Neonatal Emergencies Flashcards
Fulminant illness with onset within 48 h of birth, with infection likely acquired in utero from contaminated amniotic fluid environment.
Common bacterial [group B Streptococcus (most common), Escherichia coli, Listeria monocytogenes, Haemophilus influenzae B, Streptococcus pneumoniae, Klebsiella species, Enterobacter aerogenes]
Respiratory distress, unstable temperature (high or low), irritability or lethargy, tachycardia, and poor feeding may be present.
Common bacterial [group B Streptococcus (most common), Escherichia coli, Listeria monocytogenes, Haemophilus influenzae B, Streptococcus pneumoniae, Klebsiella species, Enterobacter aerogenes]
Develops in 3%–16% of exposed neonates (in colonized mothers)
Chlamydia
Usually occurs after 3 wk of age, accompanied by conjunctivitis in one half of cases. Often afebrile, tachypneic, with prominent “staccato” cough. Wheezing uncommon.
Chlamydia
In addition to pneumonia, may cause paroxysms of cough ± cyanosis and posttussive emesis in otherwise well-looking infant. Characteristic whoop is not present in neonates. Apnea may be the only symptom. Suspect when adult caregiver also has persistent cough.
Bordetella pertussis
Often presents with nonspecific systemic symptoms with multiorgan involvement (fever, failure to thrive, respiratory distress, organomegaly).
May be acquired by transplacental means, aspiration/ ingestion of infected amniotic fluid, or postnatal airborne transmission.
Half of infants born to actively infected mothers develop this if not immunized or treated.
Mycobacterium tuberculosis
Initial upper respiratory illness progressing to respiratory distress and feeding difficulty.
Hypoxia, apnea, and bradycardia (with HSV) may be present.
Often indistinguishable from bronchiolitis.
Viral pneumonia/pneumonitis (HSV, respiratory syncytial virus, adenovirus, human metapneumovirus, influenza, parainfluenza)
<24 h Causes of Jaundice in Neonates
Hemolysis due to ABO, Rh incompatibility
Congenital infection (rubella, toxoplasmosis, cytomegalovirus infection)
Excessive bruising from birth trauma (cephalohematoma or intramuscular hematoma)
Acquired infection (e.g., sepsis, pneumonia)
Physiologic jaundice occurs
2–3 d
3 d–1 wk Causes of Jaundice in Neonates
Acquired infection (e.g., sepsis, urinary tract infection, pneumonia)
Congenital decrease in glucuronyl transferase (e.g., Crigler-Najjar syndrome, Gilbert’s syndrome)
Congenital infections (syphilis, toxoplasmosis, cytomegalovirus infection)
Breast milk jaundice occurs
> 1 wk
> 1 wk Causes of Jaundice in Neonates
Breast milk jaundice
Acquired infection (e.g., sepsis, urinary tract infection, pneumonia)
Biliary atresia
Congenital and acquired hepatitis
Red cell membrane defects (e.g., sickle cell anemia, spherocytosis, elliptocytosis)
Red cell enzyme defects (e.g., glucose-6-phosphate dehydrogenase deficiency)
Hemolysis due to drugs
Endocrine disorders (hypothyroidism)
Metabolic disorders (galactosemia, fructosemia)
Pyloric stenosis
Physiologic jaundice is characterized by a slow rise in bilirubin (< _____milligrams/ dL per 24 hours), with a peak of ____ to ____ milligrams/dL during the second to the fourth days of life and a decrease to <____ milligrams/ dL by 5 to 7 days.
Physiologic jaundice is characterized by a slow rise in bilirubin (<5 milligrams/ dL per 24 hours), with a peak of 5 to 6 milligrams/dL during the second to the fourth days of life and a decrease to <2 milligrams/ dL by 5 to 7 days.
Physiologic jaundice physiology
Decreased neonatal hepatic glucuronyl transferase activity,
a shortened life span of neonatal red blood cells and relative polycythemia, and
decreased intestinal bacterial colonization all lead to an increase in enterohepatic circulation that produces the normal rise in bilirubin seen in physiologic jaundice
Type of hyperbilirubinemia:
more common, presents earlier in the neonatal period, and is related to the normal or abnormal breakdown of hemoglobin,
Unconjugated
results from the inability to excrete bilirubin into the bile and intestines and is usually the result of primary hepatic or biliary disease such as biliary atresia or hepatitis.
is always pathologic and often presents later in the neonatal period with jaundice, acholic stools, and dark urine.
Conjugated
Breast milk jaundice physiology
due to the presence of substances that inhibit glucuronyl transferase in the breast milk
True or False
Breast milk jaundice is unlikely to cause kernicterus and usually can be treated with phototherapy, when necessary.
True
Breastmilk vs breastfeeding jaundice
breastfeeding jaundice, or starvation jaundice, which can occur when a newborn is exclusively breastfed and the mother’s milk supply is still inadequate
True or false
most cases of unconjugated hyperbilirubinemia, phototherapy is sufficient
True
upper airway obstruction and may be evident on both inspiration and expiration
Stridor
most common cause of stridor in neonates is
laryngomalacia
noisy, crowing, inspiratory sounds, usually present from birth, that usually decrease during the first
year of life.
laryngomalacia
confirms the diagnosis of laryngomalacia
Nasal pharyngoscopy by an otolaryngologist
Stridor worsening with cry or increased
activity suggests
laryngomalacia,
tracheomalacia, or
subglottic hem-
angioma
Stridor accompanied by feeding difficulties
vascular ring,
laryngeal cleft, or
tracheoesophageal fistula
Stridor with hoarseness or weak cry
vocal cord paralysis
present initially
with noisy breathing or a high-pitched cry and disproportionate respiratory distress with mild upper respiratory infections
Tracheal stenosis
Infants who were intubated in the neonatal period may develop stridors from
subglottic stenosis
