Paediatrics: Non-specifi cally ill neonate

Non-specifi cally ill neonate

Early recognition of serious neonatal illness is an important skill. The nurse or parent may say that the infant is just ‘not right’. Listen, examine the baby carefully, and act if in any doubt! Any serious disease can present non-specifically.

Major causes

·  Infection (e.g. group B streptococcus or Guillain–Barré syndrome (GBS), septicaemia, meningitis;).

·  Hypothermia (may be sign of infection).

·  Metabolic (e.g. hypoglycaemia, inborn errors of metabolism).

·  Cardiac (e.g. congenital heart disease, arrhythmias;).

·  GI (e.g. NEC).

·  CNS (e.g. intracranial haemorrhage, seizures).

Presentation

·  Skin: pallor, mottling, peripheral cyanosis, cool peripheries; capillary refill >2secs; rash; jaundice.

·  Temperature: rise or fall.

·  CNS: lethargy, weak or unusual cry, generalized hypotonia, irritability, jittery, seizures.

·  Respiratory: apnoea, expiratory grunting, flaring nostrils, tachypnoea (>60breaths/min), intercostal or subcostal recession, tracheal tug.

·  CVS: tachycardia (>160/min), weak or absent pulses, (bradycardia <80 or hypotension should be considered late/pre-terminal signs).

·  GI: vomiting, distended abdomen (ileus), diarrhoea, bloody stools; abdominal tenderness; bilious vomit or aspirate.

·  Metabolic: ‘rise’or ‘fall’ blood glucose.