Infection_Neonatal

Question 1

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

Answer 1

Congenital Infection

Question 2

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

Answer 2

Perinatal Infection

Question 3

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

Answer 3

Early-onset infection

Question 4

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

Answer 4

Late-onset infection

Question 5

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

Answer 5

Hospital-acquired infections

Question 6

— 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

Answer 6

Systemic Inflammatory Response Syndrome

Question 7

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

Answer 7

• 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

Question 8

the systemic inflammatory response to an infectious process

Answer 8

Sepsis

Question 9

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

Answer 9

• increased ambient temperature
• isolette or radiant warmer malfunction,
• dehydration

Question 10

Respiratory symptoms of increasing severity are

Answer 10

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

Question 11

neonatal infection resulting from unhygienic care of the
umbilical cord

Answer 11

Omphalitis

Question 12

Signs of Omphalitis

Answer 12

— Erythema
— Foul smelling discharge
— Swelling

Question 13

Omphalitis Tx

Answer 13

• Topical
  — 70% alcohol
  — Topical antibiotics
• Intravenous antibiotics

Question 14

Therapy for Early-Onset Sepsis

Answer 14

Ampicillin + aminoglycoside

Question 15

Therapy for Late-Onset Sepsis

Answer 15

Vancomycin + aminoglycoside

Question 16

• 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

Answer 16

• Recombinant G-CSF
• Recombinant GM-CSF

Question 17

• 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

Answer 17

IVIG

Question 18

Common signs: Meningitis

Answer 18

• fever,
• neck pain and rigidity
• focal neurologic deficits, seizures, obtundation and coma

Question 19

• 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

Answer 19

• Kernig Sign
• Brudzinski sign

Question 20

the Kernig and Brudzinski signs are not consistently present in

Answer 20

those younger than 12-18 mo

Question 21

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

Answer 21

Lumbar puncture (LP)

Question 22

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

Answer 22

brain herniation

Question 23

Contraindications: Lumbar puncture (LP)

Answer 23

(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

Question 24

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

Answer 24

Corticosteroids

Question 25

The most common neurologic sequelae from meningitis

Answer 25

- hearing loss- mc - cognitive impairment, - recurrent seizures, - delay in acquisition of language,

Question 26

Vaccination in Prevention of Meningitis

Answer 26

- Hemophilus influenzae - Streptococcus pneumoniae - Neisseria meningitidis

Question 27

- 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

Answer 27

Necrotizing Enterocolitis

Question 28

3 major risk factors of Necrotizing Enterocolitis

Answer 28

- prematurity, - bacterial colonization of the gut, and - formula feeding

Question 29

The first signs of impending disease may be nonspecific:

Answer 29

- lethargy and temperature instability - abdominal distention, feeding intolerance, and bloody stools

Question 30

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

Answer 30

2nd or 3rd week

Question 31

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

Answer 31

pneumatosis intestinalis (air in the bowel wall) confirms

Question 32

The most effective preventive strategy for NEC is the use of

Answer 32

human milk

Question 33

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

Answer 33

STAGE 1B SUSPECTED

Question 34

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

Answer 34

STAGE IIA DEFINITE MILDLY ILL

Question 35

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

Answer 35

STAGE IIB MODERATELY ILL

Question 36

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

Answer 36

STAGE IIIA ADVANCE SEVERLY ILL, BOWEL INTACT

Question 37

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

Answer 37

STAGE IIIA ADVANCE SEVERLY ILL, BOWELPERFORATED

Question 38

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

Answer 38

STAGE 1A SUSPECTED