Recognising the Ill Baby

Chapter 31 Recognising the Ill Baby



Assessment of the infant


Immediately after birth, all infants should be examined for any gross congenital abnormalities or evidence of birth trauma. They should also have their weight and gestational age plotted on a standard growth chart.



History



Maternal health


Any disease in the mother can have an effect on the pregnancy. Influencing factors include:



image pregnancy-induced hypertension


image history of epilepsy


image maternal diabetes


image history of substance abuse


image history of sexually transmitted diseases.



Fetal wellbeing and health


The following are examples of factors that may have a critical influence on the wellbeing of the infant:



image Small for gestational age (SGA).


image Poor intrauterine growth.


image Evidence of congenital abnormality detected on ultrasound.



Perinatal and birth complications


Labour and birth may also have an effect on the general welfare of the newborn infant in the following ways:



image Prolonged rupture of membranes.


image Abnormal fetal heart rate pattern.


image Meconium staining.


image Difficult or rapid birth.


image Caesarean section and the reason for this.



Physical assessment



The skin


The presence of meconium on the skin, usually seen in the nail beds and around the umbilicus, is frequently associated with infants who have cardiorespiratory problems. The skin of all babies should be examined for:



image pallor


image plethora


image cyanosis


image jaundice


image rashes.



Pallor


A pale, mottled baby is an indication of poor peripheral perfusion. At birth this can be associated with low circulating blood volume or with circulatory adaptation and compensation for perinatal hypoxaemia. The anaemic infant’s appearance is usually pale pink, white or in severe cases where there is vascular collapse, grey. Other presenting signs are:



image tachycardia


image tachypnoea


image poor capillary refill.


The most likely causes of anaemia in the newborn period are listed in Box 31.1.



Box 31.1 Common causes of anaemia in the newborn period




• A history in the infant of haemolytic disease of the newborn


• Twin-to-twin transfusions in utero (which can cause one infant to be anaemic and the other polycythaemic)


• Maternal antepartum or intrapartum haemorrhage


Pallor can also be observed in infants who are hypothermic or hypoglycaemic. Problems associated with pallor include:



image anaemia and shock


image respiratory disorders


image cardiac anomalies


image sepsis (where poor peripheral perfusion might also be observed).



Plethora


The baby’s colour may indicate an excess of circulating red blood cells (polycythaemia). This is defined as a venous haematocrit greater than 70%. Newborn infants can become polycythaemic if they are recipients of:



image twin-to-twin transfusion in utero


image a large placental transfusion.


Other infants at risk are:



image SGA babies


image infants of diabetic mothers


image chromosomal disorders e.g. Down syndrome


image neonatal hypothyroidism.


Hypoglycaemia is commonly seen in plethoric infants because red blood cells consume glucose. The infant can exhibit a neurological disorder; irritability, jitteriness and convulsions can occur. Other problems that may manifest are:



image apnoea


image respiratory distress


image cardiac failure


image necrotising enterocolitis.



Cyanosis


The mucous membranes are the most reliable indicators of central colour in all babies, and if the tongue and mucous membranes appear blue, this indicates low oxygen saturation levels in the blood, usually of respiratory or cardiac origin. Episodic central cyanotic attacks may be an indication that the infant is having a convulsion. Peripheral cyanosis of the hands and feet is common during the first 24 hours of life; after this time it may be a non-specific sign of illness.



Jaundice (see Ch. 35)


Early-onset jaundice (occurring in the skin and sclera within the first 12 hours of life) is abnormal and needs investigating. If a jaundiced baby is unduly lethargic, is a poor feeder, vomits or has an unstable body temperature, this may indicate infection and action should be taken to exclude this.



Surface lesions and rashes


Rashes (Box 31.2) are quite common in newborn babies but most are benign and self-limiting.



Box 31.2 Surface lesions and rashes in the newborn baby



Milia




• White or yellow papules seen over the cheeks, nose and forehead


• Invariably disappear spontaneously over the first few weeks of life



Miliaria




• Clear vesicles on the face, scalp and perineum, caused by retention of sweat in unopened sweat glands


• Appear on the chest and around areas where clothes can cause friction


• Treatment is to care for the infant in a cooler environment or remove excess clothing



Petechiae or purpura rash




• Can occur in neonatal thrombocytopenia, a condition of platelet deficiency that usually presents with a petechial rash over the whole of the body


• There may also be prolonged bleeding from puncture sites and/or the umbilicus and bleeding into the gut


• Thrombocytopenia may be found in infants with:


image Congenital infections, both viral and bacterial

image Maternal idiopathic thrombocytopenia

image Drugs (administered to mother or infant)

image Severe Rhesus haemolytic disease


Bruising




• Can occur extensively following breech extractions, forceps and ventouse deliveries


• Bleeding can cause a decrease in circulating blood volume, predisposing the infant to anaemia or, if the bruising is severe, hypotension



Erythema toxicum




• A rash that consists of white papules on an erythematous base


• Occurs in about 30–70% of infants


• Is benign and should not be confused with a staphylococcal infection, which will require antibiotics


• Diagnosis can be confirmed by examination of a smear of aspirate from a pustule, which will show numerous eosinophils (white cells indicative of an allergic response, rather than infection)



Thrush




• A fungal infection of the mouth and throat


• Very common in neonates, especially if they have been treated with antibiotics


• Presents as white patches seen over the tongue and mucous membranes and as a red rash on the perineum



Herpes simplex virus




• If acquired in the neonatal period, this is a most serious viral infection


• Transmission in utero is rare; the infection usually occurs during birth


• 70% of affected infants will produce a rash, which appears as vesicles or pustules

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Related posts:

  1. The Placenta
  2. Prolonged Pregnancy and Disorders of Uterine Action
  3. The Third Stage of Labour
  4. Problems of Pregnancy

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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Recognising the Ill Baby

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