Neonatal respiratory distress is due to failure to maintain adequate exchange of oxygen and carbon dioxide due to a variety of reasons. It is characterized by: Tachypnoea, respiration rate more than 60 per minute, expiratory grunt and cyanosis, intercostal, subcostal and sternal recession, flaring of alae nasi. These features may be present at birth or develop within hours of birth. This may be due to Respiratory Distress Syndrome (RDS), pneumonia, aspiration of meconium or feeds, transient tachypnoea of newborn, congenital heart disease, diaphragmatic hernia.

Features that may assist in diagnosis include:

• RDS More common in premature babies, following Caesarian section, in infants of diabetic mothers and in multiple pregnancy. Chest X-ray shows a reticulogranular pattern.

• Pneumonia History of prolonged rupture of membranes (more than 24 hours) and maternal fever, offensive liquor or vaginal discharge.

• Meconium aspiration Meconium stained liquor and staining of skin, nails and cord

• Transient Tachypnoea of newborn Difficult to differentiate from RDS but usually in term/near term babies

• Diaphragmatic hernia - CXR.

Management

• Oxygen should be administered to relieve cyanosis

• Fluid and electrolyte balance should be maintained through an IV line

• Babies with more than mild distress should not be fed. IV 10% dextrose at 60 ml/kg/day should be used instead

• Antibiotics: As infection cannot usually be excluded, start a course of crystalline penicillin 50,000 units/kg BD and gentamicin 2.5 mg/kg BD

• IM vitamin K 0.5 mg as a STAT dose.

Refer

• To paediatrician for further management.

SEPSIS AND MENINGITIS

Have similar aetiology, epidemiology, clinical manifestations and pathogenesis. Characterised by symptomatic illness and bacteraemia. In meningitis the CSF contains low sugar, increased cells and protein, bacteria or bacterial antigens. Common organisms are E. colt and group B streptococcus, which together cause 50-75% of cases. Other organisms are Staph aureas, Klebsiella-enterobacteriaceae sp., Pseudomonas aeruginosa, Proteus, and Listeria monocytogenes.

Clinical Features

Temperature instability. Jaundice. Respiratory distress. Lethargy. Vomiting. Abdominal distension. In meningitis irritability and convulsions.

NB Bulging fontanelle and stiff neck areabsent in 75% of neonates with meningitis

Investigations

• Blood - HB, PBF especially immature WBC Blood - C&S

• CSF - Microscopy, C&S

• Urine - Microscopy, C&S

• Obtain simultaneous blood sugar to rule out hypoglycaemia which is common in neonates.

Management

• Immediate antibiotic therapy (after collecting samples)

• Crystalline penicillin 50, 000 units/kg BD and gentamicin 2.5 mg/kg BD

• Amikacin 7.5 mg/kg BD is indicated in hospital acquired infections.

If suspecting

• Staphylococcus sepsis - start cloxacillin 25 mg/kg BD and gentamicin 2.5 mg/kg BD

• Sepsis - therapy should be continued for a total of 10-14 days or at least 5-7 days after clinical response where there is no evidence of deep tissue sepsis or abscess formation.

Treatment for meningitis should be continued for 3 weeks.

Prevention

• Increased and improved pre-natal care

• Regular cleaning and decontamination of nursery equipment

• Sound hand-washing principles

• Regular surveillance for infection.

Complications

Significant neurological sequelae: Hydrocephalus, blindness, mental retardation, hearing loss, motor disability, abnormal speech patterns.