Congential CMV Flashcards
Risks for infants of adolescent mothers
Lower birth weight
Vertically acquired STI
Poorer developmental outcomes
Increased risk of fetal death
Tobacco effects
maternal use increases risk of low birth weight
- no charateristic facies
Alcohol affects
there is no “safe” amount
- distinct pattern of facial abnormalities, growth deficiency, and CNS dysfunction
- neurobehavioral deficits and learning problems
Marijuana effects
no distinctive effects have been identified
Cocaine effects
cause vasoconstriction leading to placental insufficiency and low birth weight
- can cause some cognitive deficits later in life as well
- possible withdrawal symptoms
Maternal factors limiting growth of fetus
- poor weight gain in 3rd trimester
- preeclampsia
- drug use
- infections
- uterine abnormalities
Placental factors limiting growth of fetus
Placenta previa
Placental abruption
Abnormal vessel insertions
Fetal factors limiting growth of fetus
Malformations
Metabolic disease
Chromosomal abnormalities
Congenital infections
Small for Gestational Age
newborns who are smaller than expected
- not same as IUGR
Risks of vertical transmission of HIV
- frequent, unprotected sex during pregnancy
- advanced maternal HIV
- membrane rupture > 4 hrs and mom not on anti-retroviral therapy
- vaginal delivery
- breastfeeding
- premature delivery
APGAR scores
Appearance (color) Pulse (HR) Grimace (irritability) Activity (tone) Respirations At 1 and 5 minutes, max of 10
Growth terms reviewed
SGA - weight below 10th percentile for age
Microcephalic - head circumference below 10th percentile
Term - born at > 37 weeks gestation
Ballard gestational age
uses signs of physical and neuromuscular maturity to estimate gestational age
- helpful if no early US to gage
Risks for SGA in newborns
- Hypoglycemia - decreased glycogen stores, heat loss, hypoxia
- Hypothermia - cold stress, hypoxia, hypoglycemia, decreased insulation
- Polycythemia - chronic hypoxia, maternal-fetal transfusion
TORCH infections
T - toxoplasmosis O - HIV, Hep B, parvovirus, syphilis R - rubella C - CMV H - herpes simplex 2
Sequelae Congenital CMV
hearing loss –> often progressive (bilateral)
Microcephaly and Intracranial calcifications
- developmental delay, retardation, cerebral palsy
Hepatosplenomegaly and Rash
- self resolve
Brain imaging in CMV
intracranial calcifications
diminished brain gyri and thick cortex
enlarged ventricles
Breastfeeding
preferred method of nutrition for infants
Contraindications
- HIV, herpes lesions on breast, TB, drug use
Benefits of breastfeeding
- GI growth and maturity
- decreases acute illnesses
- reduction in obesity and other problems
Newborn Screening
Metabolic disorders - PKU, hypothyroidism, MSUD, G6PD deficiency, CF
Congenital deafness - hearing test before leaving hospital
Signs and symptoms of inborn errors in metabolism
present 24-72 hours after birth anorexia lethargy vomiting seizures
Clinical findings of newborns with CMV
leading congenital infection in US - 90% of kids asymptomatic
- Skin: petechiae, jaundice, purpura
- Liver: high bilirubin, elevated ALT, heptaomegaly
- Hematopoietic: anemia, thrombocytopenia
- CNS: microcephaly, seizures, calcifications
- Auditory: sensorineural hearing loss
- Visual: chorioretinitis
Adolescent Interview
H - home E - eating disorders E - employment/education A - activity D - drugs S - safety S - sexuality S - suicide
Newborn Resuscitation
warm and dry the infant
stimulate infant to cry
suction amniotic fluid from nose and mouth
initiate further resuscitation if needed
Primitive Reflexes
Rooting - turn cheek when touched Sucking - sucks finger appropriately Moro (startle) Palmar/plantar grasp - grasps finger when stroked Neck Response Babinski
DDx for SGA, microcephaly, and rash
TORCH infection FAS Chromosomal abnormality Tobacco exposure HIV infection
Prenatal lab screening
serological screening for HIV, rubella, Hep B
Blood type and Rh
Urine drug screen
Testing for TORCH infections
Maternal HBsAg
Maternal and infant rubella titer
Infant toxoplasma titer
Infant urine culture (CMV)
Decreasing risk of vertical HIV transmission
treat mother with anti-retrovirals
C-section delivery
No breastfeeding
Routine Newborn Medications
Vitamin K - hemorrhagic disease of newborn
Hep B vaccine
Erythromycin - gonococcal conjuctivitis
Antiviral treatment of congenital CMV
gangciclovir IV for 6 months to prevent progression of hearing loss and CNS sequelae
CMV follow-up
Audiometry - at all first year check-ups
Vision - 12 months and 3 years
Neuro - at all checkups
