Ch 35 Acquired Newborn Issues Flashcards
What is TORCH syndrome?
Any group of infections in newborns due to one of the TORCH infectious agents having crossed the placenta during pregnancy
What does the TORCH acronym stand for?
T - toxoplasmosis O - other agents R - rubella C - cytomegalovirus H - herpes simplex
What is another name for rubella?
German measles
What is the etiology of toxoplasmosis?
Toxoplasma gondii
Most healthy people who contract toxoplasmosis have what symptoms?
Are asymptomatic OR have flu like symptoms such as malaise, fever, headache, muscle pain, lymphadenopathy
What percent of the world’s population is infected with toxoplasma gondii?
About 1/3 but it often goes unrecognized
What are the consequences of toxoplasma gondii crossing the placenta and infecting the fetus?
Hydrocephalus Microcephaly Intracranial calcifications Retinochoroiditis Strabismus Blindness Epilepsy Psychomotor and mental retardation Petechiae
What causes the petechiae in baby’s born with toxoplasma gondii infection?
Thrombocytopenia and anemia
What infections are included in the “other” part of TORCH
Neonatal syphilis and parvovirus b19
What are complications of neonatal syphilis?
Miscarriage Stillbirth Prematurity Low birth weight or death shortly after birth
What can syphilis cause in the living newborn?
Deformed bones Severe anemia Enlarged liver and spleen Jaundice Blindness/deafness Meningitis Skin rashes
What are major diseases caused by parvovirus b19 in the fetus?
Hydrops fetalis
Congenital anemia
What are major diseases caused by parvovirus b19 in normal children?
Fifth disease
What are major diseases caused by parvovirus b19 in normal adults?
Arthropathy
What are major diseases caused by parvovirus b19 in patients with increased erythropoiesis?
Transient aplastic crisis
What are major diseases caused by parvovirus b19 in immunocompromised patients?
Persisten anemia
About 50% of pregnant women are immune to…
Parvovirus b19
What is fifth disease?
A mild rash caused by Parvo b19
What is a rare complication of a pregnant mother becoming infected with Parvo b19?
Baby may severe anemia and mother will have a miscarriage
A miscarriage resulting from Parvo b19 most commonly happens during what trimester?
1st
When does congenital rubella syndrome usually occur?
During the first 3 months of pregnancy
What are symptoms of congenital rubella syndrome?
Cloudy/white appearance to eyes (cataracts)
Deafness
Heart defects
Developmental delay
What is the treatment for congenital rubella sydrome?
There is none. Therapy focuses on addressing complications
Babies with congenital CMV that have signs at birth include:
Rash Jaundice Microcephaly Low birth weight Heptasplenomegaly Seizures Retinitis
In the most severe cases of congenital CMV…
Cause death of unborn baby / pregnancy loss
Symptoms of congenital CMV can occur…
later during infancy or childhood
What are the long term health problems associated with congenital CMV?
Deafness Developmental and motor delay Vision loss Microcephaly Seizures
Which woman are at greater risk for contracting CMV?
Those with frequent contact with young children
How can women in frequent contact with young children reduce their risk?
Reducing contact with SALIVA and urine from babies and young children
Most neonatal herpes infections occur…
As a result of asymptomatic cervical shedding of virus after a primary episode in the third trimester
When should a c section be performed in a patient with HSV?
If active infection at time of delivery
What is congenital herpes associated with?
Preterm labor and low birth weight infants
When should HSV infection be suspected in a newborn?
A newborn with irritability, lethargy, fever, or poor feeding at one week of age
How is congenital herpes diagnosed?
Cultures of: Blood Cerebrospinal fluid Urine and fluid from eyes Nose and mucus membranes
How is HSV infection in newborns treated?
Parenteral acyclovir
What are the 3 subtypes of HSV infections in newborns?
1) eye, skin or mouth
2) encephalitis without skin/eye
3) disseminated infection that involves multiple sites
What are the locations of HSV infection that the third type can be found?
CNS Lung Liver Adrenal glands Eyes Mouth
What syndromes can toxoplasma gondii cause in the neonate?
Hydrocephalus
diffuse intracranial calcification
Choriorenitis
What syndromes can the rubella virus cause in neonates?
blueberry muffin skin
interstitial pneumonitis
How long does it take for sepsis to manifest after infection acquired perinatally?
24-72 hrs
What is the neonatal mortality rate of sepsis?
2-40%
What are the most common pathogens that cause neonatal sepsis?
GBS Haemophilus influenza Listeria monocytogenes E Coli Strep pneumoniae
What is late onset sepsis?
Occurs in the first 7-30 days of life as a consequence of infection acquire postnatally
Late onset sepsis may include what routes on infection?
Vertically transmitted infection or acquired infection
What are the most common pathogens responsible for late onset sepsis?
Staph, klebsiella, enterococci, e coli, pseudomonas, and yeast
What are early clinical signs of sepsis?
Lethargy Poor feeding Poor weight gain Irritability A change from previous assessments
What are respiratory signs of sepsis?
Apnea Bradycardia Tachypnea grunting nasal flaring retractions decreased o2 sat acidosis
What are cardiovascular signs of sepsis?
Decreased CO tachycardia bradypnea arrhythmia hypotension decreased perfusion
What are CNS signs of sepsis?
Temperature instability Hypothermia Fever Lethargy Hypotonia Irritability Seizures Bulging fontanels high pitch or abnormal cry
What are GI signs of sepsis?
Feeding intolerance Abdominal distention Vomiting Diarrhea Hypoactive bowel sounds
What are skin signs of sepsis?
Jaundice
Pallor
Petechiae
What are metabolic signs of sepsis?
Hypoglycemia, hyperglycemia, metabolic acidosis
What are hematologic signs of sepsis?
Thrombocytopenia
Neutropenia
What is erythroblastosis fetalis?
Condition cause by specific antibodies of the mother, directed against red cell antigens of the fetus.
What is another name for erythroblastosis fetalis?
hemolytic disease of the newborn
What is another name of hemolytic disease of the newborn?
erythroblastosis fetalis
What type of antigens are responsible for erythroblastosis fetalis?
RhD antigens
What is hydrops fetalis?
abnormal amounts of fluid build up in tow or more body areas of a fetus or newborn
What are the two types hydrops fetalis?
Immune and non immune
What is immune hydrops fetalis caused by?
Hemolytic disease of the newborn
What is non-immune hydrops fetalis caused by?
TORCH, heart or lung problems, thalassemia, genetic defects such as Turner’s syndrome
Which type of hydrops fetalis is worse?
Non immune hydrops fetalis, frequently fatal
What is thalassemia?
Inherited blood disorder that causes your body to have less hemoglobin than normal
A baby with hydro fetalis may have abdominal distention due to…
a swollen liver
What does the indirect Coombs test measure?
The number of antibodies in the MATERNAL blood
What is done if a RH- mother is not iso-immunized?
Repeat antibody screen is done around 28 weeks and patient is give rhogam
What is another name for rhogam?
anti-Rh gamma globulin
what is another name for anti-Rh gamma globulin?
Rhogam
What abnormal antigens does the indirect Coombs test the mother’s blood for?
Rh, Kell, Duffy, etc
Fetal tests for hydrops fetalis includes…
Percutaneous umbilical cord blood sampling (PUBS),
amniocentisis, amniotic fluid analysis, ultrasound
What does PUBS stand for?
percutaneous umbilical blood sampling
What is another name of PUBS?
cordocentesis
What should be done first in erythroblasis fetalis?
Ultrasound ASAP in frist trimester to determine gestational age
After the initial ultrasound, what is next for erythroblasis fetalis?
serial ultrasounds and amniotic fluid analysis to monitor fetal progress
What are indications that a complication is occurring in erythroblasts fatalis?
High levels of bilirubin in the amniotic fluid or baby’s blood OR
if ultrasound reveals hydrops fetalis
In erythroblasis fatalis, if bilirubin levels remain normal that pregnancy can…
Be followed to term and spontaneous labor.
What happens if the amniotic fluid reveals high bilirubin levels? (in erythroblastis fetalis)
Fetal transfusions at 10-day to 2-week intervals up until 32-34 weeks. Then the fetus must be delivered.
What do high bilirubin levels mean in a patient with erythroblastis fetalis?
Impending intrauterine death
What is the treatment for erythroblastis fetalis?
Exchange infusion
What does an exchange infusion do?
Removes bilirubin
Removes anitbodies
Removes sensitized cells which are liable to be hemolyses
Increase RBCs and reduce anemia
Type O- blood will not trigger an immune response except in the case of…
Rh disease
What type of blood is used for fetal blood transfusion until the baby is born?
O-
ABO incompatibility is more severe in …
African American infants
Which is more severe, ABO hemolytic disease or Rh hemolytic disease of the newborn?
Rh hemolytic disease of the newborn
Why is ABO incompatibility less serious?
Fewer antibodies cross the placenta in ABO versus Rh
Fewer ABO antibodies than Rh antigens
