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paediatrics > Term Admisssions > Flashcards

Term Admisssions Flashcards

1
Q

What are the categories of term admissions?

A
  • Sepsis
  • Respiratory problems
  • Cardiac problems
  • Hypoglycaemia
  • Hypothermia
  • Jaundice
  • Birth asphyxia
  • Surgical problems
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2
Q

What are the symptoms of sepsis in a neonate?

A
  • Baby pyrexia or hypothermia
  • Poor feeding
  • Lethargy
  • Early jaundice
  • Hypoglycaemia
  • Hyperglycaemia
  • Asymptomatic
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3
Q

What are the risk factors for sepsis in neonates?

A
  • Premature rupture of membranes
  • Maternal pyrexia
  • Maternal GBS carriage
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4
Q

How is presumed sepsis managed?

A

-Admit NNU
-Partial septic screen (FBC, CRP, blood cultures) and blood gas
-Consider CXR, LP
IV penicillin and gentamicin 1st line
-2nd line iv vancomycin and gentamicin
-Add metronidazole if surgical/abdominal concerns
-Fluid management and treat acidosis
-Monitor vital signs and support respiratory and cardiovascular systems as required

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5
Q

What are the commonest organisms implicated in neonatal sepsis?

A
  • Group B streptococci
  • E.coli
  • Listeria
  • Coagulase negative staphylococci (if lines in situ)
  • Haemophilus influenzae
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6
Q

When does group B streptococcus sepsis occur?

A
  • Early onset – birth to 1 week

- Late onset or recurrence – up to 3 months

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7
Q

How may babies with GBS sepsis present?

A

Non-specific symptoms

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8
Q

What are the possible complications of GBS sepsis?

A
  • Meningitis
  • DIC
  • Pneumonia
  • Respiratory collapse
  • Hypotension
  • Shock
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9
Q

What is the prognosis of GBS sepsis?

A

4 to 30% mortality

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10
Q

What may congenital infection result in?

A
  • IUGR
  • Brain calcifications
  • Neurodevelopmental delay
  • Visual impairment
  • Recurrent infections
  • Other
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11
Q

Give examples of congenital infections.

A
  • Toxoplasmosis
  • Rubella
  • Cytomegalovirus
  • Herpes
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12
Q

What may cause respiratory distress?

A
  • Sepsis
  • Transient tachypnoea of the newborn
  • Meconium aspiration
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13
Q

How does transient tachypnoea of the new-born present?

A

Usually within the first few hours

  • Grunting
  • Tachypnoea
  • Oxygen requirement
  • Normal blood gases
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14
Q

What is the pathophysiology of transient tachypnoea of the new-born?

A

Delay in clearance of foetal lung fluids

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15
Q

What is the management of transient tachypnoea of the new-born?

A
  • Self-limiting and common
  • Supportive management
  • Antibiotics
  • Fluids
  • O2
  • Airway support
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16
Q

What is meconium aspiration?

A

Meconium is inhaled into the lungs

17
Q

What are the risk factors for meconium aspiration?

A
  • Post dates (aged placenta)
  • Maternal diabetes
  • Maternal hypertension
  • Difficult labour
18
Q

What are the symptoms of meconium aspiration?

A
  • Cyanosis
  • Increased work of breathing
  • Grunting
  • Apnoea
  • Floppiness
19
Q

How is meconium aspiration investigated?

A
  • Blood gas
  • Septic screen
  • CXR
20
Q

How is meconium aspiration treated?

A
  • Suction below cords
  • Airway support including intubation and ventilation
  • IV fluids and antibiotics
  • Surfactant
  • NO or ECMO
21
Q

What is the prognosis of meconium aspiration?

A
  • Most do well
  • Some develop PPHN
  • There is a associated mortality
22
Q

When does cyanosis occur?

A

Cyanosis occurs when there is more than 5g/dl of deoxyhaemoglobin

23
Q

How is the ‘blue baby’ investigated?

A
  • Examination and history
  • Sepsis screen
  • Blood gas and blood glucose
  • CXR
  • Pulse oximetry
  • ECG
  • ECHO
  • Hyperoxia test
24
Q

What is the differential cardiac diagnosis for the blue baby?

A
  • Transposition of the great arteries
  • Teratology of fallots
  • TAPVD
  • Hypoplastic left heart syndrome
  • Tricuspid atresia
  • Truncus arteriosus
  • Pulmonary atresia
25
Q

What is the treatment for hypoglycaemia?

A
  • If requires admission to NNU may still manage with enteral feeds
  • Monitor blood glucose
  • Start iv 10% glucose
  • Increase fluids
  • Increase glucose concentration (central iv access)
  • Glucagon
  • Hydrocortisone
26
Q

How should hypothermia be managed?

A
  • If unable to maintain temperature on PNW admit and place in incubator
  • Sepsis screen and antibiotics
  • Consider checking thyroid function
  • Monitor blood glucose
27
Q

What may sever jaundice require?

A
  • In severe jaundice may require admission for intensive phototherapy and/or exchange transfusion
  • Incubator and IV fluids may also be required
28
Q

What is birth asphyxia?

A

Lack of oxygen at or around the birth which leads to multi-organ dysfunction

29
Q

What are the causes if birth asphyxia?

A
  • Placental problem
  • Long, difficult delivery
  • Umbilical cord prolapse
  • Infection
  • Neonatal airway problem
  • Neonatal anaemia
30
Q

What is the first stage of birth asphyxia?

A
  • Occurs within minutes without O2

- Cell damage occurs with lack of blood flow and O2

31
Q

What is the second stage of birth asphyxia?

A
  • Reperfusion injury
  • Can last days or weeks
  • Toxins are released from damaged cells
32
Q

What are the degrees of hypoxic ischaemic encephalopathy?

A
  • Mild
  • Moderate
  • Severe
33
Q

How is birth asphyxia managed?

A
  • Supportive
  • Fluid restriction (avoid cerebral oedema)
  • Monitor for renal and liver failure
  • -Respiratory support
  • Cardiac support
  • Treat seizures
  • Therapeutic hypothermia (cooling): improves outcomes especially in the moderate group
34
Q

What surgical problems may babies be admitted with?

A
  • Oesophageal atresia/fistula
  • Duodenal atresia and other GI atresias
  • Causes of failure to pass stool
  • Abdominal wall defects
  • Diaphragmatic hernia
35
Q

What causes of failure to pass stool are there?

A
  • Constipation
  • Large bowel atresia
  • Imperforate anus +/- fistula
  • Hirschsprungs disease
  • Meconium ileus (think CF)
36
Q

What abdominal wall defects can occur?

A
  • Exomphalos

- Gastroschisis

37
Q

What is the epidemiology of diaphragmatic hernias?

A
  • 1 in 2500 births
  • 90% on left
  • M>F
  • Can be syndromic
38
Q

How are diaphragmatic hernias managed?

A
  • Intubation at birth
  • Respiratory support
  • Surgery
  • (ECMO)
39
Q

What do diaphragmatic hernias usually present with?

A

Pulmonary hypoplasia

paediatrics (37 decks)

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