Define the neonatal period
What are the warning signs of a sick infant ?
- Not feeding well
- Drowsy or unconcious
- Movement only when stimulated or no movement at all
- Tachypnoea (>= 60)
- Accessory muscles used
- Raised temp >= 38
- Hypothermia < 35.5
- Central cyanosis
What is the emergency management of a neonate and the treatment given ?
- ABC - use a nasal cannula if O2 sat ≤ 90%, use bag & mask ventilation if aponea, gasping or RR < 20
- IV access
- IV antibiotics - is pyrexia of unknown source give GAM, if suspected menigococcal septicaemia follow meningitis treatment (in preterm lecture)
- If drowsy or convulsing check BG - give IV glucose if needed
- If convulsing - 1st line = phenobarbitol, 2nd line = phenytoin
- Admit & monitor + further investigations if needed
What are the main causes of convulsions or fits in infants ?
- Hypoxic ichaemic encephalopathy (result of perinatal asphyxia)
- CNS infection e.g. meningitis/ encephalitis
- Itrancranial haemorrhage
Define what hypoxic ischaemic encephalopathy is
This is where the babies O2 supply was interupted at birth, this can then result in neurodevelopmental problems in the future e.g. cerebral palsy
What are the symptoms of hypoxic ischaemic encephalopathy?
- Hyperalert or decreased conciousness
- Eye rolling
What is the treatment of hypoxic ischaemic encephalopathy?
May need mild hypothermia/cooling treatment & need to be admitted to NICU where they may have ventilation or CPAP
Define hypoglycaemia in neonates
What are the symptoms of hypoglycaemia in neonates ?
- Coma or decreased conciousness
- Transient hypermesis (vomiting)
What is the treatment of hypoglycaemia in neonates ?
IV glucose infusion
Define hypocalcaemia in neonates
< 2.1 (norm is 2.1-2.6)
What are the symptoms of hypocalcaemia in neonates ?
- Convulsion/fits - muscle spasms
- Prolonged QT interval
What is the treatment of hypocalcaemia in neonates ?
- 1st line = Low PO43- + calcium gluconate
- If also have hypomagnesaemia the give IV MgSO4
What are the 4 main serious infections in neonates ?
What are the signs of sepsis in neonates ?
- Stiff limbs
- Cyanosis - looks mottled, blueish or pale
- Cap refill ≥ 3 secs
- Difficulty feeding
- Severe chest indrawing
- Temp ≤ 35.5 or ≥ 37.5
- Movement only when stimulated
- RR ≥ 60
Sepsis should always be a differential in neonates
In the early neonatal period (<48hrs) what is the most common causative organisms for sepsis ?
E.coli & Group B strep (streptococcus agalactiae)
In late onset sepsis alongside the common ones for early onset what are the other potential causative organisms ?
- Staph. epidermis
- Listeria monocytogenes
In suspected or confirmed sepsis of a neonate what investigations should be done as an infeciton screen to find the possible source ?
- Blood culture & virology
- Lumbar puncture
- Stool sample for virology
- Urine sample for culture & virology
- ENT swabs for culture
What is the management of neonatal sepsis ?
- BUFALO (Abx = GAM)
- then once the cause is found treat as per guidelines
What are the 3 potential causative organsims of neonatal meningitis ?
- Group B strep
- Listeria monocytogenes
What are the signs/symptoms of neonatal meningitis ?
- High pitched abnormal cry
- Difficulty feeding
- Bulging fontanelles
Note photophobia, stiff neck etc is less common in young kids
How is neonatal meningitis diagnosed ?
What is the treatment of meningitis in young kids < 3months and kids > 3months ?
- If < 3 months tx = cefotaxime + amoxicillin
- If > 3months (upto age of 18) tx = 1st dose cefotazimine followed by once daily ceftriaxone + dexamethasone
What are the signs/symptoms of penumonia in neonates ?
- Poor feeding
- Respiratory excessory muscle use
How is penumonia diagnosed in neonates ?
CXR + FBC + blood & sputum cultures
List the causes of pneumonia neonates, infants & school children ?
- Neonates: GBS, E.coli, Klebsiella, Staph aureus
- Infants: Strep pneumoniae, Chlamydia
- School age: Strep pneumoniae, Staph aureus, Gr A strep, Bordetella, Mycoplasma, Legionella
How is the severity of CAP pneumonia determined ?
Using CURB 65
What is the treatment of severe and non-severe CAP in children < 1 and > 1y/o ?
- > 1y/o 1st line = amoxicillin, 2nd line = clarithromycin
- < 1y/o 1st line = co-amoxiclav
- 1st line = co-amoxiclav (+ clarithromycin if signs of atypical pneumonia or pertussis)
What is the treatment of HAP/post-op/aspiration penumonia in young children ?
1st line = co-amoxiclav
What are the signs/symptoms of UTI in neonates ?