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OB/GYN > Ch 35 Acquired Newborn Issues > Flashcards

Ch 35 Acquired Newborn Issues Flashcards

1
Q

What is TORCH syndrome?

A

Any group of infections in newborns due to one of the TORCH infectious agents having crossed the placenta during pregnancy

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2
Q

What does the TORCH acronym stand for?

A 
T - toxoplasmosis
O - other agents
R - rubella
C - cytomegalovirus 
H - herpes simplex
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3
Q

What is another name for rubella?

A

German measles

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4
Q

What is the etiology of toxoplasmosis?

A

Toxoplasma gondii

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5
Q

Most healthy people who contract toxoplasmosis have what symptoms?

A

Are asymptomatic OR have flu like symptoms such as malaise, fever, headache, muscle pain, lymphadenopathy

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6
Q

What percent of the world’s population is infected with toxoplasma gondii?

A

About 1/3 but it often goes unrecognized

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7
Q

What are the consequences of toxoplasma gondii crossing the placenta and infecting the fetus?

A 
Hydrocephalus
Microcephaly
Intracranial calcifications
Retinochoroiditis
Strabismus
Blindness
Epilepsy
Psychomotor and mental retardation
Petechiae
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8
Q

What causes the petechiae in baby’s born with toxoplasma gondii infection?

A

Thrombocytopenia and anemia

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9
Q

What infections are included in the “other” part of TORCH

A

Neonatal syphilis and parvovirus b19

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10
Q

What are complications of neonatal syphilis?

A 
Miscarriage
Stillbirth
Prematurity
Low birth weight
or death shortly after birth
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11
Q

What can syphilis cause in the living newborn?

A 
Deformed bones
Severe anemia
Enlarged liver and spleen
Jaundice
Blindness/deafness
Meningitis
Skin rashes
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12
Q

What are major diseases caused by parvovirus b19 in the fetus?

A

Hydrops fetalis

Congenital anemia

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13
Q

What are major diseases caused by parvovirus b19 in normal children?

A

Fifth disease

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14
Q

What are major diseases caused by parvovirus b19 in normal adults?

A

Arthropathy

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15
Q

What are major diseases caused by parvovirus b19 in patients with increased erythropoiesis?

A

Transient aplastic crisis

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16
Q

What are major diseases caused by parvovirus b19 in immunocompromised patients?

A

Persisten anemia

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17
Q

About 50% of pregnant women are immune to…

A

Parvovirus b19

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18
Q

What is fifth disease?

A

A mild rash caused by Parvo b19

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19
Q

What is a rare complication of a pregnant mother becoming infected with Parvo b19?

A

Baby may severe anemia and mother will have a miscarriage

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20
Q

A miscarriage resulting from Parvo b19 most commonly happens during what trimester?

A

1st

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21
Q

When does congenital rubella syndrome usually occur?

A

During the first 3 months of pregnancy

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22
Q

What are symptoms of congenital rubella syndrome?

A

Cloudy/white appearance to eyes (cataracts)
Deafness
Heart defects
Developmental delay

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23
Q

What is the treatment for congenital rubella sydrome?

A

There is none. Therapy focuses on addressing complications

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24
Q

Babies with congenital CMV that have signs at birth include:

A 
Rash
Jaundice
Microcephaly
Low birth weight
Heptasplenomegaly
Seizures
Retinitis
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25
Q

In the most severe cases of congenital CMV…

A

Cause death of unborn baby / pregnancy loss

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26
Q

Symptoms of congenital CMV can occur…

A

later during infancy or childhood

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27
Q

What are the long term health problems associated with congenital CMV?

A 
Deafness
Developmental and motor delay
Vision loss
Microcephaly
Seizures
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28
Q

Which woman are at greater risk for contracting CMV?

A

Those with frequent contact with young children

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29
Q

How can women in frequent contact with young children reduce their risk?

A

Reducing contact with SALIVA and urine from babies and young children

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30
Q

Most neonatal herpes infections occur…

A

As a result of asymptomatic cervical shedding of virus after a primary episode in the third trimester

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31
Q

When should a c section be performed in a patient with HSV?

A

If active infection at time of delivery

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32
Q

What is congenital herpes associated with?

A

Preterm labor and low birth weight infants

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33
Q

When should HSV infection be suspected in a newborn?

A

A newborn with irritability, lethargy, fever, or poor feeding at one week of age

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34
Q

How is congenital herpes diagnosed?

A 
Cultures of:
Blood
Cerebrospinal fluid
Urine and fluid from eyes
Nose and mucus membranes
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35
Q

How is HSV infection in newborns treated?

A

Parenteral acyclovir

36
Q

What are the 3 subtypes of HSV infections in newborns?

A

1) eye, skin or mouth
2) encephalitis without skin/eye
3) disseminated infection that involves multiple sites

37
Q

What are the locations of HSV infection that the third type can be found?

A 
CNS
Lung
Liver
Adrenal glands
Eyes
Mouth
38
Q

What syndromes can toxoplasma gondii cause in the neonate?

A

Hydrocephalus
diffuse intracranial calcification
Choriorenitis

39
Q

What syndromes can the rubella virus cause in neonates?

A

blueberry muffin skin

interstitial pneumonitis

40
Q

How long does it take for sepsis to manifest after infection acquired perinatally?

A

24-72 hrs

41
Q

What is the neonatal mortality rate of sepsis?

A

2-40%

42
Q

What are the most common pathogens that cause neonatal sepsis?

A 
GBS
Haemophilus influenza
Listeria monocytogenes
E Coli
Strep pneumoniae
43
Q

What is late onset sepsis?

A

Occurs in the first 7-30 days of life as a consequence of infection acquire postnatally

44
Q

Late onset sepsis may include what routes on infection?

A

Vertically transmitted infection or acquired infection

45
Q

What are the most common pathogens responsible for late onset sepsis?

A

Staph, klebsiella, enterococci, e coli, pseudomonas, and yeast

46
Q

What are early clinical signs of sepsis?

A 
Lethargy
Poor feeding
Poor weight gain
Irritability 
A change from previous assessments
47
Q

What are respiratory signs of sepsis?

A 
Apnea
Bradycardia
Tachypnea
grunting
nasal flaring
retractions
decreased o2 sat
acidosis
48
Q

What are cardiovascular signs of sepsis?

A 
Decreased CO
tachycardia
bradypnea 
arrhythmia 
hypotension
decreased perfusion
49
Q

What are CNS signs of sepsis?

A 
Temperature instability
Hypothermia
Fever
Lethargy
Hypotonia
Irritability
Seizures
Bulging fontanels
high pitch or abnormal cry
50
Q

What are GI signs of sepsis?

A 
Feeding intolerance 
Abdominal distention
Vomiting
Diarrhea
Hypoactive bowel sounds
51
Q

What are skin signs of sepsis?

A

Jaundice
Pallor
Petechiae

52
Q

What are metabolic signs of sepsis?

A

Hypoglycemia, hyperglycemia, metabolic acidosis

53
Q

What are hematologic signs of sepsis?

A

Thrombocytopenia

Neutropenia

54
Q

What is erythroblastosis fetalis?

A

Condition cause by specific antibodies of the mother, directed against red cell antigens of the fetus.

55
Q

What is another name for erythroblastosis fetalis?

A

hemolytic disease of the newborn

56
Q

What is another name of hemolytic disease of the newborn?

A

erythroblastosis fetalis

57
Q

What type of antigens are responsible for erythroblastosis fetalis?

A

RhD antigens

58
Q

What is hydrops fetalis?

A

abnormal amounts of fluid build up in tow or more body areas of a fetus or newborn

59
Q

What are the two types hydrops fetalis?

A

Immune and non immune

60
Q

What is immune hydrops fetalis caused by?

A

Hemolytic disease of the newborn

61
Q

What is non-immune hydrops fetalis caused by?

A

TORCH, heart or lung problems, thalassemia, genetic defects such as Turner’s syndrome

62
Q

Which type of hydrops fetalis is worse?

A

Non immune hydrops fetalis, frequently fatal

63
Q

What is thalassemia?

A

Inherited blood disorder that causes your body to have less hemoglobin than normal

64
Q

A baby with hydro fetalis may have abdominal distention due to…

A

a swollen liver

65
Q

What does the indirect Coombs test measure?

A

The number of antibodies in the MATERNAL blood

66
Q

What is done if a RH- mother is not iso-immunized?

A

Repeat antibody screen is done around 28 weeks and patient is give rhogam

67
Q

What is another name for rhogam?

A

anti-Rh gamma globulin

68
Q

what is another name for anti-Rh gamma globulin?

A

Rhogam

69
Q

What abnormal antigens does the indirect Coombs test the mother’s blood for?

A

Rh, Kell, Duffy, etc

70
Q

Fetal tests for hydrops fetalis includes…

A

Percutaneous umbilical cord blood sampling (PUBS),

amniocentisis, amniotic fluid analysis, ultrasound

71
Q

What does PUBS stand for?

A

percutaneous umbilical blood sampling

72
Q

What is another name of PUBS?

A

cordocentesis

73
Q

What should be done first in erythroblasis fetalis?

A

Ultrasound ASAP in frist trimester to determine gestational age

74
Q

After the initial ultrasound, what is next for erythroblasis fetalis?

A

serial ultrasounds and amniotic fluid analysis to monitor fetal progress

75
Q

What are indications that a complication is occurring in erythroblasts fatalis?

A

High levels of bilirubin in the amniotic fluid or baby’s blood OR
if ultrasound reveals hydrops fetalis

76
Q

In erythroblasis fatalis, if bilirubin levels remain normal that pregnancy can…

A

Be followed to term and spontaneous labor.

77
Q

What happens if the amniotic fluid reveals high bilirubin levels? (in erythroblastis fetalis)

A

Fetal transfusions at 10-day to 2-week intervals up until 32-34 weeks. Then the fetus must be delivered.

78
Q

What do high bilirubin levels mean in a patient with erythroblastis fetalis?

A

Impending intrauterine death

79
Q

What is the treatment for erythroblastis fetalis?

A

Exchange infusion

80
Q

What does an exchange infusion do?

A

Removes bilirubin
Removes anitbodies
Removes sensitized cells which are liable to be hemolyses
Increase RBCs and reduce anemia

81
Q

Type O- blood will not trigger an immune response except in the case of…

A

Rh disease

82
Q

What type of blood is used for fetal blood transfusion until the baby is born?

A

O-

83
Q

ABO incompatibility is more severe in …

A

African American infants

84
Q

Which is more severe, ABO hemolytic disease or Rh hemolytic disease of the newborn?

A

Rh hemolytic disease of the newborn

85
Q

Why is ABO incompatibility less serious?

A

Fewer antibodies cross the placenta in ABO versus Rh

Fewer ABO antibodies than Rh antigens

OB/GYN (11 decks)

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