Fetal Exposure to Hepatitis

Question 1

hep B immunization for newborns

Answer 1

-given prior to discharge, at 2 months and at 6 months
-if premature, given at 2kg or 2 months

Question 2

if mother is hep B positive, what to do for newborn?

Answer 2

-careful bathing with gloves to remove all maternal blood and body fluids
-infant should received IM injection of hep B immunoglobulin within 12 hours of birth, 95% effective at preventing disease

Question 3

how does maternal hep C infection effect infant?

Answer 3

rarely transmitted and those that are infection 75% are clear of infection by age 2

Question 4

how does hepatitis E effect mother and baby?

Answer 4

greater risk to mother with a mortality rate of 20% during pregnancy, increased risk of fetal complications and death

Question 5

risk for untreated HIV mothers to pass it onto neonate?

Answer 5

30% and it usually happens during delivery

Question 6

risks of neonates born to untreated HIV positive mothers?

Answer 6

neonates are usually asymptomatic but are at risk for prematurity, low birth weight, and SGA

Question 7

risk for infants born to untreated HIV positive mothers?

Answer 7

FTT, hepatomegaly, interstitial lymphocytic pneumonia, recurring infections and CNS abnormalities

Question 8

what 4 things can reduce the risk of mother transmitting HIV to newborn?

Answer 8

-antiviral therapy during pregnancy
-elective C section
-antiviral medication given to neonate for the first 6 weeks of life
-avoid breastfeeding

Question 9

what is parvovirus B19 and what does is cause?

Answer 9

• very common DNA virus
• fever, malaise, depression of pregenitor cells in bone marrow with a drop in reticulocyte (developing RBCs) that can lead to anemia in those with preexisting low blood count
  -generalized rash
  -arthralgia (joint pain)/arthritis

Question 10

how does parvovirus B19 affect the fetus?

Answer 10

-1-2% of infections, cause spontaneous abortion nonimmune hydroid fetalis

Question 11

what is hydrops fetalis?

Answer 11

characterized by marked anemia, cardiac failure and extramedullary hematopoiesis (formation and activation of blood cells outside of the bone marrow)

Question 12

what is parvovirus congenital infection syndrome?

Answer 12

rash, anemia, and enlarged heart and liver

Question 13

when do you screen a woman for GBS?

Answer 13

37 weeks

Question 14

if the neonate gets GBS what is the treatment?

Answer 14

IV ampicillin and gentamicin for 10-14 days

Question 15

what are the signs of early onset of GBS in a neonate?

Answer 15

onset in the first 24 hours; pneumonia and or meningitis, respiratory distress, floppiness, poor feeding, tachycardia, shock, and seizures

Question 16

what are the outcomes of late onset GBS in a neonate?

Answer 16

can occur 7-10 days of age; more serious; usually meningitis; intelligential disability, quadriplegic, blindness, deafness, uncontrollable seizures, and hydrocephalus (build of fluid in brain)

Question 17

when is the worst time for a mother’s exposure to rubella?

Answer 17

first 4-5 months of pregnancy, consequences for the infant are far greater

Question 18

What are the symptoms of congenital rubella syndrome?

Answer 18

-intrauterine growth restriction
-Deafness
-Cataracts
-Jaundice
-purpura (rash, purple spots)
-hepatosplenomegaly
-microcephaly (small head)
-chronic encephalitis (inflamed brain)
-cardiac defects

Question 19

what are the death rates with neonates born with cytomegalovirus?

Answer 19

20-30% with neonates born with symptoms - 90% of survives have neurological disorders

Question 20

what is the most common sexually transmitted disease in the United States??

Answer 20

Chlamydia

Question 21

how do you treat a newborn whose mother was positive for chlamydia?

Answer 21

Eye antibiotics either erythromycin or tetracycline -these prevent the infant from developing pneumonia or ear infection

Question 22

What are symptoms of infants born with syphilis exposure?

Answer 22

non-viral hepatitis with jaundice, hepatosplenomegaly, pseudoparalysis, pneumonitsis, bone marrow failure, myocarditis, meningitis, anemia, Adema associated with nephrotic syndrome, and rash to the palms of hands and soles of the feet 

Question 23

name the facial abnormalities I can be caused by fetal alcohol syndrome

Answer 23

Hypoplastic (under developed) maxilla, mircognathia (undersize jaw), Hydroplastic phil trim (grooves beneath the nose), short palpebral fissures ( eyes slits between upper and lower lids)

Question 24

name neurological deficits that can be caused by fetal alcohol syndrome

Answer 24

Microcephaly, intellectual disability, motor delay and hearing deficit. Learning disorders may include problems with visual- spatial and verbal learning, attention disorders, delayed reaction times

Question 25

What are growth restrictions caused by fetal alcohol syndrome?

Answer 25

Prenatal growth deficiencies persist with slow growth after birth

Question 26

What behavioral problems are caused by fetal alcohol syndrome?

Answer 26

Irritability and hyperactivity, poor judgment

Question 27

What is a women exposing her child to when she smokes during pregnancy?

Answer 27

carbon monoxide, nicotine, and hydrogen, cyanide all cross the placenta

Question 28

What does carbon monoxide due to the fetus?

Answer 28

Carbon monoxide displace his oxygen from hemoglobin, resulting in decreased oxygen delivery to the fetus. Exposure increases risk of miscarriage and perinatal death.

Question 29

what are some problems in utero that tobacco may cause?

Answer 29

Decrease length and weight and head circumference. Increase rates of congenital birth defects, such as cleft palate or limb, limb, reduction defects, and urinary tract abnormalities. Increased incidence of placenta previa, placental, abruption, and preterm birth.

Question 30

what side effects does smoking around a neonate have?

Answer 30

sudden infant death syndrome, increase infant respiratory tract infections, and childhood asthma. And behavioral problems later in childhood.

Question 31

what effect does marijuana have on the neonate?

Answer 31

Some studies report that exposure can result in fine tremors, irritability and prolonged startle response for the first 12 months after birth

Question 32

what are the side effects of mothers using PCP?

Answer 32

The biggest problem with PCP is that mothers may overdose, resulting in hypertension, hyperthermia, and coma compromising the fetus

Question 33

is there any evidence of MDMA causing any problems to the fetus or neonate?

Answer 33

There is no clear evidence regarding effects on the fetus although some research suggests long-term impairments in learning

Question 34

what does methamphetamine do to the mother?

Answer 34

Causes hypertension tachycardia which can lead to miscarriage, placental, abruption, and premature delivery

Question 35

what does methamphetamine use in the mother do to the fetus?

Answer 35

Vasoconstriction effects of placental vessels, decreases circulation, nutrients and oxygen to the fetus. That’s something I mean classes the percentile barrier, causing fetal, hypertension, and perinatal strokes that caused damage to the heart and other organs

Question 36

what does methamphetamine use do to the neonate?

Answer 36

it is common for new, needs to be small for gestational age, usually less than 5 pounds, with shortened length and smaller head circumference. The neonate will go through withdrawals from the maternal use of methamphetamine

Question 37

what are the symptoms of a neonate going through withdrawals from methamphetamine?

Answer 37

Abnormal sleep pattern often characterized by Lizardi an excessive sleeping during the first few weeks, poor feeding, tremors, diaphoresis, miosis (excessive constriction of the pupil of the eye), frantic sucking of fist, high-pitched crying, fever, excessive, yawning, and hyper reflexia that

Question 38

What is the mother at risk for if she’s using heroin?

Answer 38

Poor nutrition, iron deficiency anemia, preeclampsia, eclampsia

Question 39

what are neonates at risk for if the mother uses heroin?

Answer 39

intrauterine, growth, restriction, born prematurely, neonatal, abstinence syndrome (60-80% of neonates

Question 40

how long after birth does neonatal abstinence syndrome, show signs and symptoms in a neonate, whose mother used heroin?

Answer 40

Heroin is a relatively short, half-life and symptoms usually begin 48 to 72 hours after delivery

Question 41

What are the symptoms of neonatal abstinence syndrome?

Answer 41

high-pitched cry, hyper, active reflexes, irritability, tremors, poor, feeding, periods of frantic sucking or rooting, vomiting, loose or watery stools, frequent yawning, sneezing multiple times, sweating, fever, tachypnea

Question 42

why is methadone given to Heroin addicted mothers?

Answer 42

decrease the dangers associated with heroin, such as fluctuating levels of the drug and exposure to hepatitis and HIV from sharing needles. Methadone may still result in miscarriage, stillborn, intrauterine, growth, restriction, fetal distress, low birth weight. The symptoms are usually’s less severe than with heroin. sudden withdrawal from methadone may cause preterm, labor, or death in the fetus so methadone should be monitored closely.

Question 43

what does cocaine do to the fetal heart?

Answer 43

The blood supply to the placenta is severely compromised. Cocaine causes programmed cell death in the heart, muscles of the fetus, resulting in cardiac dysfunction of the fetus.

Question 44

what does maternal cocaine use cause in the fetus and newborn?

Answer 44

risk of premature birth, cerebral infarctions, non-duodenal, intestinal, atresia, anal atresia, necrotizing enterocolitis, defects of the limbs and and genitourinary defects.

Question 45

what signs does a neonate show if exposed to cocaine use?

Answer 45

Extreme irritability and tremors followed by sluggish and lethargic behavior

Question 46

what is fetal warfarin syndrome - exposure at 7 to 12 weeks?

Answer 46

-exposure at 7 to 12 weeks
-Nasal Hypoplasia (smaller nose), laryngomalacia (defect in voice box), patent ductus arteriosus, ear, eye and skull abnormalities, intellectual disabilities, and growth restriction, brachydactyly (short fingers), scoliosis

Question 47

what is fetal warfarin syndrome - exposure second and third trimester?

Answer 47

May result in eye abnormalities such as Cataracts, optic atrophy, mircophthalmia (eyes stop developing resulting in abnormally small eyes), fetal – maternal hemorrhage, microcephaly (significantly smaller head)

Question 48

what is fetal hydantoin (dilantin) syndrome?

Answer 48

exposure in first trimester; facial dysmorphism, Microcephaly, under develop nails on hands and feet, cleft lip – palate, and developmental delays ranging from mild to severe

Question 49

what is fetal valproate (depakote) syndrome?

Answer 49

exposure in first trimester; fetal dysmorphism, spinal bifida, CNS, and cardiac abnormalities and delay in development

Question 50

ACE inhibitors adverse effects on fetus/infant

Answer 50

Second and third trimester exposure; skull in pulmonary hyperplasia, renal tubular, dysphasia, oligohydramnios (low, amniotic fluid)

Question 51

Carbamazepine adverse effects on fetus/infant?

Answer 51

first trimester exposure; cranial, facial defects, neutral, tube, defects, restrictions of growth, hypoplasia of fingernails

Question 52

antineoplastic alkylating drugs (chemo) effects on fetus/infant?

Answer 52

first through third trimester exposure; eye disorders including mircophthalmia (one or both eyes are small) and Cataracts, cardiac defects, renal agenesis (absence or one or both kidneys)

Question 53

Iodides effects on fetus/infant?

Answer 53

third trimester exposure; thyroid disorders, including goiter and fetal hypothyroidism

Question 54

methimazole effects on fetal/infant?

Answer 54

first trimester exposure; aplasia cutis (rare, congenital disorder, characterized by focal or widespread absence of the skin)

Question 55

tetracyclines effects on fetus/infant?

Answer 55

Second and third trimester exposure; yellow discoloration of teeth, weakening of fetal bones, and dysplasia of tooth enamel

Question 56

androgens affects on fetal/infants?

Answer 56

first trimester exposure; female fetus will become masculinized

Question 57

Retinoids affects on fetus/infants?

Answer 57

First trimester exposure; multiple deformities to heart, ears, face limbs, liver, cognitive impairment, thymic hypoplasia (under developed thymus) microcephalus, hydrocephalus (fluid build up in brain), microtia (external ear is small, and not formed properly) and miscarriages

Question 58

thalidomide affects on fetus/infant?

Answer 58

day 34 to 60 exposure; multiple facial, intestinal, cardiac limb abnormalities, including lack of limbs, limb reductions, and deafness

Question 59

vitamin a affects on fetus/infant?

Answer 59

Above 18,000IU/daily - multiple cranial facial deformities, microtia, cardiac abnormalities, atresia of bowel, and limb reductions, and defects on urinary tract