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Sick Term Infant Flashcards

1
Q

when is the neonate period

A

first 28 days of life

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2
Q

what are the most common causes of neonate and later deaths in babies

A

neonate:
prematurity
birth asphyxia and trauma
pneumonia and sepsis

1-59 months
pneumonia
conditions
non communicable diseases

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3
Q

what are the components of the apgar score

A 
heart rate  (absent -> <100 -> >100)
resp effort (absent -> weak irregular gasping -> strong cry)
tone (none -> some flexion -> flexed arms and legs that resist extension)
colour (blue/ pale -> blue extremities -> normal)
response (none -> grimace/ feeble cry when stimulated -> cry/ pull away when stimulated)

(0 ->1 -> 2, scored out of ten)

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4
Q

when might a neonate become unwell

A

at delivery
after 1st few hours
first days
up to 28 days

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5
Q

what are the components of a newborn clinical exam

A

Hx- maternal (PMHx, pregnancy, drugs, infection risks) and infant (fetal growth, fetal anomaly, delivery, resuscitation)
inspection (tone, level of arousal, colour)
vital signs (HR, RR)
work of breathing and resp effort (subcostal recession, indrawing, apnoea)
cap refill 2-3 seconds
O2 sats (>95%)
check for jaundice, sezures, poor feeding, bilious vomit

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6
Q

why is level of cyanosis not a good predictor of O2 sats

A

as need sats less than 80 to get this so might miss a lot of low sats if relying on colour

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7
Q

what is normal newborn resp rate

A

40-60

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8
Q

what is normal newborn HR

A

120-140

120-160 if newborn

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9
Q

how might a baby having a seizure present

A

lip smacking
eye rolling
cycling movements of legs
apnoea

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10
Q

why do pre term babies get apnoea

A

forget to breath as resp centres in brain not mature

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11
Q

what temperature should babies be

A

36.5-37.4

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12
Q

what happens to babies when glucose metabolism abnormal

A

means surfactant cant work properly so get hypoglycaemia and resp distress

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13
Q

how much is a babies blood volume

A

80ml/kg

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14
Q

should you wait to give a baby antibiotic

A

no give asap unti you are sure its not infection causing illness

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15
Q

what might babies need to improve circulation

A

fluid and inotropes

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16
Q

how do you support the babies airway

A

head in neural position- some evidence oxygen is harmful so only given if needed
ventilation

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17
Q

what is the role of therapeutic cooling

A

when there has been significant brain damage this can prevent further damage or ischaemia- prevents cerebral palsy

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18
Q

what are the 4 categories of causes of a sick baby

A

pregnancy/ birth related
metabolic
infection
congenital abnormalities

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19
Q

what are the likely causes of ante, peri and post natal infections

A

ante- bacterial (worry about mothers who are strep a carriers)
peri- viral
post- fungal (unlikely unless in intensive care)

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20
Q

what makes antenatal infection more likely

A

premature rupture of membranes

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21
Q

what are the sites of infection in a newborn

A 
blood stream (bacteraemia)
CNS- meningitis 
resp- pneumonia
GU- UTI (more common in boys)
skin 
bone- osteomyelitis
GI- necrotising enterocolitis
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22
Q

what bacterial infections are common in newborns

A 
group B strep (most common) 
e coli 
listeria myocytogenes 
staph aureus 
staph epidermis (babies who have had surgery/ procedure done)
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23
Q

what viral infections are common in newborns

A

CMV
parvovirus
herpes
enterovirsuses

toxoplasma gondii
HIV
syphilis (treponema pallidum)
TORCH

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24
Q

what is hypoxic ischaemic encephalopathy

A

multi organ damage due to tissue hypoxia (peri natal asphyxia)
will have poor apgar score and need active resus
neurodevelopmental sequeli

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25
Q

what will be seen on x ray in transient tachypnoea of the newborn

A

white lungs with fluid in the horizontal fissure

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26
Q

what are the resp complications of pregnancy/ birth

A 
pneumothorax
TTN
Resp distress syndrome 
infection/ sepsis 
pneumonia
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27
Q

what are cardiac complications of pregnancy/ birth

A

Heart failure:
-Hydrops foetalis
(caused by: Rhesus disease (happens because baby is extremely anaemic), Chromosomal or Idiopathic (50%))

Failure to adapt to postnatal life:
-Persistent Pulmonary Hypertension of the Newborn (PPHN)- BP in lungs stays high so blood doesn’t go to them and get oxygenated

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28
Q

what are the features of hydrops fetalis

A

abnormal fluid accumulation in two or more fetal compartments. These may include ascites, pleural effusion, pericardial effusion and skin oedema, hepatomegaly. It may also be associated with polyhydramnios and placental oedema.

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29
Q

list the congenital cardiac diseases

A 
Tetralogy of Fallot
Transposition of great arteries
Coarctation of the aorta
TAPVD (Total Anomalous Pulmonary Venous Drainage- not connected to LA)
Hypoplastic heart
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30
Q

how do congenital heart defects present

A

cyanosis, murmurs, tachpnoea

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31
Q

what congenital resp problems can occur

A 
Tracheo-oesophageal fistula (on x ray NG tube curled up, no stomach bubble. babies will be slavery and have blue episodes)
Diaphragmatic hernia (bowel in lung cavity)
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32
Q

what is potters syndrome

A 
renal congenital anomlies
renal agenesis (cant produce urine, reduced amniontic fluid, pulmonary hypoplasia)
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33
Q

name a MSK congenital anomaly

A

myotonic dystophy

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34
Q

what can cause newborn hypoglycaemia

A

related to reduced “reserves” - LBW/SGA
related to maternal disease - IDM
evidence of more complex metabolic disorder

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35
Q

what factors are the most influential to a babies weight

A

IU conditions (rather than mothers height)

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36
Q

what tests determine the risk of hepatitis transmission

A

Viral load- if no viral load and antibodies then previously infected
IgM levels

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37
Q

is hep C transmitted in breast milk

A

no regardless of viral load- UNLESS nipples are chapped

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38
Q

are methodone and valium CI in breast feeding

A

no

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39
Q

why are new born at risk of heat loss

A 
Large head
Large surface area to volume 
Pre term thin epithelium 
Wet 
Naked 
Can’t shiver
40
Q

simple measures can be done to prevent heat loss in babies

A 
Hat on 
Shut windows 
Skin to skin 
Warmed blankets 
If still cold can use heated mattress (only put baby in baby grow when on this as heat wont get to baby if has lots of layers on)
41
Q

what classifies as neonatal hypoglycaemia

A

BM <2.6

42
Q

how might hypoglycaemia present

A 
Hypothermia
abnormal Feeding behaviour 
 Infection/sepsis
 Lethargy
 Jitteriness
Seizure activity
apnoea
cyanosis
hypotonia
high pitched cry
43
Q

how do you prevent hypoglycaemia

A

Keep baby warm and dry 36.6°C - 37.2°C
Early feed (within 1 hour)
Minimal Handling
Consider environment/stressors

44
Q

what are the risk factors for hypoglycaemia

A 
preterm 
weight <2nd centile 
diabetic mother 
maternal labetolol >2 doses 
perinatal acidosis (cord pH <7.1 + BE >-12mmol/l)
more likely to happen when infant cold
45
Q

what is the management for asymptomatic babies at risk of hypoglycaemia

A

check pre feed b, prior to 2nd feed 2-4 after birth
record on NEWs with vital signs
if breast feeding no more than 3 hours between feeds
if formula 10-15mls 3 hourly
check pre feed glucose before 3rd feed

46
Q

how do you treat asymptomatic hypoglycaemia

A

consider buccal dextrose gel
support breast feeding
if fomrula 10-15mls 3 hourly
check pre 3rd feed glucose

47
Q

how do you treat symptomatic hypoglycaemia

A

urgent neonate review
buccal dextrose if bm <2.6
feed 3 hourly
check pre 3rd feed glucose

if doesnt improve call neonate team who will sens urgent lab /analyser glucose
repeat bucaal dextrose gel as part of feeding plan
may require admission to NMU

48
Q

how do you treat symptomatic hypoglycaemia

A

urgent neonate review
buccal dextrose if bm <2.6
feed 3 hourly
check pre 3rd feed glucose

if doesnt improve call neonate team who will sens urgent lab /analyser glucose
repeat bucaal dextrose gel as part of feeding plan
may require admission to NMU
of BG<1 IV glucose

49
Q

what are the indications for oral dextrose gel

A

BG <1
signs of hypoglycaemia
BG 1-2.6 with no clincal signs

50
Q

what must be considered in the administration of oral dextrose gel

A

infant must be 35 weeks gestation and younger than 48 hours

must be used in conjunction with feeding plan

51
Q

how is oral dextrose given

A

0/5 ml/kg up to two doses given 30 mins apart
max of 6 doses in 48 hours
dry mucosa with gauze
squirt gel onto cheel with oral syringe and massage with latex fee gloves
offer feed immediately afterwards

52
Q

what should you do if there are 2 consecutive bm >2.6

A

stop measuring unless clinically indicated

53
Q

what is heme converted to before bilirubin

A

bilverderin

54
Q

what are the causes of neonatal jaundice

A 
physiological 
blood group incompatability (rhesus/ ABO)
haemolytic disorders 
sepsis 
liver disease
metabolic disorders
55
Q

why does physiological jaundice happen

A

Increased production of bilirubin (haemolysis of fetal RBC)
Decreased uptake and binding by liver cells
Decreased conjugation(most important)
Decreased excretion
Increased enterohepatic circulation of bilirubin

56
Q

when is jaundice pathological

A

<24 hours of age
when bilirubin are too high and require treatment
lasting more than 10 days, esp more than 2 weeks

57
Q

what causes jaundice <24 hrs after birth

A

haemolysis:
-ABO incompatibility
-Rh immunisation
-Sepsis
hepatitis (will have substantial elevation of conjugated bilirubin (>15% of the total))
red cell enzyme defects e.g. G6PD deficiency
red cell membrane defects, e.g. hereditary spherocytosis

58
Q

how do you investigate early pathological jaundice

A

Total and conjugated serum bilirubin concentration (SBR)
Maternal blood group and antibody titres (if Rh negative)
Baby’s blood group, direct antiglobulin (Coombs) test (detects antibodies on the baby’s red cells), and elution test to detect anti-A or anti-B antibodies on baby’s red cells (more sensitive than the direct Coombs test)
Full blood examination, looking for evidence of haemolysis, unusually-shaped red cells, or evidence of infection
CRP might assist with diagnosis of infection

59
Q

what can cause very high levels of bilirubin= pathological jaundice days 1-10

A

Mild dehydration/insufficient milk supply (breast-feeding jaundice)
Haemolysis
Breakdown of extravasated blood (e.g. cephalhaematoma, bruising, CNS haemorrhage, swallowed blood)
Polycythaemia (increased RBC mass)
Infection - a more likely causeduring this time
Increased enterohepatic circulation (e.g. gut obstruction)

60
Q

what can cause persistent unconjugated hyperbilirubinaemia

A

Breast milk jaundice (diagnosis of exclusion, cessation not necessary)
Continued poor milk intake
Haemolysis
Infection (especially urinary tract infection)
Hypothyroidism

61
Q

what can cause persistent conjugated hyperbilirubinaemia

A

ALWAYS ABNORMAL
hepatitis- infection, metabolic disease
biliary atresia (pale stools and dark urine)

62
Q

what is kernicterus

A

Unconjugated bilirubin is toxic to the brain and can cross blood brain barrier
characterised by the death of brain cells and yellow staining, particularly in the grey matter
=the permanent clinical sequelae of bilirubin toxicity

63
Q

what are the signs of acute bilirubin encephalopathy include (kernicterus)

A 
lethargy
poor feeding
temperature instability
hypotonia
arching of the head, neck and back (opisthotonos)
spasticity
seizures
64
Q

what increases the risk of developing kernicterus

A

Increasing unconjugated bilirubin - concentrations greater than 340 micromol/L

Decreasing gestation

Asphyxia, acidosis, hypoxia, hypothermia, meningitis, sepsis, and decreased albumin binding

65
Q

what Tx for jaundice

A

treat cause
re hydrate (milk not water, IV fluids if needed)
phototherapy
exchange transfusion
IV immunoglobulin for isoimmune haemolytic disease

66
Q

what is the course of physiological jaundice

A

Onset day 2
Peak day 3
Resolve by day 10-14
Otherwise well infant

67
Q

what are the perinatal risk factor for sepsis

A 
group B strep colonisation 
PROM
group b strep bacteriuria during pregnancy 
high maternal temp during labour 
chorioamnionitis 
sustained intrapartum fetal tachycardia
 previous child born with infection
68
Q

what is the physical appearance of a neonate with sepsis

A 
resp distress:
-grunting 
-retractions 
-pallor/cyanosis
pallor:
-hypotension 
-delayed cap refill
-hypoxia
lethargy:
-poor feeding
-indifferent to pain 
vital signs:
-tachy pnoea and cardia 
-hypotension 
-temp high/low/normal
69
Q

what Ix for neonate sepsis

A

blood culture
LP
urine culture
blood sugar
FBC (low WBC, look for anaemia due to haemolytic disease also)
CRP (>4)
U&Es (can get hyponatraemic in sepsis)

70
Q

what organisms usually causes neonatal sepsis

A 
group B strep
e coli 
staph aureus 
enterococcus 
staph epi 
klebsiella 
listeria
71
Q

what is the treatment for neonate sepsis

A

if newly delivered:
Benzylpenciliin
Gentamicin

if got sepsis from hospital in NICU with central catheters:
Vancomycin/Flucloxacillin (Staph)

72
Q

what are the features of neonate withdrawal

A 
continuous/ excessive high pitched cry 
reduced sleep after feeds 
tremor 
increased muscle tone
generalised convulsing 
frantic fist sucking
poor feeding 
regurgitation projectile vomiting 
loose stools/ diarrhoea 
frequent yawning 
sneezing 
mottling 
high temo 
high resp rate
indrawing 
excoriations
73
Q

what score to evaluate fetal withdrawal

A

neonatal abstinence score

74
Q

when do you start treatment for neonatal withdrawal

A

An infant with 3 consecutive scores on NAS, averaging more than 8 should be commenced on
treatment (and therefore admitted to SCBU), scoring should be 4 hourly

75
Q

how does phototherapy work to treat jaundice

A

Blue light, 420-470 nm wavelength
Photo-isomerization of bilirubin
converts trans-bilirubin to the more water soluble cis-form which is excreted in the bile without conjugation.
Photosensitised oxidisation

76
Q

what are the side effects of phototherapy

A

dehydration
skin rash
eye damage

77
Q

when in jaundice prolonged

A

2 weeks if term

3 weeks if pre term

78
Q

what Ix for jaundice

A

FBC/LFTS/SBR/TFTS
Serum bilirubin if within 24hrs of life/ <35 weeks gestation
transcutaneous bilirubinometer if over 35 weeks
blood grouping

79
Q

what is it important to ask about in a jaundice Hx

A 
Feeding
 Weight loss
 Family Hx
 Stool/Urine
 Behaviour
 Organomegaly
80
Q

what can cause conjugated jaundice

A 
Biliary atresia
total parentral nutrition 
 Hypothyroidism
 α1 Antitrypsin 
 Galactosaemia
 Cystic Fibrosis
 Trisomy 21
 Dubin Johnson
 Alagille Syndrome
81
Q

what can cause unconjugated jaundice

A 
Physiological
 Breast Milk
 Haemolysis
 Infection
 Inherited causes
 Intestinal obstruction
82
Q

what is the course of breast milk jaundice

A

develops after day 4 or day 7, peaks toward end of 2nd week of life

83
Q

what are the metabolic causes of resp distress

A

Acidosis, Inborn errors of metabolism, hypoglycaemia

84
Q

what are the haematological causes of resp distress

A

Polycythaemia, Blood loss/anaemia

85
Q

what are the cardiac causes of resp distress

A

congenital heart disease

PPHN

86
Q

what are the neuro causes of resp distress

A

Seizures, Intracranial bleed, Withdrawl

87
Q

what are the anatomical causes of resp distress

A

CCAM (Congenital Cystic Adenomatoid Malformation)

Chest wall deformities, diaphragmatic hernia, TOF

88
Q

what is the management for resp distress

A

Suction = yankauer, fine bore suction catheter (mouth and nose)
Airway opening maneuvres = head tilt to neutral position, jaw thrust. Be careful not to make matters worse by pressing on soft submandibular/submental tissues.
Respiratory support, surfactant, stop feeds, antibiotics
Ix and Rx underlying cause

89
Q

how are most babies with hypoglycaemia asymptomatic

A

as can use ketones as brain fuel

90
Q

how can you minimised the affects of NAS

A

Reduce noise, bright lights, regular feeding (breast milk if possible)
Dressed appropriately, swaddle (only top half as don’t want DDH)
Containment hold- gentle pressure of hands, not bouncing them, Is more calming in abstinence syndrome

91
Q

what medications are used in the Tx of NAS

A

Opiate given to baby if mum on methadone/ opiates
Benzos if mum was on them or was on a lot of polypharmacy
Phenobarbitone if babies very distressed

92
Q

what weight loss is normal after birth

A

up to 10%

93
Q

what does the Guthrie Card/Newborn Screening card screen for

A 
Cystic fibrosis (immunoreactive trytin screened for)
Thyroid function testing (TSH measured) 
Haemoglobinopathies
Metabolic disease
phenylketonuria (PKU)
94
Q

what are anaemic babies given when discharged

A

folic acid

95
Q

what treatment for biliary atresia

A

surgery to loop duodenum onto liver so bile flows from liver into bowel, good outcomes in 90% if done before 8 weeks of life, if done after 8 weeks then almost all need liver transplant

96
Q

why is vitamin K given

A

to prevent haemorrhagic disease of the newborn

97
Q

what are all day 5 babies screened for

A 
congenital hypothyroidism 
PKU
CF
heamoglobinopathies 
MCAD

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