinatal
   • Postnatal
4. Congenital anomalies

Question 9

Sites of infection in a newborn?

Answer 9

Sepsis

CNS - meningitis

Respiratory - pneumonia

GU - UTI (in the 1st month of life, these are more common in boys; this is different from

Others - skin, bone, GI (Necrotising Enterocolitis, NEC)

Question 10

Bacterial infections in neonates?

Answer 10

Group B Strep. (most lethal)

E. coli

Listeria myocytogenes

Staph. aureus

Staph. epidermidis

Question 11

Viral infection in neonates?

Answer 11

Cytomegalovirus (CMV)

Parvovirus

Herpes virus

Enterovirus

Question 12

Other infections in neonates?

Answer 12

Toxoplasma gondii

HIV

Syphilis (Treponema pallidum)

TORCH infections - some of the most common infections during pregnancy
• Toxoplasma
• Others (syphilis, varicella-zoster, parvovirus B19)
• Rubella
• CMV
• Herpes

Question 13

What is hypoxic ischaemic encephalopathy?

Answer 13

Multi-organ damage due to tissue hypoxia; these babies have poor APGAR scores and active resuscitation is required

The prognosis is variable and neurodevelopment sequeli can occur

Question 14

Pregnancy / birth-related respiratory issues of the newborn?

Answer 14

Transient Tachypnoea of the Newborn (TTN) - occurs in the first few hours of life and improves over 12-24 hours; it is more common with elective caesarian sections, as the process of labour switches off lung fluid production in the baby

Pneumothorax - spontaneous vs secondary to active resuscitation

Question 15

Pregnancy / birth-related cardiac issues of the newborn?

Answer 15

Hydrops foetalis - foetal condition characterised by an accumulation of oedema in at least two foetal compartments, e.g: ascites, pleural effusion, pericardial effusion, skin oedema; these babies often have abdominal swelling and hepatomegaly
Mainly caused by:
• Rhesus disease
• Chromosomal issues

Persistent Pulmonary Hypertension of the Newborn (PPHN) - there is a failure to adapt to perinatal life

Question 16

Congenital cardiac diseases?

Answer 16

Tetralogy of fallot

Transposition of great arteries

Coarctation of the aorta

Total Anomalous Pulmonary Venous Drainage (TAPVD)

Hypoplastic heart

Question 17

Congenital respiratory diseases?

Answer 17

Tracheo-oesophageal fistula

Diaphragmatic hernia

Question 18

Other congenital anomalies?

Answer 18

Neurological:
• Microcephaly, e.g: due to Zika virus although there are many other causes
• Spina bifida

Renal:
• Potters syndrome (not compatible with life)

Muscular:
• Myotonic dystrophy

Surgical issues

Question 19

Metabolic issues in the newborn?

Answer 19

Hypoglycaemia:
• Related to reduced reserves (due to low birth weight, small gestation age, etc)
• Related to maternal disease (Infant of Diabetic Mother)
• Evidence of more complex metabolic disorder

Acidosis:
• Inborn errors of metabolism