the sick new born

Question 1

what is the definition for a term infant?

Answer 1

babies born at 37 weeks gestation and above

Question 2

what is neonatal period?

Answer 2

the first 28 days in life

Question 3

what would be taken in a history to clinically assess a neonate?

Answer 3

Maternal:

• PMH
• pregnancy issues
• drugs
• infection risks

Fetal:

• fetal growth
• fetal anomaly
• delivery
• resuscitation

Question 4

what would be inspected in a clinical assessment of a neonate?

Answer 4

• tone
• level of arousal
• colour

Question 5

what vital signs are taken in a clinical assessment of a neonate?

Answer 5

• heart rate, perfusion
• respiratory rate
• cap refill
• SaO2

Question 6

what scoring system is used to assess neonates quickly after birth?

Answer 6

-Apgar score

Question 7

when is Apgar score done?

Answer 7

usually scored at 1 minute and then at 5 minutes and sometimes longer if necessary

Question 8

what is measured in Apgar soring?

Answer 8

Appearance (skin colour)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration

Question 9

what is normal RR in a newborn baby?

Answer 9

40-60 breaths/minute

Question 10

what is a normal HR in a newborn baby?

Answer 10

120-140 bpm

Question 11

whart is a normal capillary refill time in babies?

Answer 11

2-3 seconds

Question 12

what is a normal SaO2 in a baby?

Answer 12

95%

Question 13

what occurs to SaO2 in babies when born?

Answer 13

-O2 sats will gradually increase and don’t reach above 90% until about 10 minutes old

Question 14

what is the normal temperature for babies?

Answer 14

36.5- 37.4 degrees Celcius

Question 15

what is initial management of newborns?

Answer 15

• temperature (36.5-37.4)
• assess and support baby’s breathing
• circulation may need supporting using fluids and in very unwell babies use inotroped
• metabolic homeostasis must be established (glucose management, acid-base balance correction)
• antibiotics if infection

Question 16

what usually causes antenatal infection?

Answer 16

-bacterial infection

Question 17

what usually causes perinatal infection in babies?

Answer 17

-viral infection

Question 18

what usually causes postnatal infections in babies?

Answer 18

-fungal infection

Question 19

how does sepsis present in a newborn baby?

Answer 19

• quiet
• poor feeding
• tachypnoea
• apnoea
• tachycardia
• bradycardia
• temperature instability

Question 20

where can infection present in neonates?

Answer 20

• blood stream
• CNS
• respiratory
• GU

others:

• skin
• bone
• GI

Question 21

what is an example of a blood stream infection?

Answer 21

-bacteraemia/ septicaemia

Question 22

what is an example of a CNS infection?

Answer 22

-meningitis

Question 23

what bacterial infection is common in mums and what is done to pick it up early?

Answer 23

-group B strep

screening progamme in place for pregnant women

Question 24

when is staphilococcus aureus infection usually seen in neonates?

Answer 24

-when IV fluids used and needles

Question 25

what are some common bacterial infections seen in neonates?

Answer 25

- group B streptococus - E.coli - staphylococcus aureus - staph epidermis - staph capitis - Klebsiella Oxytoca - Listeria monocytogenes

Question 26

what is first line antibiotic choice for neonatal sepsis?

Answer 26

Benzylpenicillin and gentamicin

Question 27

what is the most common bacteria in neonatal sepsis?

Answer 27

Group B strep

Question 28

what are some examples of viruses that may affect a neonate?

Answer 28

- cytomegalovirus - parvovirus - herpes viruses - enteroviruses Other: - syphilis - toxoplasma gondii - HIV - TORCH

Question 29

what are some examples of viruses that may affect a neonate?

Answer 29

- cytomegalovirus - parvovirus - herpes viruses - enteroviruses Other: - syphilis - toxoplasma gondii - HIV - TORCH

Question 30

what causes syphilis?

Answer 30

-Treponema Pallidum readily crossing the placenta

Question 31

when are babies at highest risk of catching syphilis?

Answer 31

-when mum has early stage syphilis (infection within last 2 years)

Question 32

what can reduce a mother passing on syphilis to her neonate?

Answer 32

-if treatment is given 30 days prior to delivery

Question 33

what are some pregnancy/birth related respiratory pathologies?

Answer 33

- TTN - pneumothorax - meconium aspiration - RDS - birth asphyxia

Question 34

what are some clinical signs of respiratory distress?

Answer 34

- tachypnoea - subcostal and intercostal recession - grunting - blue - low sats

Question 35

who is TTN (transient tachypnoea of the newborn) usually seen in?

Answer 35

-in term infants delivered by caesarean section

Question 36

what is transient tachypnoea of the newborn (TTN)?

Answer 36

-a breathing disorder seen shortly after birth due to delay in clearing lung fluid

Question 37

how is lung fluid cleared out in a healthy newborn?

Answer 37

-usually clears into interstitium and then in to lymphatic system

Question 38

what does the clearing out of lung fluid depend on ?

Answer 38

-dependant on active Na channels, activated by adrenaline

Question 39

how long does it take for transient tachypnoea of the newborn to resolve?

Answer 39

-resolves over the first 24 hours of life

Question 40

what would a CXR of a neonate with transient tachypnoea of the newborn (TTN) show?

Answer 40

-CXR shows fluid in horizontal fissure

Question 41

what causes a pneumothorax to occur in a neonate?

Answer 41

-can occur spontaneously secondary to: - resus - infection - meconium - surfactant deficiency

Question 42

what causes respiratory distress syndrome?

Answer 42

-surfactant deficiency

Question 43

who is RDS more common in?

Answer 43

-preterm infants

Question 44

what is RDS associated with?

Answer 44

- IUGR - maternal diabetes - infection - birth asphyxia - multiple birth - PROM - meconium aspiration

Question 45

how does RDS appear on a CXR?

Answer 45

-ground glass appearance

Question 46

what is treatment for respiratory distress syndrome??

Answer 46

-respiratory support and surfactant replacement

Question 47

who is meconium aspiration syndrome more common in?

Answer 47

-more common in later gestation

Question 48

what is meconium aspiration syndrome?

Answer 48

-when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery

Question 49

what can meconium aspiration syndrome cause?

Answer 49

- airway obstruction - inflammation - surfactant dysfunction

Question 50

what is hypoxic ischaemic encephalopathy?

Answer 50

-multi organ tissue damage due to tissue hypoxia