Diseases in the newborn child Flashcards
How common is it for a child to become jaundiced within the first week of life?
50-60 % of children become jaundiced within the first week of life.
What is kernicterus?
Kernicterus is a bilirubin-induced brain dysfunction. Unconjugated bilirubin crosses the blood-/brain
barrier and acts neurotoxic (mainly in the basal ganglia).
What should be suspected if jaundice within first day of life or there is rapidly increasing bilirubin levels?
Suspect hemolysis due to immunization.
True or false: ABO-immunization is common in pregnancies, but rarely cause any prenantal symptoms.
True. It occurs 15-20% of pregnancies, but rarely causes prenatal symptoms.
What are fetal consequences of serious Rh-immunization?
Erythroblastosis foetalis: Serious anemia → heart failure in the fetus.
Hepatoslenomegaly: Extramedullary hematopoiesis. Liver failure lead to low albumin.
Hydrops foetalis: Heart failure and low albumin leads to edema. Ascites, pericardial effusion, pleural effusion, subcutanous edema.
What are the causes of physiologic jaundice?
Degradation of fetal hemoglobin. Immature liver (low activity of conjugating enzymes).
When does physiologic jaundice usually disappear?
In 4-7 days.
What is the treatment for breastfeeding jaundice?
Breastfeeding jaundice is a benign condition and resolves itself within 12 weeks of life. (Photo-therapy is indicated in cases of “not enough breastfeeding” jaundice.)
In what ways can pathological jaundice in newborn be treated?
Oral hydration – breast milk.
Phototherapy.
Immunoglobuline.
Exchange transfusion.
What are indications for exchange transfusion as treatment against jaundice in newborns? Is this type of therapy common?
Indications include serious anemia and hydrops fetalis - like in Rh-immunization.
It is seldom used as therapy in Norway (about 9-10 cases per year need exchange transfusion).
Besides exchange transfusion, what treatment is used when managing antibody mediated jaundice in newborns?
Intravenous immunoglobulin.
What are causes of conjugated jaundice > 2 weeks in newborns?
Conjugated jaundice: Bile duct atresia. Neonatal hepatitis. Prolonged total parenteral nutrition.
What are the main types of newborn infections based on when and how it is acquired?
Transplacental infections.
Ascending infection.
Intrapartum infections.
Postnatal infections.
What is a congenital infection?
Maternal infection with transplacental hematogen transmission in utero.
When should a congenital infection be suspected?
Fetal growth restriction (FGR) Enlarged liver and spleen CNS symptoms/signs Microcephaly, hydrocephalus, intracerebral calcifications, cataract, chorioretinitis, deafness Trombocytopenia and anemia Skin hemorrhages Jaundice/neonatal hepatitis (conjugated)
What are some viral agents that may cause congenital infections?
Rubella Cytomegalovirus Parvovirus Varicella Herpes Enterovirus Hepatitis B and C (Syphilis is caused by a bacterial agent and toxoplasmosis by a parasite, but may cause congenital infections.)
What are risk factors of congenital herpes?
Premature rupture of membranes, prematurity and traumatic lesions.
True or false: Neonatal herpes simplex is a common disease in Norway.
False. Incidence of 1-3 per year.
What is characteristic of neonatal herpes infection skin-eye-mouth disease?
Vesicles in skin, mouth and/or conjunctiva.
Age of onset 5-11 days.
All cases have vesicles at onset of disease.
The mortality and disability are 0 %.
What is characteristic of congenital herpes infection?
Vesicles. Scarring of skin. Brain damage. Microcephaly.
Disability is 100 %, mortality is unknown.
How is neonatal herpes infection diagnosed and treated?
Diagnosis: PCR from vesicles or spinal fluid. Serology.
Treatment: At first intravenous acyclovir, followed by 6 months of treatment with oral acyclovir to reduce the risk of recurrence.
Are congenital CMV infection most commonly symptomatic or asymptomatic?
Asymptomatic infections are most common - but may cause deafness.
What is the most important non-genetic cause of deafness?
Congenital CMV infections in newborn children.
How are CMV infections in newborn children diagnosed?
PCR based on saliva, urine or blood. Serology of maternal blood. Liver and hematological blood tests. Eye examination. Ultrasound or MRI. Auditory test. Lumbar puncture can by considered.
How common is it that a maternal HBV infection is transmitted vertically to her child? How high percentage of HBV infected newborns become chronic carrier (without intervention)?
If mother is HBsAg and HBcAg positive at least 70-90%
of the children will be infected perinatally.
90 % become chronic carriers.
What are symptoms of toxoplasmosis in newborns?
Most cases (90 %) are asymptomatic. The most common symptoms are chorioretinitis, hydrocephalus and intracranial calcifications. Other symptoms and findings include growth retardation, microcephalia, seizures, feeding difficulties and hypotermia.
What are the most common agents in early onset neonatal sepsis? What antibiotics are used to treat early onset neonatal sepsis?
Group B streptococci.
E. coli and other gram negative bacteria.
Antibiotics: Penicillin G + gentamicin (aminoglycoside).
What are the most common agents in late onset neonatal sepsis? What antibiotics are used to treat late onset neonatal sepsis?
Hospital acquired infections: Mainly S. aureus and S. epidermidis.
Gram negative bacteria.
(Late onset) group B streptococci.
Abtibiotics: Cefolatin + Aminoglycoside. Cefotaxim (kidney failure) + Vancomycin (against S. epidermidis).
What are risk factors of neonatal sepsis?
Premature rupture of membranes. Prematurity. Maternal fever, such as in chorioamniotitis. Total parenteral nutrition. "Long lines."
True or false: Fever in neonatal sepsis is an uncommon symptom.
True.
True or false: Because an early onset neonatal sepsis with group B streptococci often is dramatic, a screening program is used to detect those in risk of infection is used in Norway.
False. There is no consensus about screening, although GBS sepsis of early onset often i dramatic.
What are the differences between transient tachypnea and wet lung in newborn children?
They are probably the same condition, however …
Chest X-ray shows interlobar fluid in wet lung, but is normal in transient tachypnea.
Transient tachypnea is usually brief, whereas wet lung slowly resolves itself (could take hours to days).
How is meconium aspiration syndrome treated?
Oxygen
CPAP/ventilator
Surfactant
Treat Persistent Pulmonary Hypertension in the Neonate (PPHN) and other complications.
What are causes of pulmonary hypoplasia?
Primary causes.
Reduced amniotic fluid: Kidney agenesis, kidney dysplasia, polycystic kidney disease. or premature rupture of membranes.
Space occupying process in chest: E.g. diaphragmatic hernia.
What are common
Immaturity
Respiratory: RDS, Broncopulmonary dysplasia (BPD)/Chronic lung disease (CLD)
Intraventricular hemorrhage
Periventricular leukomalacia (PVL)
Infections: Staphylococci epidermidis, candida
Gastrointestinal: Necrotizing enterocolitis (NEC)
Retinopathi of prematurity (ROP)
How is respiratory distress syndrome?
Prophylaxis: Prenatal steroids.
Treatment: Surfactant. Gentle ventilation. Ventilator/CPAP/High flow.
(Spontanous improvement.)
What are problems with the diagnostic criteria for bronchopulmonary dyplasia (BPD)?
Need of oxygen and gestational age as part of diagnostic criteria.
What are consequences of grade 4 intraventricular hemorrhage?
Mortality is 50 %.
60-100 % develop cerebral palsy.
What are causes of periventricular leukomalacia?
The causes are unclear, but might include hypoxemia (and ischemia), hypotension and hypocapnia, as well as pre- and perinatal infection/inflammation.
What is the prognosis of periventricular leukomalacia?
Cystic PVL is strongly associated with development of cerebral palsy.
Diffuse PVL is associated with cognitive and behavioral problems.
