Last updated on 27 Aug 2014 at 2:53 PM (Paed25)

Unwell neonate
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.

 

Applied 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

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

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

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

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)

 

Conditions to be considered relating to this scenario

Common

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

Uncommon

congenital diaphragmatic hernia, inherited metabolic disorders, vitamin K/haemorrhagic disease of the newborn, tracheoesophageal fistula