Neonatal death/Cot death
Sudden infant death syndrome
Definition & DDx - Perinatal death = death from 28wks
Most common at 3mths old to first 7 days)
Protective factors
- Breastfeeding Anatomy & Risks
- Room sharing Major risk factors for SIDS
- Use of dummies - Prone sleeping
Other: - Parental smoking
- Stillbirth = death after 24wks - Prematurity
before/during birth - Bed sharing
o Risk factors: Foetal growth - Hyperthermia
restriction; rises with Other risk factors for SIDS
increasing maternal age; - Male
- Neonatal death = death within first - Multiple births
28days - Social classes IV and V
o Risk factors: preterm birth; - Maternal drug use
mothers <25/>40yo; - Winter months
maternal health
(BMI/smoking/etc.)/foetal Investigations
health (congenital/low birth Following a cot death – screen siblings for
weight/)/obstetric sepsis/inborn errors of metabolism
complications (pre-
eclampsia/malpresentation)
Paediatric BLS - Start with 5 rescue breaths
Airway Pulse
- Infants: neutral - 2 = ≥100bpm
- Young children: slight extension - 1 = <100bpm
‘sniffing air’ - 0 = non-detectable
- Older children: head tilt/chin lift Grimace (response to stimulation)
Carotid pulse in ≥1yo (Brach/fem. - infants) - 2 = crying on stimulation
Chest compressions 100-120bpm (15:2) - 1 = grimace
- Infants: 2 fingers from 1 hand - 0 = no response
- Small children: 1 handed Activity
- Larger children: same as adults - 2 = flexed limbs resisting extension
Depth = 2/3rds chest unless adult size, - 1 = some flexion
then 5cm - 0 = floppy baby
APGAR (assessed at 1, 5 and 10mins) Respiration
Appearance - 2 = strong cry
- 2 = pink - 1 = weak cry
- 1 = pink centrally - 0 = no respiratory effort
- 0 = blue all over
,
,Vaccinations
Contraindications
Not CI to imms:
- Atopy
- Seizure hx
- Breastfed child
- Hx natural pertussis/MMR
- Hx neonatal jaundice
- FHx autism
- Down’s/CP/neuro conditions
- Low birth weight/prematurity
- Pts on steroids
CI to imms:
- Confirmed anaphylaxis to prev. dose of same antigens/another vaccine component
e.g., eggs
CI to live imms:
- Pregnancy
- Immunosuppression
Delay required:
- Febrile illness/intercurrent infection
Specific vaccines:
- DTP: deferred if evolving/unstable neurological condition
- Rotavirus: CI in hx intussusception
Vaccine Schedule
TB vaccine: given at birth if baby at risk e.g., TB in family <6mths
MenACWY and DTP booster for 13-18yo (HPV at 12yo)
Annual flu vaccine = 2-8yo
MMR DT; whooping cough; polio = 3-4yo
2, 3 and 4mths = DT; whooping cough; polio; Hib; Hep B
2 and 4mths = Men B
2 and 3mths = rotavirus PO
3mths = PCV
1yr = Hib/MenC, MMR, PCV, MenB
, Child Abuse / Non-Accidental Injury
Definition
NAI normally affects children ≤2yo
DDx
Risk factors: - Accidental injury (history
- Caregiver substance abuse corresponds to injury, often same
- Young parental age age)
- Single-parent households - Bleeding disorders
- Socio-economic disadvantage - Haematological malignancy
Suspecting Abuse
Physical
- Bruising/lacerations/burns in child not yet independently mobile or absent/unsuitable
explanation
- Human bite mark not by young child
- ≥1# if unsuitable explanation including of different ages/XR occult #
- Retinal haemorrhages without explanation
Neglect
- Failure to seek medical advice which compromises child’s health
- Persistently smelly/dirty
- Repeat observations of inadequate food provision/living environment/hygiene
Sexual
- Persistent/recurrent genital/anal symptoms associated with behavioural/emotional
change
- Anal fissure when constipation and Crohn’s disease are excluded as causes
- STI in child <12yo without evidence of vertical/blood transmission
- Sexualised behaviour in prepubertal child
Other
- Delayed presentation
- Bruising
- Torn frenulum e.g., forcing bottle into child’s mouth
- Failure to thrive
- STIs
- Withdrawn and frightened
Investigation Management
Comprehensive skeletal survey - Report suspicions
- Rib/finger/clavicle # - Admit for safeguarding while
- Skull #/intracranial bleeds investigations continue
- Metaphyseal corner # o Ensure safety of other
(twisting/pulling motion on a limb) children in the home
- Appropriate management for
injuries
- Clear documentation
- Check if known to social care
LOC >5mins / vomiting ≥2 after head injury = CT head
Sudden infant death syndrome
Definition & DDx - Perinatal death = death from 28wks
Most common at 3mths old to first 7 days)
Protective factors
- Breastfeeding Anatomy & Risks
- Room sharing Major risk factors for SIDS
- Use of dummies - Prone sleeping
Other: - Parental smoking
- Stillbirth = death after 24wks - Prematurity
before/during birth - Bed sharing
o Risk factors: Foetal growth - Hyperthermia
restriction; rises with Other risk factors for SIDS
increasing maternal age; - Male
- Neonatal death = death within first - Multiple births
28days - Social classes IV and V
o Risk factors: preterm birth; - Maternal drug use
mothers <25/>40yo; - Winter months
maternal health
(BMI/smoking/etc.)/foetal Investigations
health (congenital/low birth Following a cot death – screen siblings for
weight/)/obstetric sepsis/inborn errors of metabolism
complications (pre-
eclampsia/malpresentation)
Paediatric BLS - Start with 5 rescue breaths
Airway Pulse
- Infants: neutral - 2 = ≥100bpm
- Young children: slight extension - 1 = <100bpm
‘sniffing air’ - 0 = non-detectable
- Older children: head tilt/chin lift Grimace (response to stimulation)
Carotid pulse in ≥1yo (Brach/fem. - infants) - 2 = crying on stimulation
Chest compressions 100-120bpm (15:2) - 1 = grimace
- Infants: 2 fingers from 1 hand - 0 = no response
- Small children: 1 handed Activity
- Larger children: same as adults - 2 = flexed limbs resisting extension
Depth = 2/3rds chest unless adult size, - 1 = some flexion
then 5cm - 0 = floppy baby
APGAR (assessed at 1, 5 and 10mins) Respiration
Appearance - 2 = strong cry
- 2 = pink - 1 = weak cry
- 1 = pink centrally - 0 = no respiratory effort
- 0 = blue all over
,
,Vaccinations
Contraindications
Not CI to imms:
- Atopy
- Seizure hx
- Breastfed child
- Hx natural pertussis/MMR
- Hx neonatal jaundice
- FHx autism
- Down’s/CP/neuro conditions
- Low birth weight/prematurity
- Pts on steroids
CI to imms:
- Confirmed anaphylaxis to prev. dose of same antigens/another vaccine component
e.g., eggs
CI to live imms:
- Pregnancy
- Immunosuppression
Delay required:
- Febrile illness/intercurrent infection
Specific vaccines:
- DTP: deferred if evolving/unstable neurological condition
- Rotavirus: CI in hx intussusception
Vaccine Schedule
TB vaccine: given at birth if baby at risk e.g., TB in family <6mths
MenACWY and DTP booster for 13-18yo (HPV at 12yo)
Annual flu vaccine = 2-8yo
MMR DT; whooping cough; polio = 3-4yo
2, 3 and 4mths = DT; whooping cough; polio; Hib; Hep B
2 and 4mths = Men B
2 and 3mths = rotavirus PO
3mths = PCV
1yr = Hib/MenC, MMR, PCV, MenB
, Child Abuse / Non-Accidental Injury
Definition
NAI normally affects children ≤2yo
DDx
Risk factors: - Accidental injury (history
- Caregiver substance abuse corresponds to injury, often same
- Young parental age age)
- Single-parent households - Bleeding disorders
- Socio-economic disadvantage - Haematological malignancy
Suspecting Abuse
Physical
- Bruising/lacerations/burns in child not yet independently mobile or absent/unsuitable
explanation
- Human bite mark not by young child
- ≥1# if unsuitable explanation including of different ages/XR occult #
- Retinal haemorrhages without explanation
Neglect
- Failure to seek medical advice which compromises child’s health
- Persistently smelly/dirty
- Repeat observations of inadequate food provision/living environment/hygiene
Sexual
- Persistent/recurrent genital/anal symptoms associated with behavioural/emotional
change
- Anal fissure when constipation and Crohn’s disease are excluded as causes
- STI in child <12yo without evidence of vertical/blood transmission
- Sexualised behaviour in prepubertal child
Other
- Delayed presentation
- Bruising
- Torn frenulum e.g., forcing bottle into child’s mouth
- Failure to thrive
- STIs
- Withdrawn and frightened
Investigation Management
Comprehensive skeletal survey - Report suspicions
- Rib/finger/clavicle # - Admit for safeguarding while
- Skull #/intracranial bleeds investigations continue
- Metaphyseal corner # o Ensure safety of other
(twisting/pulling motion on a limb) children in the home
- Appropriate management for
injuries
- Clear documentation
- Check if known to social care
LOC >5mins / vomiting ≥2 after head injury = CT head
