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PEDIA 1 > Infection_Neonatal > Flashcards

Infection_Neonatal Flashcards

1
Q
  • denotes infection acquired in utero.
  • are generally caused by viral or other nonbacterial organisms
  • often associated with injury to developing organs
A

Congenital Infection

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2
Q
  • indicates acquisition around the time of delivery
  • organisms include both bacteria and viruses
A

Perinatal Infection

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3
Q
  • occurs in the 1st wk of life
  • generally the consequence of infection caused by organisms acquired during the perinatal period
A

Early-onset infection

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4
Q
  • occurs between 7 and 30 days of life
  • include bacteria, viruses, or other organisms that are typically acquired in
  • the postnatal period
A

Late-onset infection

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5
Q
  • typically occur beyond the 1st wk of life
  • Earliest is hospital stay of > 72hrs and onset of new signs and symptoms
A

Hospital-acquired infections

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6
Q

— clinical manifestations of infection depend on the virulence of the infecting organism and the body’s inflammatory response
— is most frequently used to describe this unique process of infection and the subsequent systemic response
— In addition to infection, may result from trauma, hemorrhagic shock, other causes of ischemia, necrotizing enterocolitis, and pancreatitis

A

Systemic Inflammatory Response Syndrome

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7
Q

SIRS: the systemic inflammatory response to a variety of clinical insults, manifested by 2 or more of the following conditions:

  • Temperature
  • Respiratory dysfunction:
    > RR
    > PaO2
  • Cardiac dysfunction:
    > HR
    > capillary refill
    > BP
  • Perfusion abnormalities:
    > urine output
    > Lactate
    > mental status
A
  • Temperature instability <35°C (95°F) or >38.5°C (101.3°F)
  • Respiratory dysfunction:
    > Tachypnea >2 SD above the mean for age
    > Hypoxemia (PaO2 <70 mm Hg on room air)
  • Cardiac dysfunction:
    > Tachycardia >2 SD above the mean for age
    > Delayed capillary refill >3 sec
    > Hypotension >2 SD below the mean for age
  • Perfusion abnormalities:
    > Oliguria (urine output <0.5 mL/kg/hr)
    > Lactic acidosis (elevated plasma lactate and/or arterial pH <7.25)
    > Altered mental status
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8
Q

the systemic inflammatory response to an infectious process

A

Sepsis

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9
Q

Fever in newborn infants does not always signify infection, it also caused from

A
  • increased ambient temperature
  • isolette or radiant warmer malfunction,
  • dehydration
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10
Q

Respiratory symptoms of increasing severity are

A
  • grunting,
  • tachypnea,
  • retractions,
  • flaring of the alae nasi,
  • cyanosis,
  • apnea, and
  • progressive respiratory failure.
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11
Q

neonatal infection resulting from unhygienic care of the
umbilical cord

A

Omphalitis

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12
Q

Signs of Omphalitis

A

— Erythema
— Foul smelling discharge
— Swelling

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13
Q

Omphalitis Tx

A
  • Topical
    — 70% alcohol
    — Topical antibiotics
  • Intravenous antibiotics
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14
Q

Therapy for Early-Onset Sepsis

A

Ampicillin + aminoglycoside

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15
Q

Therapy for Late-Onset Sepsis

A

Vancomycin + aminoglycoside

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16
Q
  • Enhance neutrophil number and function, but no reduction in infection when administered as prophylaxis or improvement in survival when administered as therapy.
  • Insufficient evidence to support the clinical use as treatment or prophylaxis to prevent systemic infections
A
  • Recombinant G-CSF
  • Recombinant GM-CSF
17
Q
  • Augments antibody-dependent cytotoxicity and improve neutrophilic function, but no evidence in suspected or proven sepsis reduces death
  • Insufficient evidence from 10 RCTs or quasi-RCTs to support use in neonates with confirmed or suspected sepsis
A

IVIG

18
Q

Common signs: Meningitis

A
  • fever,
  • neck pain and rigidity
  • focal neurologic deficits, seizures, obtundation and coma
19
Q
  • flexion of the hip 90 degrees with subsequent pain with extension of the leg
  • involuntary flexion of the knees and hips after passive
    flexion of the neck while supine
A
  • Kernig Sign
  • Brudzinski sign
20
Q

the Kernig and Brudzinski signs are not consistently present in

A

those younger than 12-18 mo

21
Q

inorder to obtain CSF for Gram stain and culture, is the most important step in the diagnosis of meningitis

A

Lumbar puncture (LP)

22
Q

Some clinicians obtain a head CT scan prior to LP to evaluate for evidence of increased ICP, as an LP in the setting of elevated ICP could cause

A

brain herniation

23
Q

Contraindications: Lumbar puncture (LP)

A

(1) evidence of increased ICP
(2) severe cardiopulmonary compromise
(3) infection of the skin overlying the site of the LP
- Thrombocytopenia is a relative contraindication for LP

24
Q

reduced hearing loss in children with meningitis due to H. influenzae type b but not due to other pathogens.

A

Corticosteroids

25
Q

The most common neurologic sequelae from meningitis

A
  • hearing loss- mc
  • cognitive impairment,
  • recurrent seizures,
  • delay in acquisition of language,
26
Q

Vaccination in Prevention of Meningitis

A
  • Hemophilus influenzae
  • Streptococcus pneumoniae
  • Neisseria meningitidis
27
Q
  • is the most common life-threatening emergency of the gastrointestinal (Gl) tract in the newborn period
  • characterized by various degrees of mucosal or transmural necrosis of the Intestine
  • cause of NEC remains unclear but is most likely multifactorial
A

Necrotizing Enterocolitis

28
Q

3 major risk factors of Necrotizing Enterocolitis

A
  • prematurity,
  • bacterial colonization of the gut, and
  • formula feeding
29
Q

The first signs of impending disease may be nonspecific:

A
  • lethargy and temperature instability
  • abdominal distention, feeding intolerance, and bloody stools
30
Q

onset of NEC is usually in the ____ of life but can be as late as 3 mo in VLBW infants

A

2nd or 3rd week

31
Q

Plain abdominal radiographs are essential to make a diagnosis of NEC that shows

A

pneumatosis intestinalis (air in the bowel wall) confirms

32
Q

The most effective preventive strategy for NEC is the use of

A

human milk

33
Q

STAGES OF NECROTIZING ENTEROCOLITIS

Systemic Signs
- Temperature instability, apnoea, bradycardia
Intestinal Signs
- Elevated pregavage residuals, mild abdominal distension, occult blood in stool plus gross blood in stool
RADIOLOGIC SIGNS
- Normal or mild teus
TREATMENT
NPO, antibiotics x 3 days

A

STAGE 1B SUSPECTED

34
Q

STAGES OF NECROTIZING ENTEROCOLITIS

Systemic Signs
- Temperature instability, apnoea, bradycardia
Intestinal Signs
- Elevated pregavage residuals, mild abdominal distension, occult blood in stool plus absent bowel sounds, abdominal tenderness
RADIOLOGIC SIGNS
- lleus, pneumatosis intestinalis
TREATMENT
NPO, antibiotics x 7 days to 10 days

A

STAGE IIA DEFINITE MILDLY ILL

35
Q

STAGES OF NECROTIZING ENTEROCOLITIS

Systemic Signs
- Temperature instability, apnoea, bradycardia plus mild metabolic acidosis, mild thrombocytopenia
Intestinal Signs
- Elevated pregavage residuals, mild abdominal distension, occult blood in stool plus absent bowel sounds, definite
abdominal tenderness, abdominal cellulitis, right lower quadrant mass
RADIOLOGIC SIGNS
- Same as llA, plus portal vein gas, with or without ascites
TREATMENT
NPO, antibiotics x 14 days

A

STAGE IIB MODERATELY ILL

36
Q

STAGES OF NECROTIZING ENTEROCOLITIS

Systemic Signs
- Same as IIB, plus hypotension, bradycardia, respiratory acidosis. metabolic acidosis, disseminated intravascular
coagulation, neutropenia
Intestinal Signs
- Same as I and Il, plus signs of generalised peritonitis,
marked tendemess and distension of abdomen
RADIOLOGIC SIGNS
- Same as IIB, plus definite ascites
TREATMENT
NPO, antibiotics x 14 days, fluid resuscitation, inotropic
support, ventilator therapy paracentesis

A

STAGE IIIA ADVANCE SEVERLY ILL, BOWEL INTACT

37
Q

STAGES OF NECROTIZING ENTEROCOLITIS

Systemic Signs
- Same as IIIA
Intestinal Signs
- Same as IIIA
RADIOLOGIC SIGNS
- Same as IIB, plus pneumoperitoneum
TREATMENT
- Same as liA_ plus surgery

A

STAGE IIIA ADVANCE SEVERLY ILL, BOWELPERFORATED

38
Q

STAGES OF NECROTIZING ENTEROCOLITIS

Systemic Signs
- Temperature instability, apnoea, bradycardia
Intestinal Signs
- Elevated pregavage residuals, mild abdominal distension, occult blood in stool
RADIOLOGIC SIGNS
- Norma! or mild teus
TREATMENT
NPO, antibiotics x 3 days

A

STAGE 1A SUSPECTED

PEDIA 1 (12 decks)

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