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Flashcards in Sick-term infant Deck (112)
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1

Define the neonatal period 

0-27days old 

2

What are the warning signs of a sick infant ?

  • Not feeding well 
  • Convulsions 
  • Drowsy or unconcious 
  • Movement only when stimulated or no movement at all 
  • Tachypnoea (>= 60)
  • Grunting 
  • Accessory muscles used 
  • Raised temp >= 38 
  • Hypothermia < 35.5
  • Central cyanosis 

3

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 

4

What are the main causes of convulsions or fits in infants ?

  • Hypoxic ichaemic encephalopathy (result of perinatal asphyxia) 
  • CNS infection e.g. meningitis/ encephalitis 
  • Hypoglycaemia 
  • Hypocalcaemia 
  • Itrancranial haemorrhage 

5

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 

6

What are the symptoms of hypoxic ischaemic encephalopathy?

  • Hyperalert or decreased conciousness 
  • Irritable 
  • Eye rolling 
  • Convulsions/fits 

7

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

8

Define hypoglycaemia in neonates 

≤ 2.5

9

What are the symptoms of hypoglycaemia in neonates ?

  • Coma or decreased conciousness 
  • Convulsions 
  • Transient hypermesis (vomiting)

10

What is the treatment of hypoglycaemia in neonates ?

IV glucose infusion 

11

Define hypocalcaemia in neonates 

< 2.1 (norm is 2.1-2.6) 

12

What are the symptoms of hypocalcaemia in neonates ?

  • Convulsion/fits - muscle spasms 
  • Prolonged QT interval 
  • Laryngospasm 
  • Bronchospasm 

13

What is the treatment of hypocalcaemia in neonates ?

  • 1st line = Low PO43- + calcium gluconate 
  • If also have hypomagnesaemia the give IV MgSO4

14

What are the 4 main serious infections in neonates ?

  1. Sepsis 
  2. Meningitis 
  3. Pneumonia 
  4. UTI 

15

What are the signs of sepsis in neonates ?

  • Seizures 
  • 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
  • Lethargy 
  • Grunting 

Sepsis should always be a differential in neonates 

16

In the early neonatal period (<48hrs) what is the most common causative organisms for sepsis ?

E.coli & Group B strep (streptococcus agalactiae) 

17

In late onset sepsis alongside the common ones for early onset what are the other potential causative organisms ?

  • Staph. epidermis 
  • Listeria monocytogenes 
  • Klebsiella 
  • Enterococcus 

18

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 
  • CXR 
  • Lumbar puncture 
  • Stool sample for virology 
  • Urine sample for culture & virology 
  • ENT swabs for culture 

19

What is the management of neonatal sepsis ?

  • BUFALO (Abx = GAM)
  • then once the cause is found treat as per guidelines 

20

What are the 3 potential causative organsims of neonatal meningitis ?

Think GEL 

  1. Group B strep
  2. E.coli 
  3. Listeria monocytogenes 

21

What are the signs/symptoms of neonatal meningitis ?

  • Irritable 
  • High pitched abnormal cry 
  • Lethargy 
  • Difficulty feeding 
  • Fever 
  • Seizures 
  • Bulging fontanelles 
  • Apnoea 

Note photophobia, stiff neck etc is less common in young kids 

22

How is neonatal meningitis diagnosed ?

Lumbar puncture 

23

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 

24

What are the signs/symptoms of penumonia in neonates ?

  • Malaise 
  • Poor feeding 
  • Tachypnoea 
  • Cyanosis 
  • Grunting 
  • Respiratory excessory muscle use 

25

How is penumonia diagnosed in neonates ?

CXR + FBC + blood & sputum cultures 

26

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

27

How is the severity of CAP pneumonia determined ? 

Using CURB 65 

28

What is the treatment of severe and non-severe CAP in children < 1 and > 1y/o ?

Non severe: 

  • > 1y/o 1st line = amoxicillin, 2nd line = clarithromycin 
  • < 1y/o 1st line = co-amoxiclav 

Severe: 

  • 1st line = co-amoxiclav (+ clarithromycin if signs of atypical pneumonia or pertussis) 

29

What is the treatment of HAP/post-op/aspiration penumonia in young children ?

1st line = co-amoxiclav 

30

What are the signs/symptoms of UTI in neonates ?

  • Fever 
  • Vomiting 
  • Lethargy 
  • Irritability 
  • Poor feeding & failure to thrive 
  • May be abdo pain, loin tenderness and other characterisitc symptoms but less likely in younger children