Case Study1 Flashcards
Infants born to adolescent mothers are at greater risk for:
lower birth weight secondary to pregnancy induced htn
vertically acquired STIs (due to the higher incidence of STIs in the adolescent population)
poorer developmental outcomes
increased risk of fetal death
Infants born to adolescent mothers do not have increased incidence of chromosomal abnormalities. Trisomy 21 is more likely to occur in older mothers.
Adolescent interview: HEEADSSS questions
H home E education/ employment E eating d/o A activities/aspirations/affiliations D drugs (etoh, tobacco, steroids) S sexuality S suicidality (mdd etc) S safety (fights, abuse, weapons, wearing seatbelt)
Start interviewing at an early age alone (9-10 yoa)
Adverse effects of prenatal substance use: tobacco, alcohol, marijuana, cocaine/other stimulants
Tobacco- Maternal tobacco use during pregnancy increases the risk for LOW BIRTH WEIGHT in the fetus.
There is not a characteristic facies associated with maternal tobacco use during pregnancy.
Alcohol- There is no “safe” amount of alcohol that can be consumed during pregnancy to ensure that fetal alcohol syndrome does not occur.
FETAL ALCOHOL SYNDROME is a distinct pattern of facial abnormalities, growth deficiency, and evidence of central nervous system dysfunction.
In addition to cognitive disability, victims of fetal alcohol syndrome exhibit other neurobehavioral deficits such as poor motor skills and hand-eye coordination and learning problems (i.e., difficulties with memory, attention, and judgment).
Marijuana- Distinctive effects of marijuana have not been identified.
Cocaine and Other Stimulants- These cause VASOCONSTRICTION leading to placental insufficiency and low birth weight.
In addition, the National Institute on Drug Abuse notes that “exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some children, including deficits in some aspects of cognitive performance, information-processing, and attention to tasks—abilities that are important for success in school.”
Factors limiting fetal growth in uterine
Maternal factors: Poor weight gain in the third trimester Preeclampsia Maternal prescription or illicit drug use Maternal infections Uterine abnormalities
Placental abnormalities:
Placenta previa
Placental abruptions
Abnormal umbilical vessel insertions
Fetal abnormalities: Fetal malformations Metabolic disease Chromosomal abnormalities Congenital infections
Factors that increase the risk of hiv transmission from mother to fetus (6)
Frequent, unprotected sex during pregnancy (This increases the risk for chorioamnionitis, and chorioamnionitis and other sexually transmitted infections increase the risk of HIV transmission.)
Advanced maternal HIV disease, which may indicate high viral load
Membrane rupture greater than 4 hours prior to delivery if mother is not on antiretroviral therapy
Vaginal delivery
Breastfeeding
Premature delivery (i.e., delivery before 37 weeks’ gestation)
Apgar score
Appearance (skin color) Pulse (heart rate) Grimace (reflex irritability- facial expressions to things) Activity (muscle tone) Respiration
A newborn receives a score of 0, 1, or 2 for each component, with the final Apgar score ranging from 0 to 10.
Tells if a newborn is ready to meet the world ( transition from intrauterine to extrauterine life) need for resuscitation ; done at 1 and 5 minutes, one at 5 min is a better predictor of neonatal death
Ballard gestational age assessment tool
The Ballard assessment tool uses signs of physical and neuromuscular maturity to estimate gestational age.
This can be particularly helpful if there is no early prenatal ultrasound to help confirm dates, or if the gestational age is in question because of uncertain maternal dates.
SGA vs intrauterine growth restriction
Risks for SGA newborns (3)
SGA is determined at birth-weight below the 10th percentile
Iugr is determined in uter
Hypoglycemia, hypothermia, polycythemia
TORCH infections
TOxoplasmosis, Rubella, Cytomegalovirus and Herpes virus type 2. (Recent revisions ascribe the “O” to Other transplacental infections, including HIV, hepatitis B, human parvovirus, and syphilis.)
Cmv can be detected in the urine of the infant
Routine newborn meds (3) and screenings (3)
Vitamin K: Newborns routinely receive an intramuscular injection of vitamin K to prevent hemorrhagic disease of the newborn (now also referred to as vitamin K deficiency bleeding).
Hepatitis B vaccine: The CDC recommends that all delivery hospitals develop policies that ensure administration of hepatitis B vaccine at birth as part of the routine care of all medically stable newborns weighing > 2000 grams. This is true for all of these babies, regardless of maternal testing results. Hepatitis B immunoglobulin (HBIG) is given only to newborns at risk for vertical transmission of hepatitis B virus.
Erythromycin (also tetracycline or silver nitrate): One of these antibiotics is administered topically specifically to prevent gonococcal conjunctivitis. Chlamydia trachomatis conjunctivitis in newborns is more common than gonococcal, but chlamydia typically occurs at 7–14 days after birth, and neonatal prophylaxis does little to prevent chlamydia conjunctivitis.
Newborns are routinely screened for the following:
Metabolic disorders
The newborn screen helps test for conditions that might not be readily picked up.
It is critical that all newborns be screened so that early identification of metabolic conditions can be ensured.
All states screen for PKU and hypothyroidism.
Some states also screen for galactosemia, biotinidase deficiency, hemoglobinopathy, maple syrup urine disease (MSUD), homocystinuria, congenital adrenal hyperplasia, cystic fibrosis, G6PD deficiency, and toxoplasmosis
Many states now screen for more than 30 diseases using tandem mass spectrometry.
Congenital deafness
Congenital heart defects
Hepatitis b vertical transmission prevention
Infants weighing less than 2000 grams born to mothers positive for hepatitis B surface antigen (HBsAg):
Should receive the hepatitis B vaccine as well as hepatitis B immune globulin (HBIG) within 12 hours of delivery.
Additionally, these infants should receive the routine series of three doses of the vaccine beginning at age 1 month for a total of four doses.
Vertical transmission can be prevented in 85-95% of cases using these interventions.
At 9-18 months of age, the child should be tested for anti-HBs (antibody to Hepatitis B surface antigen) and HBsAg, and—if found to have inadequate antibody protection—should be re-immunized.
Infants born to mothers not tested for HBsAg:
Should receive hepatitis B vaccine within 12 hours of delivery.
Administration of HBIG can be delayed until the maternal HBsAg is known, and is effective if given within 7 days following delivery if the patient is greater than 2 kg at birth.
Special considerations and guidelines for premature babies are discussed in the reference.
Sequelae of congenital CMV ( leading cause of congenital infection in the us)
Treatment
Hearing loss
In many infected infants, the onset of hearing loss may be after the newborn period.
The loss is often progressive.
Even if the newborn hearing screen is normal, an infant infected with CMV may develop hearing loss and progress to severe-to-profound bilateral hearing loss during the first year of life.
Microcephaly and intracranial calcifications
These findings are associated with an increased risk of CNS sequelae of congenital CMV infection, such as developmental delay.
Infants with congenital CMV must have ongoing developmental assessments and may ultimately demonstrate intellectual disabilities and/or cerebral palsy.
Hepatosplenomegaly and petechiae rash
These nonneurological neonatal clinical abnormalities can be expected to resolve spontaneously within weeks.
Other manifestations: seizures, diminished number of gyro and abnml thick cortex-lissencephaly, enlarged ventricles, periventricular calcifications, chorioretinitis, jaundice, microcephaly
Treatment of symptomatic CMV for 6 months has been demonstrated to improve audiologic and neurodevelopmental outcomes at 2 years. Use parenteral gancyclovir or oral valgancyclovir
Breastfeeding indications and contraindications
Indications:
Recognized by the American Academy of Pediatrics as the optimal feeding for infants.
Exclusive breastfeeding is recommended for the first 6 months of life, followed by breastfeeding plus complementary foods until the infant is at least 12 months of age.
Breast milk plus fortifier is recommended for premature babies.
Mothers should nurse their babies whenever there are signs of hunger, which often is 8–12 times per day.
Absolute Contraindications
These are rare, but may include:
Maternal HIV infection (in the industrialized world)
Active herpes simplex lesions on the breast
Active untreated tuberculosis
Active maternal use of some (not all) non-prescription drugs of abuse
Infants with galactosemia
Mom has Hx of medically controlled seizures
The mother was on an anticonvulsant for her seizures. Taking anticonvulsants during pregnancy may lead to cardiac defects, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, IUGR, and microcephaly. Mental retardation may be seen. A rare neonatal side effect is methemoglobinuria.
after birth her baby is noted to have a high-pitched cry, tremulousness, hypertonicity, and feeding difficulties.
. Heroin is the correct choice. Opiate use during pregnancy may result in several different symptoms, including CNS findings (irritability, hyperactivity, hypertonicity, incessant high-pitched cry, tremors, seizures), GI symptoms (vomiting, diarrhea, weight loss, poor feeding, incessant hunger, excessive salivation), and respiratory findings (including nasal stuffiness, sneezing, and yawning).
