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MINDTHEBLEEP.COM PAEDS 101: NEONATE SURVIVAL GUIDE Dr Natasha Bechman MBChB Warwick Medical School F2 at East Surrey Hospital AIMS: NEONATES 101 Define neonates Common presentations + how to treat Aim of this Neonatal Bleep Communication styles Practical tipsound Session TRIGGER WARNINGNeonates: Definitions and DEFINITIONS: NEONATES 101 Differences First 28 days of life Birth type? Term or Pre-term? Risk Factors? PRESENTATIONS Neonates: Common presentations Jaundice Hypoglycaemia Resp Distress Syndrome SEpsis JAUNDICE Key Presentation 1: Jaundice Assessment Background: History: Very common - 50-70% in term neonates Two types: Physiological and pathological FHx anaemia/jaundice in previous pregnancies Mother’s Rhesus status Feeding - breast/bottle/combined? + volumes Risk factors Low birth weight Physical exam: Maternal Diabetes Yellowing of skin and sclera Decreased gestational age Hepatosplenomegaly Reduced feeding/weight loss Poor feeding or drowsiness Investigations: TCB/SBR FBCs DAT Test Blood group mum and baby Potentially - G6PD/septic screens if infection is suspected JAUNDICE Key Presentation 1: Jaundice Management: Phototherapy - one lamp, two or three lamps Exchange transfusion HYPOGLYCAEMIA Key Presentation 2: Hypoglycaemia Assessment History: Background: Mother’s medical hx Feeding - breast/bottle/combined? + volumes Also common - 40% in term neonates Occurs hrs-days Any vomiting/reflux symptoms in baby Physical exam: Risk factors Drowsy Cyanotic IUGR Hypothermic Suspected/confirmed neonatal sepsis <2 birth centile Clinically small Abnormal high pitched cry Babies of a mother with diabetes Jittery Babies of a mother who had Beta blockers in Seizures third trimester Investigations: BM + VBG HYPOGLYCAEMIA Key Presentation 2: Hypoglycaemia Treatment:Sugar! >2.0 mmol/L - encourage feed + <3hr intervals & optimise. 1.0 ->1.9 and no abnormal signs - buccal dextrose + feeding support <1.0 +/- signs - IV 10% dextrose 2.5ml/kg OR 40% buccal 200mg/kg if no access THEN: Treat the underlying cause!! Complications Seizures Neurological damage In rare cases - death. SEPSIS Key Presentation 3: Sepsis Assessment Background: History: Within 72 hours of life Maternal infections? Commonly GBS Previous GBS +/- abx given in pregnancy Neonatal meningitis 5-20% mortality Hx chorioamniotis Suspected sepsis one of the most common pathways of Tx Physical exam: Apnoeas/Grunting/Recessions Risk factors Seizures CPR GBS +ve Mother Shock Preterm Jaundice Prolonged ROM (>18hr) Change in tone Pre-labour rupture of membranes >24hrs Feeding refusal Cyanosis before labour Intrapartum fever >38 Investigations: Blood gas Blood culture + CPR + U&Es + FBCs + LFTs Swabs if local site indicated (eye infection) Kaiser Permente Score SEPSIS Key Presentation 3: Sepsis Treatment - Sepsis 6 GIVE: Oxygen, Fluid, IV Abx TAKE: Blood Culture, Bloods incl Lactate, Urine output CLOSE monitoring Consider transfer if not responding - tier 2 unit Complications Meningitis CLD Neurological deficits RDS Key Presentation 4: Respiratory Distress Syndrome Assessment Background: History: Deficiency of Surfactant Birth Hx? Surfactant production starts 24-28weeks Maternal infection Completed approx 34 weeks Meconium aspiration B>G incidence Physical exam: Tachypnoea, grunting, intercostal/subcostal Risk factors recession Nasal flaring Prematurity Apnoea Low birth weight Cyanotic GDM/Maternal diabetes Investigations: C-section + no antenatal steroids Blood gas Septic Screen Coagulation profile CXR RDS Key Presentation 4: Respiratory Distress Syndrome Treatment In-Out Surfactant +/- Intubation for longer periods +/- Abx - treat the cause Neonatal Bleep A lot of neonatal bleeps are just Surg attendance Key Questions: Gestation Any risk factors for sepsis? Any maternal factors to be aware of? section delivery aimed for - instrumental/C- Communication in Neonates Remember you’re treating a family - in whatever permutation Think location/who is available and can hear Emotions will run high - give space for that SPIKES principles If you need help from senior team - ask POST NATES WR Post-nates WR Example: Examination: Background: Gen: Pink, well perfused. D2 Male Neuro: fontanelles soft normotensive, moving all 4 limbs spontaneously 37 + 2 SVD - no complications CVS: No murmurs, HS 1+2+0, fem pulses BW: 3.2kg CW: 3.5kg present BL Resp: Chest clear, no resp distress, RR 46 GI: Abdo SNT, bowels open, passing urine, Key Issues: genitalia normal, testes descended BL Hypothermia V: SVIA F: EBM - 45mls every 3 hrs Plan: M: None - on hot cot 1.NIPE 2.Continue on hotcot for 2hrs then recheck temp NAME DESIGNATION DATEMINDTHEBLEEP.COM Thank you for listening Any questions? mindthebleep.com/webinar-feedback MINDTHEBLEEP.COM References https://www.londonpaediatrics.co.uk/wp- content/uploads/2018/01/NICUSurvivaldayFlyer_23Mar18.pdf Jaundice in newborn babies: what is it?- Patient Leaflet | BMJ Best Practice Neonatal jaundice - History and exam | BMJ Best Practice Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE Kernicterus & High Bilirubin Causes & Treatments | Newborn Jaundice Signs & Symptoms (abclawcenters.com) SHO_Survival_Guide_to_Neonates_updated_November_21.pdf (sash.nhs.uk) 1._Neonatal_PIP_Guidelines_Updated_December_2023_-_31012024.pdf (sash.nhs.uk) Neonatal hypoglycaemia | BMJ Medicine Life support algorithm (image) | Medicines guidance | BNFC | NICE Neonatal hypoglycaemia | BMJ Medicine Illustrated Textbook of Paediatrics 4th Edition - Lissauer and Claydon https://www.ncbi.nlm.nih.gov/books/NBK539840/ https://www.infantjournal.co.uk/pdf/inf_070_eon.pdf