Sick Term Infants Flashcards
What is the time period for classifying a new baby as a neonate?
Up to 28 days
What is the most common cause of neonatal death?
Prematurity
What are the components of the APGAR score?
Appearance Pulse Grimace (reflex irritability) Activity (tone) Respirations
What is a normal APGAR score?
8 or 10
How is appearance scored on APGAR?
Blue or pale = 0
Blue in extremities = 1
No cyanosis = 2
How is pulse scored on APGAR?
Absent = 0
Less than 100 = 1
More than 100 = 2
How is grimace scored on APGAR?
No response = 0
Feeble cry when stimulated = 1
Cry or pull away when stimulated = 2
How is activity scored on APGAR?
No activity = 0
Some flexion = 1
Flexed arms and legs that resist extension = 2
How is respiration scored on APGAR?
No respiration = 0
Weak, irregular, gasping = 1
Strong cry = 2
List important parts of the maternal history to ask about during newborn clinical assessment
PMHx
Pregnancy issues
Drugs
Infection risks
List important parts of the fetal history to ask about during newborn clinical assessment
Fetal gorwth
Fetal anomaly
Delivery
Resuscitation
List the important examinations involved in a newborn clinical assessment
Inspect: tone, arousal, colour, vomit, feeding, seizures
AB: respiratory rate, effort, colour, sats (95%)
C: heart rate, CRT, BP
What is a normal respiratory rate for a neonate?
40-60 breaths/min
What is a normal heart rate for a neonate?
120-160/min
List aspects of initial management in an ABCDE assessment
AB: oxygen
C: fluids, inotropes, umbilical access
D: glucose management, acid-base balance
E: temperature, antibiotics
What are the 4 main causes/groups of causes of a sick term infant?
Congenital abnormality
Metabolic disorder
Pregnancy/Birth-related
Infection
List the main bacterial infections that affect neonates
Group B Strep. E. coli Listeria Staph. aureus Staph. epidermidis
List the main viral infections that affect neonates
Cytomegalovirus Parovirus Herpes virus Enterovirus Toxoplasma gondii HIV Syphilus
List the TORCH infections which are commonly associated with congenital anomalies
Toxoplasmosis Other (syphilis, varicella-zoster, parvovirus B19) Rubella Cytomegalovirus (CMV) Herpes
List the most common sites of infection found in sick term infants
Blood stream (bacteraemia,septicaemia) CNS (meningitis) Respiratory (pneumonia) GU (UTI) GI (NEC) Skin, bone
Give a cause of neurodevelopmental problems shortly after delivery that requires immediate resuscitation in the newborn
Hypoxic ischaemic encephalopathy
Multi-organ damage due to tissue hypoxia
List respiratory problems that can be seen in the newborn shortly after delivery
Transient tachypnoea of newborn (TTN)
Pneumothorax (spontaneous or secondary to resusc)
What is transient tachypnoea of newborn? What is a major risk factor?
Inability of the newborn’s lungs to expel or absorb amniotic fluid during and following delivery
Cesarean delivery
State a cardiac problem that is a common cause of heart failure in the newborn
Hydrops foetalis
What is hydrops foetalis?
Accumulation of fluid in at least 2 compartments (ascites, pleural effusion, abdominal swelling etc.)
What are the two main types of hydrops foetalis?
Immune (due to Rhesus disease)
Chromosomal
State a cardiac problem that is due to a failure to adapt to postnatal life
Persistant pulmonary hypertension of newborn
Pressure in lungs does not drop, causing hypoxia
List common cardiac-related congenital diseases found in the newborn
Tetralogy of fallot Transposition of great arteries Coarctation of aorta Total anomolous pulmonary venous drainage Hypoplastic heart
What is a common clinic sign of coarctation of aorta?
Absent femoral pulses
List the main components of tetralogy of fallot
"Don't DROP the baby" Defect (VSD) Right ventricular hypertrophy Overriding aorta Pulmonary stenosis
What is total anomolous pulmonary venous drainage (TAPVD)?
Four pulmonary veins drain abnormally to the right atrium, instead of the left, by way of an abnormal (anomalous) connection
What is hypoplastic heart?
Left ventricle is underdeveloped leading to reduced pumping action of the heart
List common respiratory-related congenital diseases found in the newborn
Tracheo-oesophageal fistula
Diaphragmatic hernia
What is a common sign on imaging of tracheo-oesophageal fistula?
NG tube can’t pass down oesophagus as it isn’t formed properly
List common neuro-related congenital diseases found in the newborn
Microcephaly
Spina bifida
State a common renal-related congenital disease found in the newborn
Potter’s syndrome
Kidney’s fail to develop in the womb leading to reduced amniotic fluid production
State a common muscular-related congenital disease found in the newborn
Congenital myotonic dystrophy
Weak muscles and a lack of muscle tone
List common metabolic congenital diseases found in the newborn
Hypoglycaemia
Acidosis
List risk factors for hypoglycaemia in the neonate
Maternal diabetes
SGA or LGA
Prematurity
Difficult birth
List signs of hypoglycaemia in the newborn
Jitteriness Cyanosis Apnea Hypothermia Poor body tone Poor feeding Lethargy Seizures
List some conditions tested for on the Guthrie card or heel prick test
PKU
Sickle cell anaemia
Cystic fibrosis
Congenital hypothyroidism
