PBL 5: Death in Infancy Flashcards
Define whooping cough?
A highly contagious infection of the lungs caused by the bacteria Bordetella pertussis.
Define SIDS
The sudden, unexplained death of an infant under 1 year old.
Define MCADD
Impairment of fatty acid oxidation, preventing the breakdown of medium chain fatty acids into acetyl CoA.
What occurs at 2 months?
• 5-in-1 injection: - DTaP (Diphtheria, Tetanus and Pertussis). - IPV (Polio). - Hib (Haemophilus influenza type b). • Pneumococcal vaccine. • Rotavirus. • Meningitis B.
What occurs at 3 months?
- 5-in-1 injection.
* Rotavirus.
What occurs at 4 months?
- 5-in-1 injection.
- Pneumococcal vaccine.
- Meningitis B.
What occurs at 1 year?
- Hib.
- Pneumococcal vaccine.
- Meningitis B.
- Meningitis C.
- MMR.
What occurs between 2-7 years?
• Annual flu vaccination (nasal spray).
What occurs at 3 years + 4 months?
• 4-in-1 injection:
- DTaP.
- IPV.
• MMR.
What occurs for 12-13 yr old girls?
• HPV 16/18 vaccine.
What occurs at 14 years?
• 3-in-1 injection: - Diphtheria. - Tetanus. - Polio. • Men ACWY vaccine.
What occurs at 65 years?
- Pneumococcal (PPV) vaccine.
* Annual flu vaccine.
What occurs at 70 years?
• Shingles.
Discuss 2012 whooping cough disease outbreak
- Whooping cough outbreaks occur every 3-4 years.
* But the outbreak of 2012 was much larger than expected (x10).
What were causes of 2012 whooping cough outbreak?
- Not enough people are vaccinated (pertussis vaccine is not life-long).
- Vaccinations fail.
- Seasonal variations.
- Increased diagnosis.
What causes whooping cough?
Bordetella pertussis
S+S of whooping cough?
- Runny nose.
- Sneezing.
- Dry cough.
- Sore throat.
- Intense bouts of coughing with a ‘whoop’ sound (later stage).
- Vomiting after each coughing episode.
Coughing complications?
- Subconjunctival haemorrhage.
- Rib fractures.
- Hernias.
- Pneumothorax.
- Urinary incontinence.
Pertussis complications?
- Apnoea.
- Pneumonia.
- Seizures.
- Encephalopathy.
- Otitis media (ear infections).
How to diagnose whooping cough?
- Full blood count.
- Serology.
- PCR.
Reproductive number of whooping cough?
15
Treatment of whooping cough?
Clarithromycin
erythromycin.
What is used to screen neonates?
Hearing
Blood Tests
What does heel test test for?
- Sickle cell disease.
- Cystic fibrosis.
- MCADD.
- Phenylketonuria.
- Congenital hypothyroidism.
When is heel test taken?
After 48 hrs
Where is MCAD located?
Mitochondria matrix
Function of MCAD?
enzyme used to break down fatty acids into acetyl CoA through oxidation.
What is heel prick test also known as?
Guthrie test
What will patient suffer with in MCAD and why?
hypoglycaemia as glucose cannot be produced
S+S of MCADD?
- Intermittent hypoglycaemia.
- Vomiting.
- Lethargy.
- Excessive sweating.
- Tachypnoea.
- Seizures.
- If untreated it can lead to coma and death.
- Typically occurs from 3 months – 2 years old.
what does MCAD stand for?
medium-chain acyl-CoA dehydrogenase
Causes of MCADD?
- Autosomal recessive disorder.
- Mutation of ACADM gene on chromosome 1.
- The gene is found at the locus 1p31.
- The most common mutation is G985, this is because a guanine is switched for an adenine nucleotide at the 985th residue.
Diagnosis of MCADD?
- Acute hypoglycaemia.
- U + E (show reduced anion gap).
- Liver function tests (elevated enzymes).
- Urine tests.
What is MCADD commonly misdiagnosed as?
Reye Syndrome
Management of MCADD?
- Avoiding fasting, this is when the MCAD enzyme usually functions.
- Increased dietary intake of calories from proteins and carbohydrates, while also avoiding lipid intake (due to loss of Beta oxidation).
- Genetic counselling.
Causes of SIDS?
- Lethal congenital malformations.
- Infections.
- Rare inherited conditions.
- Accidents.
- Non accidental injuries.
Risk factors for SIDS?
- Male babies.
- Premature babies.
- Low birthweight.
- Parents that smoke.
- Not breast-fed.
- Overheating.
- Sleeping prone on stomach.
Prevention of SIDS?
- Sleep on back.
- Lack of pillows and stuffed animals (dress the child warmly).
- Make the child sleep alone, not with parents.
What is CONI?
Care of next infant
What does coni involve?
nurse visiting and supervising babies born after the death of a previous infant.
• They make sure they baby is weighed regularly, attend clinics etc.
What may parents use to help prevent SIDS?
Apnoeic alarm
