CH 2 The Newborn Infant

Question 1

Bacterial Sepsis in infants

Answer 1

increased risk if there is rupture of membranes or preterm.

Question 2

Bacterial Sepsis in infants clinical findings

Answer 2

most commonly happen between 12 hours to 1 day of life. Resp distress related to pneumonia is most common. presents as low apgar score without fetal distress, poor perfusion, and hypotension. Late sepsis (greater than 3 days of age and usually related to meningitis) presents as poor feeding, lethargy, hypotomia, temp instability, altered perfusion, new or increased o2 need, and apnea

Question 3

Bacterial Sepsis in infants labs

Answer 3

low WBCs, absolute neutropenia and elevated ratio of immature to mature neutrophils. Thrombocytopenia, hypoglycemia or hyperglycemia, unexplained metabolic acidosis, elevated c reactive protein, procalcitonin

Question 4

Bacterial Sepsis in infants imaging

Answer 4

with pneumonia cxr will show infiltrates or pleural effusion

Question 5

Diagnosis of Bacterial Sepsis in infants

Answer 5

made with positive cultures from blood, CSF, or other body fluids

Question 6

cause of early onset sepsis

Answer 6

group B hemolytic streptococci (GBS), and gram negative enteric pathogens (like e coli)

Question 7

cause of late onset sepsis

Answer 7

coagulase negative staphylococci (especially in those with central lines), s aureus, GBS, enterococcus, and gram negative organisms as well as candida

Question 8

bacterial sepsis treatment

Answer 8

early onset: broad spectrum like ampicillin plus aminoglycoside or 3rd generation cephalosporin (cefotaxime). Late onset: vancomycin, third generation cephalosporin (cefotaxime), or an aminoglycoside

Question 9

Bacterial Sepsis prevention

Answer 9

intrapartum admin of penicillin more than 4 hours before delivery. Perform vaginal and rectal GBS culture at 35-37 weeks gestation. Give pcn or ampicillin to all those with GBS positive culture

Question 10

Normal stump

Answer 10

normal umbilical cord stump atrophies and separates at the skin level. A small amount of purulent material at the base of the cord is common and can be minimized by keeping the cord open to air and dry

Question 11

Omphalitis, how it happens, signs

Answer 11

cord becomes colonized with streptococci, staphylcocci, or gram negative organisms that can cause local infections. More common in cords manipulated with venous or arterial lines. redness and edema develops in soft tissues around stumps

Question 12

Omphalitis Treatment

Answer 12

broad spectrum IV antibiotics (nafcillin), or vancomycin, a third generation cephalosporin and anaerobic coverage with flagyl

Question 13

Omphalitis complications

Answer 13

septic thrombophlebitis, hepatic abscess, necrotizing fasciitis (need surgical consultation), and portal vein thrombosis

Question 14

herpes simplex virus

Answer 14

acquired at birth during transit through an infected birth canal. Mother may have primary or reactivated secondary infection

Question 15

herpes simplex virus presentation

Answer 15

time of presentation is usually 5-14 days of age. Will be localized (skin, eye, or mouth), or disseminated disease (pneumonia, shock, or hepatitis). CNS disease presents later (14-28 days) with lethargy, fever, seizures

Question 16

herpes simplex virus diagnosis

Answer 16

PCR testing of vesicles, blood, or CSF may be falsely negative. If so, it should be repeated

Question 17

herpes simplex virus treatment

Answer 17

do cultures of infants eyes, oropharynx, nasopharynx, and rectum 24 hours after delivery. IV acyclovir for 14 days (21 days if there are CNS symptoms)

Question 18

herpes simplex virus prevention

Answer 18

possible if c section is done within 6 hours after rupture of membranes. C section not indicated for asymptomatic mothers.