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Year 2 CV > Neonatal case conference, brandau > Flashcards

Neonatal case conference, brandau Flashcards

1
Q

newborn infant not thriving, what is on top of Ddx until proven otherwise

A

sepsis

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2
Q

what hour of membrane rupture raises chance of problems occuring

A

18 hours or more

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3
Q

what is definition for neonatal sepsis

A

clinical syndrome in neonate characterized by systemic signs of infection with bacteremia in first mo of life

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4
Q

how is meningitis related to sepsis

A

sequela of bacteremia and usually shares common cause and pathogenesis

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5
Q

What are the two patterns of disease with neonatal sepsis

A

early and late onset

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6
Q

What is time of onset with early onset sepsis? source? clincal presentation?

A

0-6 days
mothers genital tract
fulminante, multisystem with pneumonia

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7
Q

what is time of onset in late onset sepsis? source? clinical presentation?

A

7-90 days
mothers genial tract of postnatal environment
slowly progressive or fulminant, focal meningitis frequent

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8
Q

what are the gram + organisms assoc with sepsis

A

group B stresp Ealry and late onset
Staph aureus late onset
coagulase neg staph late onset
listeria monocytogenes

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9
Q

what are the gram - organisms assoc with sepsis

A

E coli (early and late)

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10
Q

what are common clincal signs of neonatal bacterial sepsis

A 
fever (hyperthermia)
resp distress
jaundice
hepatomegaly
anorexia
cyanosis
vomiting
lethargy
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11
Q

What is gold standard for Dx neonatal sepsis

A

blood cultures

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12
Q

What is most commonly used biomarker for sepsis

A

CRP c reactive protein

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13
Q

If infant is not doing well and CRP comes back normal limits, is sepsis ruled out

A

pretty much

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14
Q

What labs do you want on apneic infant not doing well

A

cultures, blood, CSFm ABG, CXR, glucose, electrolytes, BUN, creatinine
CRP

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15
Q

gentamycin can have negative effects on what systems of a neonate

A

ears and kidneys

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16
Q 
CSF shows mononuclear pleocytosis (330)
EEG showed multifocal epileptic potentials consistent with encephalitis
CRP 5 (Normal <10)
what type of process?
intial Tx?
A

viral

empirical Tx with amoxicillin, gentamicin, acyclovir, loading dose of phenobarbital

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17
Q

how can enterovirus neonatal be transmitted

A

antenatally, intrapartum and post natally

can be transplacentally or ascending infection

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18
Q

What are common presenting features of neonatal enterovirus sepsis

A

fever, irritability, poor feeding, lethargy
nonspecific rash
half have evidence of hepatitis or jaundice

19
Q

How to Tx enterovirus in neonate

A

IV Ig
dopamine and milrinone started for dec CO and arrhythmias
extracorporeal membrane oxygenation

20
Q

what age group are pediatric patients

A

<18

21
Q

premature is under what age

A

<37 weeks

22
Q

a neonate is how old

A

1 day-1 mo

23
Q

what is gray baby syndrome

A

chloramphehenicol
antibiotic for severe R infections
cause abdominal distension, vomiting, diarrhea, resp distress, hypotension, progressive shock and gray color

24
Q

What does thalidomide cause

A

phocomelia

congenital abnormalities, polyneuritis, nerve damage, mentl retardation

25
Q

what does sulfonamide cause in neonates

A

kernicterous

displaces bilirubin from protein binding sites, bilirubin depisits in crain resulting in encephalopathy

26
Q

what is gastric pH in full term infant at birth

A

6-8 at birth and drops to 1-3 in 24 hours

27
Q

how is gastric pH affected in premature infants

A

have immature acid secretion, so pH remains elvated

28
Q

how is gastric emptying changed in premature infants

A

slowed and prolonged. can increase drug absorption at site

29
Q

how are gestational age and gastric aborsorption related** look up to see if correct

A

inverese relationship

30
Q

Why is IM drug injection not as effective in neonates

A

muscle mass, poor perfusion, peripheral vasomotor instability
insufficeint muscle contractions

31
Q

drug absorption in skin relies on what

A

directly related to degree skin hydration and relative absorptive area
inversely related to thickness of stratum corneum

32
Q

what is total body water in a premature infant and full term vs adult

A

premature 85%
full term 78%
adult 60%

33
Q

why do you have to use higher doses in infants

A

have higher total body water and extracell fluid volume

34
Q

why is protein binding decreased in infants

A

decreased protein concentration, lower binding capacity, decreased affinity for drug binding
competition for certain binding sites by endogenous compounds

35
Q

how long can it take for drug elimination pathways take in infants

A

1 mo to 1 year

36
Q

what are common baterial pathogens of neonatal sepsis

A

Group B strep
E coli
listeria

37
Q

what antibiotics can we use in neonates

A

ampicillin, gentamicin
third generation cephalosporin
Acyclovir

38
Q

how does ampicillin work

A

inhibits bacterial cell wall synthesis

inhibits PBP, inhibits final transpeptidation of peptidoglycan syntehsis. leads to bacterial cell wall lysis

39
Q

how does acyclovir work

A

inhibits viral DNA synthesis and viral replication

40
Q

what is the pathophys of viral myocarditis. 3 phases

A

acute phase- inflammatory cell invasion of myocardium and myocardial necrosis and apoptosis
T cell invasion- most destructive 7-14 days post innoculation
Healing phase- myocardial fibrosis, continued inflammation and persistent viremia may lead to left ventricular dysfunction and dilation

41
Q

How do you Tx acute phase neonatal myocarditis

A 
inotropes
afterload reduction- milrininone
mechanical ventialation
extracorporeal membrane oxygenation
Immune Therapy (IV Ig, Immunosuppressive agents)
42
Q

What IV Ig do you give neonates for sepsis

A

sterile solution of human Ig 98% gamma, trace IgA and IgM

43
Q

What are indications for Extracorporeal membrane oxygenation ECMO

A 
primary pulm HTN
meconium aspiration syndrome
resp distress syndrome
gorup B strep sepsis
asphyxia
congenital diaphragmatic hernia

Year 2 CV (31 decks)

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