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What could u consider when trying to identify a sick neonate?

Listen to the parents
Examine the baby undressed

It is suggested that observation of the baby’s appearance and behaviour is the first and most important stage of clinical assessment’ (Lumsden & Holmes (2010)

Do observations
Get an accurate feeding history and watch a feed if necessary

Check nappies for poos and wees


What should be assessed when looking at baby

- Airway
- Breathing



- Crying
-Abnormal movements

•Physical signs of infection


Why would u assess the neonates' airways

1. May have meconium aspriation syndrome
2. May find it difficult to breathe
3.May have respiratory distress syndrome


Why would u assess a neonates colour?

Cyanosis- when breathing could indicate cogential heart problems
Cyanosis- with Apnoea, investigate Apnoea
Grey- Shocked and very sick babies
Jaundiced- always suspect infection of pathological( if within the first 24hrs)


Why would u assess the temperature?

Raised temperature = can indicate infection or overheating which is dangerous

Hypothermia=may indicate sepsis,under-feeding, intercrani bleeding,baby must be warmed slowly if true hypothermia.


Why would u assess attitude and Behaviour of a neonate?

They could be too floppy (Hypotonia)

They could be I tense with clenched fist(Hypertonia)

They may not be moving when awake or one side moves differently to the other

They do not want to attach onto the breast and suck

Babies with such symptoms need to be seen by the peads.


Why would u assess an abnormal cry?

Some can be persistent, which could indicate hunger so investigate feeding, wind/colic or pain

If a high pitch cry, then it may indicate brain damage or a chromosomal condition.


Why would u assess abnormal movements

Could be having neonatal fits


Why would u assess feeding behaviour?

Does not demand feeds
–Affected by maternal medication/drugs?

•Too tired to suck long

-Prolonged crying or disturbance?
–Underfed or sick


Why do we assess Abnormal urine or stool?

check for meconium plug

reduced urine

delayed changed stool, could indicate undernutrition


Name 3 obvious signs of infection



What is MAS?

Meconium Aspiration Syndrome

Term, Post term, Hypoxia in labour are more at risk

if meconium is present in labour in liquor, care to be taken with resuscitation

If neonate not breathing, check for meconium and suction under direct supervision

if crying and breathing observe for RDS Over next 12hrs


What is respiratory distress syndrome (RDS) and reference?

A deficiency caused by surfactant (Cameron,2010)


what are the factors that increase incidence of RDS?

being preterm infants. 80% babies up to 28/40, 50% up to 33/40

it can also occur in term infants if there is hypoxia, diabetic mothers, pr-labour lscs


What factors that decrease incidence of RDS?

Stress in utero and narcotic addiction •Steroids to mother at risk of pre-term delivery (24-34/40) diminish the risk/reduce the severity of RDS (pre-term labour guidelines (NICE, 2015)


Signs of RDS?

Tachypnoea/increased respiratory rate
•Apnoeic episodes
•Nasal flaring
•Sternal and intercostal recession
•Peripheral or Central cyanosis



Treatment of RDS?

Surfactant (via ET tube)
–O2 with ventilation if needed
–Maintain temperature
–Biochemical balance
–Nutrition (IV if ventilated)


How can u tell when a neonate is having a fit?

Brief jerking or twitching of a single limb which move from one part of the body to the other
–Sometimes this is so rapid it looks generalised
–Generalised tonic seizures with hyperextension
–Momentary changes in respiration, eye movement, drooling, lip smacking


What are the causes of neonate fits?

•Cerebral haemorrhage or oedema from birth trauma or head injury
•Metabolic disturbances and inborn errors of metabolism
•Structural abnormalities in brain
•Drug withdrawal
•Benign familial neonatal seizures


How to identify dehydration in a neonate?

Dry mouth
•Dry wrinkled inelastic skin
•Little darker urine and infrequent stool
•Sunken fontanelle and eyes
•Tachycardia, hypotension and greyish pallor
•Excessive weight loss