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Unwell neonate
| Clinical Discipline(s)/Organ System(s) Paediatrics, Respiratory System, Emergency Medicine | Progress Test Topic(s) Child health, Seriously ill patient |
Description
A NZ European baby presents at 24 hours of age with grunting, respiratory distress and poor feeding. The pregnancy was unremarkable but there was prolonged rupture of membranes before the baby was born at term.
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Risk factors for vertically acquired bacterial sepsis
- Congenital infections (TORCHHS; toxoplasmosis, rubella, cytomegalovirus (CMV), HIV, herpes simplex virus, syphilis) and perinatally acquired infections
- Risk of serious sepsis across differing paediatric age groups
- Most common bacterial pathogens causing infection in neonates and maternal sepsis
- Pharmacokinetics, pharmacodynamics and side effects of antibiotics in neonates and children using beta-lactams and aminoglycosides as examples
- Glucose homeostasis in fetus and newborn
- harmacology of acyclovir
- Risk factors for vertically acquired bacterial sepsis
- Congenital infections (TORCHHS; toxoplasmosis, rubella, cytomegalovirus (CMV), HIV, herpes simplex virus, syphilis) and perinatally acquired infections
- Risk of serious sepsis across differing paediatric age groups
- Most common bacterial pathogens causing infection in neonates and maternal sepsis
- Pharmacokinetics, pharmacodynamics and side effects of antibiotics in neonates and children using beta-lactams and aminoglycosides as examples
- Glucose homeostasis in fetus and newborn
- harmacology of acyclovir
Clinical and Communication Skills
- Newborn examination; recognition of the seriously unwell infant
- Basic resuscitation infant/neonate
- Obtain antenatal history (maternal infective diseases)
- Review newborn record to obtain information about labour and delivery (note administration of antibiotics to mother in labour, duration of ruptured membranes, presence of maternal fever, use of vitamin K in the newborn)
- Use of pulse oximetry
- Recognition of signs of congenital infection
- Perform and interpret a septic screen (full blood count, blood culture, urine microscopy and culture, lumbar puncture, chest X-ray)
- Knowledge about the steps required to collect blood, urine and cerebrospinal fluid samples in a sterile fashion; securing intravenous access in neonate; umbilical vessel anatomy and access
- Initiate appropriate antibiotic therapy
- Calculate appropriate drug doses for individual patients by weight and body surface area
- Knowledge of treatments of congenital infection (toxoplasmosis, CMV, HIV)
- Recognition and management of hypoglycemia of the newborn
- Newborn examination; recognition of the seriously unwell infant
- Basic resuscitation infant/neonate
- Obtain antenatal history (maternal infective diseases)
- Review newborn record to obtain information about labour and delivery (note administration of antibiotics to mother in labour, duration of ruptured membranes, presence of maternal fever, use of vitamin K in the newborn)
- Use of pulse oximetry
- Recognition of signs of congenital infection
- Perform and interpret a septic screen (full blood count, blood culture, urine microscopy and culture, lumbar puncture, chest X-ray)
- Knowledge about the steps required to collect blood, urine and cerebrospinal fluid samples in a sterile fashion; securing intravenous access in neonate; umbilical vessel anatomy and access
- Initiate appropriate antibiotic therapy
- Calculate appropriate drug doses for individual patients by weight and body surface area
- Knowledge of treatments of congenital infection (toxoplasmosis, CMV, HIV)
- Recognition and management of hypoglycemia of the newborn
Personal and Professional Skills
- Demonstrate empathic approach to parents of an infant with a distressing presentation
- Explain the need for a septic screen to parents and obtain consent to perform lumbar puncture
- Demonstrate empathic approach to parents of an infant with a distressing presentation
- Explain the need for a septic screen to parents and obtain consent to perform lumbar puncture
Hauora Māori
- Health disparities for newborn Māori; higher burden of preterm birth and infectious disease
- Understand the barriers to care that face whānau for accessing antenatal care
- Health disparities for newborn Māori; higher burden of preterm birth and infectious disease
- Understand the barriers to care that face whānau for accessing antenatal care
Population Health
- Epidemiology of group B streptococcal disease and screening in pregnancy
- The role of intrapartum antibiotics in women colonised with group B Streptococcus
- HIV screening in pregnancy
- Antenatal care structure and providers in New Zealand (lead maternity carers)
- Epidemiology of group B streptococcal disease and screening in pregnancy
- The role of intrapartum antibiotics in women colonised with group B Streptococcus
- HIV screening in pregnancy
- Antenatal care structure and providers in New Zealand (lead maternity carers)
Conditions to be considered relating to this scenario
Common
neonatal sepsis, pneumonia, septicaemia, meningitis, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycaemia
neonatal sepsis, pneumonia, septicaemia, meningitis, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycaemia
Less common but 'important not to miss'
congenital heart disease, pneumothorax, shaken baby syndrome/ non-accidental injury
congenital heart disease, pneumothorax, shaken baby syndrome/ non-accidental injury
Uncommon
congenital diaphragmatic hernia, inherited metabolic disorders, vitamin K/haemorrhagic disease of the newborn, tracheoesophageal fistula
congenital diaphragmatic hernia, inherited metabolic disorders, vitamin K/haemorrhagic disease of the newborn, tracheoesophageal fistula
