Fetal Exposure to Hepatitis Flashcards
hep B immunization for newborns
-given prior to discharge, at 2 months and at 6 months
-if premature, given at 2kg or 2 months
if mother is hep B positive, what to do for newborn?
-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
how does maternal hep C infection effect infant?
rarely transmitted and those that are infection 75% are clear of infection by age 2
how does hepatitis E effect mother and baby?
greater risk to mother with a mortality rate of 20% during pregnancy, increased risk of fetal complications and death
risk for untreated HIV mothers to pass it onto neonate?
30% and it usually happens during delivery
risks of neonates born to untreated HIV positive mothers?
neonates are usually asymptomatic but are at risk for prematurity, low birth weight, and SGA
risk for infants born to untreated HIV positive mothers?
FTT, hepatomegaly, interstitial lymphocytic pneumonia, recurring infections and CNS abnormalities
what 4 things can reduce the risk of mother transmitting HIV to newborn?
-antiviral therapy during pregnancy
-elective C section
-antiviral medication given to neonate for the first 6 weeks of life
-avoid breastfeeding
what is parvovirus B19 and what does is cause?
- 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
how does parvovirus B19 affect the fetus?
-1-2% of infections, cause spontaneous abortion nonimmune hydroid fetalis
what is hydrops fetalis?
characterized by marked anemia, cardiac failure and extramedullary hematopoiesis (formation and activation of blood cells outside of the bone marrow)
what is parvovirus congenital infection syndrome?
rash, anemia, and enlarged heart and liver
when do you screen a woman for GBS?
37 weeks
if the neonate gets GBS what is the treatment?
IV ampicillin and gentamicin for 10-14 days
what are the signs of early onset of GBS in a neonate?
onset in the first 24 hours; pneumonia and or meningitis, respiratory distress, floppiness, poor feeding, tachycardia, shock, and seizures
what are the outcomes of late onset GBS in a neonate?
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)
when is the worst time for a mother’s exposure to rubella?
first 4-5 months of pregnancy, consequences for the infant are far greater
What are the symptoms of congenital rubella syndrome?
-intrauterine growth restriction
-Deafness
-Cataracts
-Jaundice
-purpura (rash, purple spots)
-hepatosplenomegaly
-microcephaly (small head)
-chronic encephalitis (inflamed brain)
-cardiac defects
what are the death rates with neonates born with cytomegalovirus?
20-30% with neonates born with symptoms - 90% of survives have neurological disorders
what is the most common sexually transmitted disease in the United States??
Chlamydia
how do you treat a newborn whose mother was positive for chlamydia?
Eye antibiotics either erythromycin or tetracycline -these prevent the infant from developing pneumonia or ear infection
What are symptoms of infants born with syphilis exposure?
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 
name the facial abnormalities I can be caused by fetal alcohol syndrome
Hypoplastic (under developed) maxilla, mircognathia (undersize jaw), Hydroplastic phil trim (grooves beneath the nose), short palpebral fissures ( eyes slits between upper and lower lids)
name neurological deficits that can be caused by fetal alcohol syndrome
Microcephaly, intellectual disability, motor delay and hearing deficit. Learning disorders may include problems with visual- spatial and verbal learning, attention disorders, delayed reaction times
What are growth restrictions caused by fetal alcohol syndrome?
Prenatal growth deficiencies persist with slow growth after birth
What behavioral problems are caused by fetal alcohol syndrome?
Irritability and hyperactivity, poor judgment
What is a women exposing her child to when she smokes during pregnancy?
carbon monoxide, nicotine, and hydrogen, cyanide all cross the placenta
What does carbon monoxide due to the fetus?
Carbon monoxide displace his oxygen from hemoglobin, resulting in decreased oxygen delivery to the fetus. Exposure increases risk of miscarriage and perinatal death.
what are some problems in utero that tobacco may cause?
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.
what side effects does smoking around a neonate have?
sudden infant death syndrome, increase infant respiratory tract infections, and childhood asthma. And behavioral problems later in childhood.
what effect does marijuana have on the neonate?
Some studies report that exposure can result in fine tremors, irritability and prolonged startle response for the first 12 months after birth
what are the side effects of mothers using PCP?
The biggest problem with PCP is that mothers may overdose, resulting in hypertension, hyperthermia, and coma compromising the fetus
is there any evidence of MDMA causing any problems to the fetus or neonate?
There is no clear evidence regarding effects on the fetus although some research suggests long-term impairments in learning
what does methamphetamine do to the mother?
Causes hypertension tachycardia which can lead to miscarriage, placental, abruption, and premature delivery
what does methamphetamine use in the mother do to the fetus?
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
what does methamphetamine use do to the neonate?
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
what are the symptoms of a neonate going through withdrawals from methamphetamine?
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
What is the mother at risk for if she’s using heroin?
Poor nutrition, iron deficiency anemia, preeclampsia, eclampsia
what are neonates at risk for if the mother uses heroin?
intrauterine, growth, restriction, born prematurely, neonatal, abstinence syndrome (60-80% of neonates
how long after birth does neonatal abstinence syndrome, show signs and symptoms in a neonate, whose mother used heroin?
Heroin is a relatively short, half-life and symptoms usually begin 48 to 72 hours after delivery
What are the symptoms of neonatal abstinence syndrome?
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
why is methadone given to Heroin addicted mothers?
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.
what does cocaine do to the fetal heart?
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.
what does maternal cocaine use cause in the fetus and newborn?
risk of premature birth, cerebral infarctions, non-duodenal, intestinal, atresia, anal atresia, necrotizing enterocolitis, defects of the limbs and and genitourinary defects.
what signs does a neonate show if exposed to cocaine use?
Extreme irritability and tremors followed by sluggish and lethargic behavior
what is fetal warfarin syndrome - exposure at 7 to 12 weeks?
-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
what is fetal warfarin syndrome - exposure second and third trimester?
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)
what is fetal hydantoin (dilantin) syndrome?
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
what is fetal valproate (depakote) syndrome?
exposure in first trimester; fetal dysmorphism, spinal bifida, CNS, and cardiac abnormalities and delay in development
ACE inhibitors adverse effects on fetus/infant
Second and third trimester exposure; skull in pulmonary hyperplasia, renal tubular, dysphasia, oligohydramnios (low, amniotic fluid)
Carbamazepine adverse effects on fetus/infant?
first trimester exposure; cranial, facial defects, neutral, tube, defects, restrictions of growth, hypoplasia of fingernails
antineoplastic alkylating drugs (chemo) effects on fetus/infant?
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)
Iodides effects on fetus/infant?
third trimester exposure; thyroid disorders, including goiter and fetal hypothyroidism
methimazole effects on fetal/infant?
first trimester exposure; aplasia cutis (rare, congenital disorder, characterized by focal or widespread absence of the skin)
tetracyclines effects on fetus/infant?
Second and third trimester exposure; yellow discoloration of teeth, weakening of fetal bones, and dysplasia of tooth enamel
androgens affects on fetal/infants?
first trimester exposure; female fetus will become masculinized
Retinoids affects on fetus/infants?
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
thalidomide affects on fetus/infant?
day 34 to 60 exposure; multiple facial, intestinal, cardiac limb abnormalities, including lack of limbs, limb reductions, and deafness
vitamin a affects on fetus/infant?
Above 18,000IU/daily - multiple cranial facial deformities, microtia, cardiac abnormalities, atresia of bowel, and limb reductions, and defects on urinary tract
