Perinatal infections of the newborn

Answer 1

Gonorrheal Opthalmia Neonatoriu

Question 2

HSV: diagnosis

what cultures are taken?

Answer 2

vesicles

nasopharyngeal or conjunctival swabs

urine

stool

tracheal secretions

CSF

Vesicle scrapings for rapid diagnostic tests

Question 3

HSV: local infections

Answer 3

Skin~ vesicles or billae

eye~ conjunctivitis, keratitis, retinitis

mouth~ ulcers

presents during first or second week of life

initial lesions often present at areas of trauma (scalp electrodes)

Question 4

HSV: CNS infection

Answer 4

seizure and encephalitis

occurs most commonly during 2nd- 4th week

Question 5

Most common causitive agents for sepsis? Early onset? Late onset?

Answer 5

Early onset sepsis= GBS, ecoli and coagulase negative staphylococcus

late onset sepsis= coagulase negative staphylococcus, e-coli, klebsiella

Question 6

chlamydia prevention

Answer 6

• screening and treatment of maternal infection should occur during pregnancy
• high risk women should be screened early in pregnancy and all women should be screened in the 3rd trimester
• appropriate treatment of the pregnant woman before delivery prevents disease in the newborn
• prophylaxis with oral erythromycin of the asymptomatic infant born to an untreated but chlamydia positive woman is generally contraindicated because of the increased risk of developing hypertrophic pyloric stenosis in the infant exposed to erythromycin

Question 7

HSV precautions

Answer 7

• infants at risk, even if cultures are negative, need to be followed closely for at least 6 weeks
• educate parents about S/S as often infants are discharged before culture results are available
• contact precautions
• neonates born to mothers with active lesions should be separated for other neonates and managed with contact precautions

Question 8

Newborn scale of sepsis score greater than 10 indicates what?

what are components of the newborn scale of sepsis? clinical indicators and laboratory indicators

Answer 8

need for further diagnositic evaluation

clinical indicators=skin color, perfusion, muscle tone, responsiveness to pain, respiratory distress, respiratory rate, temperature and apnea

laboratory indicators= WBC, Total neutraphils, platelet count, blood acidity and absolute neutrophil count

Question 10

treatment for infant born to a mother with active gonorrhea

Answer 10

administer cetriaxone 125mg IV or IM x 1

Question 11

Gonorrhea maternal infection increases the risk for what ?

Answer 11

spontaneous abortion, PROM, premature delivery and chorioamnioitis

Question 12

Gonorrhea infections may result in what?

Answer 12

-purulent eye conjunctivitis at 2-5 days after birth

systemic infection may present as neonatal sepsis, arthritis, meningitis, pneumonia, endocarditis or meningitis

**Untreated can lead to sudden blindness***

Question 13

HSV~ Breastfeeding is _____as long as the lesions are not on the breast

Answer 13

acceptable

Question 14

what can result from a exposure to maternal chlamydia to the neonate?

Answer 14

PNA

conjunctivitis

***can often have a delayed onset***

Question 15

HSV prevention: Reactivation

Answer 15

• obtain cultures 24-48 hrs after birth
• do not need to initiate therapy unless the infant is symptomatic, premature or has acquired open wound from delivery
• all persons with herpes labialis (cold sores) should follow strict hand washing guidelines and avoid contact with the infant and wear a mask when holding the infant until lesion is crusted

Question 16

HSV treatment

Answer 16

skin or mucucus membrane involvement= acyclovir IV 20 mg/kg/dose every 8 hrs for 14 days

CNS involovement=same treatment but for 21 days

Question 17

Gonorrhea prevention

Answer 17

culture for GC should occur at the first prenatal visit

repeat testing during the 3rd trimester for those at high risk for repeat infection

because gonorrheal infection can rapidly lead to blindness, all infants are given eye prophalaxis at birth with either 1% tetracycline opthalmic ointment or erythromycin .5% opthalmic ointment

Question 18

For HSV~Cutaneous and mucosal cultures are preferable obtained ______to _____ after delivery to differentiate colonization from true infection but should be done ______in symptomatic infants

Answer 18

24- 48 hrs

immediately

***Viral identification from culture generally takes 1-3 days ****

Question 19

HSV Prevention:

Primary infection

Answer 19

Empiric acyclovir IV q8 hrs after birth pending neonatal cultures ~ consider with C-section as well

Question 20

All of the following are symptoms of neonatal sepsis EXCEPT:

a. jaundice
b. poor feeding
c. temperature of 36.5 C
d. hypotonia
e. tachypnea
f. hypotension

Answer 20

C. Temperature of 36.5 C

Question 21

how is chlamydia transmitted to a neonate?

Answer 21

It is thought to occur around the time of delivery via innoculation of the infants eyes or respiratory tract with infected maternal secretions from an infected birth canal