Neonatal case conference, brandau

Question 1

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

Answer 1

sepsis

Question 2

what hour of membrane rupture raises chance of problems occuring

Answer 2

18 hours or more

Question 3

what is definition for neonatal sepsis

Answer 3

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

Question 4

how is meningitis related to sepsis

Answer 4

sequela of bacteremia and usually shares common cause and pathogenesis

Question 5

What are the two patterns of disease with neonatal sepsis

Answer 5

early and late onset

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

what are the gram + organisms assoc with sepsis

Answer 8

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

Question 9

what are the gram - organisms assoc with sepsis

Answer 9

E coli (early and late)

Question 10

what are common clincal signs of neonatal bacterial sepsis

Answer 10

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

Question 11

What is gold standard for Dx neonatal sepsis

Answer 11

blood cultures

Question 12

What is most commonly used biomarker for sepsis

Answer 12

CRP c reactive protein

Question 13

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

Answer 13

pretty much

Question 14

What labs do you want on apneic infant not doing well

Answer 14

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

Question 15

gentamycin can have negative effects on what systems of a neonate

Answer 15

ears and kidneys

Question 16

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

Answer 16

viral

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

Question 17

how can enterovirus neonatal be transmitted

Answer 17

antenatally, intrapartum and post natally

can be transplacentally or ascending infection

Question 18

What are common presenting features of neonatal enterovirus sepsis

Answer 18

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

Question 19

How to Tx enterovirus in neonate

Answer 19

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

Question 20

what age group are pediatric patients

Answer 20

<18

Question 21

premature is under what age

Answer 21

<37 weeks

Question 22

a neonate is how old

Answer 22

1 day-1 mo

Question 23

what is gray baby syndrome

Answer 23

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

Question 24

What does thalidomide cause

Answer 24

phocomelia

congenital abnormalities, polyneuritis, nerve damage, mentl retardation

Question 25

what does sulfonamide cause in neonates

Answer 25

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

Question 26

what is gastric pH in full term infant at birth

Answer 26

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

Question 27

how is gastric pH affected in premature infants

Answer 27

have immature acid secretion, so pH remains elvated

Question 28

how is gastric emptying changed in premature infants

Answer 28

slowed and prolonged. can increase drug absorption at site

Question 29

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

Answer 29

inverese relationship

Question 30

Why is IM drug injection not as effective in neonates

Answer 30

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

Question 31

drug absorption in skin relies on what

Answer 31

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

Question 32

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

Answer 32

premature 85% full term 78% adult 60%

Question 33

why do you have to use higher doses in infants

Answer 33

have higher total body water and extracell fluid volume

Question 34

why is protein binding decreased in infants

Answer 34

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

Question 35

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

Answer 35

1 mo to 1 year

Question 36

what are common baterial pathogens of neonatal sepsis

Answer 36

Group B strep E coli listeria

Question 37

what antibiotics can we use in neonates

Answer 37

ampicillin, gentamicin third generation cephalosporin Acyclovir

Question 38

how does ampicillin work

Answer 38

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

Question 39

how does acyclovir work

Answer 39

inhibits viral DNA synthesis and viral replication

Question 40

what is the pathophys of viral myocarditis. 3 phases

Answer 40

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

Question 41

How do you Tx acute phase neonatal myocarditis

Answer 41

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

Question 42

What IV Ig do you give neonates for sepsis

Answer 42

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

Question 43

What are indications for Extracorporeal membrane oxygenation ECMO

Answer 43

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