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Neonatal sepsis and Resuscitation - CRQ for the Final FRCA

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Neonatal sepsis and Resuscitation - CRQ for the Final FRCA
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Hello and welcome back to our latest episode!

In this podcast episode, we will run through the key details you need to be able to recall about neonatal sepsis and resuscitation for the Final FRCA exam, and the constructed response question we are using is very kindly donated from Sumner et al.'s CRQs and SBAs for the Final FRCA: questions and detailed answers.

If you've listened to our previous episodes you'll have heard me raving about this book on repeat, and for good reason - it's seriously good value - so go and grab a copy and get cracking on the rest of their very carefully considered and up to date questions and answers.

So here we go.

You review a 3-day-old neonate in A&E suspected to have sepsis. The child was born via normal vaginal delivery at 41 weeks and has Down's syndrome. At present, the child has been commenced on IV fluids and IV broad-spectrum antibiotics. The actual weight of the child is 4.0 kg. You are called because the paediatric team are concerned that the patient is continuing to deteriorate.

What are the most common infective organisms for sepsis in the newborn?

  • Group B streptococcus
  • Listeria monocytogenes
  • Escherichia coli
  • Staphylococcus aureus
  • Herpes simplex virus
  • Enterovirus
  • Parechoviruses
  • Candida spp

Calculate the appropriate uncuffed oral endotracheal tube size and length for this patient

  • Tube size: 3.5mm

Uncuffed: (age/4) + 4

Microcuff: (age/4) + 3.5

For Croup use 0.5 to 1 endotracheal size smaller

  • Tube length: 12cm

Oral: (age/2) + 12 or weight in kg + 6

Nasal: (age/2) + 15

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Give the correct doses for the following drugs that may be required for this patient:

  • Atropine
  • Adrenaline
  • Suxamethonium
  • Ketamine
  • Cefuroxime

Answer

  • Atropine: 20mcg/kg = 80mcg
  • Adrenaline: 10mcg/kg = 40mcg (0.4ml of a 1:10000 minijet)
  • Suxamethonium: 3-4mg/kg = 12-16mg IM
  • Ketamine: 0.5-2mg/kg = 2-8mg
  • Cefuroxime: 25mg/kg = 100mg

Outline how intravenous fluids will be used in circulatory shock in this patient

  • 10ml/kg bolus
  • Repeat boluses up to 40-60ml/kg
  • Optimise haemoglobin to keep it above 100g/litre, with packed red cells at 10ml/kg
  • If fluid refractory shock, then early intubation improves outcome

In the event of cardiac arrest, describe the CPR ratio, anatomical location of defibrillator pads, and defibrillator energy you would use

  • CPR Ratio: 15:2
  • Location of pads: Left of sternum and below left scapula, or below right clavicle and left axilla
  • (AP or anteroposterior is not accepted)
  • Energy: 4J/kg = 16J

List four potential causes of a difficult airway in this patient

  • Large tongue
  • Large tonsils or adenoids
  • Subglottic stenosis
  • Atlanto-axial instability
  • Micrognathia

‌Answer guidance

This question has been rated as easy with a pass mark of 12, and the aim is to recall neonatal anatomy, physiology and pharmacology and the resuscitation of the acutely unwell neonate.

The pass requirement is the correct knowledge of paediatric equipment and neonatal resus algorithm.

Neonatal resuscitation has a number of key differences to adult resuscitation. They often require a tertiary specialist neonatal unit but every anaesthetist needs to be aware of how to manage the initial steps as these cases can present to any hospital, and of course, it's always a sleepy district general hospital in the middle of nowhere with one anaesthetic registrar on call, so it pays to know this stuff.

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