The Sick Term Infant

Apgar scoring

  • Based on a total score of 1 to 10
  • The higher the score, the better the baby is doing after birth
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Illness in newborns

Respiratory

  • Transient tachypnoea of the newborn (TTN) - fluid in the lungs does not clear away
  • Pneumothorax - spontaneous vs. 2° active resuscitation
  • Congenital respiratory disease
    • Tracheo-oesophageal fistula
    • Diaphragmatic hernia

Cardiac

  • Heart failure
    • Hydrops foetalis - rhesus disease, chromosomal
  • Failure to adapt to postnatal life - persistent pulmonary hypertension of the newborn (PPHN)
  • Congenital heart disease
    • Tetralogy of Fallot
    • Transposition of great arteries
    • Coarction of the aorta
    • TAPVD
    • Hypoplastic heart

Others

  • Infection - aquired antenatal, perinatal or postnatally
  • Neurological - hypoxic ishcaemic encephalopathy, microcephaly, spina bifida
  • Renal - Potters syndrome
  • Muscular - myotonic dystrophy
  • Hypoglycaemia
    • Reduced to 'reserves' - LBW/SGA
    • Related to maternal disease - IDM
    • Evidence of more complex metabolic disorder
  • Acidosis - inborn error of metabolism

Management of a sick newborn

Initial management

  • Stabilise temperature - 36.5-37.4℃
  • Airway and breathing - gentle support (e.g. open airway), consider oxygen as needed
  • Circulation - fluids, inotropes
  • Metabolic homeostasis - glucose management, correction of acid-base balance
  • Antibiotics

Ongoing management

  • Diagnostic work-up
  • Further support
    • Ventilation
    • Drugs
    • Specific therapy e.g. therapeutic cooling
    • Surgery
    • Transfer
  • Care of family