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Women's health > Week 13 Conditions Affecting the Newborn > Flashcards

Week 13 Conditions Affecting the Newborn Flashcards

1
Q

How do you diagnose Chlamydia in newborn?

A

NAAT
Nasopharyngeal & conjunctival swab

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2
Q

Chlamydia PNA

Onset of symptoms

What is CXR like

how to diagnose

A

Onset: 2 to 4 months

CXR: Hyperinflation w/bilateral/symmetric interstitial infiltrates

Diagnosis: CXR, Respiratory secretion culture & symptoms

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3
Q

How do you treat Chlamydia conjunctivitis & PNA?

A

Erythromycin 50 mg/kg/day PO in 4 doses over 14 days

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4
Q

What is the risk of Erythromycin in infants?

What are you monitoring for?

A

<6 weeks = risk hypertrophic pyloric stenosis

Monitor:

  • Tx failure
  • Gonorrhea
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5
Q

What is the treatment for Gonorrhea?

A

Erythromycin ointment

or

Tetracycline ointment

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6
Q

Gonorrhea

Symptoms

Onset

Diagnosis

Treatment

A

S/S: Purulent, profuse & swelling eyelids

Onset: Faster and harder than CT, 2 to 5 days after birth

Diagnosis: Culture & Gram stain

Treatment: Ceftriaxone IV/IM & isolate

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7
Q

What are major factors for neonatal sepsis?

How many major factors to be considered high risk for sepsis?

A
  • Ruptured membranes >24 hours
  • Maternal fever >100.4
  • Chorionamnionitis
  • Sustained fetal HR >160
  • Multiple obstetric procedures

***only 1 major risk factor**

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8
Q

What are the minor risk factors for neonatal sepsis?

How many minor factors to be considered high risk?

A
  • Ruptured membrane >12 hours
  • Foul smelling liquour
  • Maternal fever >99.5
  • Low APGAR <5 at 1 min & <7 at 5 mins
  • Prematurity
  • Multiple gestations

***2 minor risk factors to be considered high risk

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9
Q

The baby has a score >10 on the newborn scale of sepsis. What does this mean?

A

“sick baby” and need further diagnostic eval

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10
Q

What is the gold standard to rule out sepsis in an infant?

A

Blood, urine & CSF cultures

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11
Q

When would you treat chlamydia?

A

When the cultures come back positive; treat with erythromycin systemically

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12
Q

T/F

  1. Chlamydia PNA has a late onset and often is characterized by a “staccato” cough and hyperinflation with bilateral infiltrates
  2. The most common pathogens for early onset sepsis in a newborn include E. Coli, GBS, & staph
  3. Negative blood and CSF cultures r/o diagnosis of sepsis
A
  1. Yes
  2. Yes
  3. No
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13
Q

HSV

ONSET

Types

A

Onset: Birth to 4 weeks

  1. Localized Disease/SEM (skin eyes mouth)
  2. CNS
  3. Disseminated *most dangerous
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14
Q

HSV treatment and when?

A

Acyclovir IV Q8 hours

If there <8 weeks: as soon as HSV is suspected

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15
Q

What is the Education/follow up for HSV?

A
  • Isolation & contact precautions
  • Early intervention to r/o disseminated disease that doesn’t how up until later life
  • Referral Opthalmology & audiology (med complications)
  • Close neurodevelopmental f/u
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16
Q

When do you treat GBS?

What do you treat with?

A

Treat at labor onset and every 4 hours until delivery

Penicillin G followed by ampicillin

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17
Q
  1. Majority of HSV infection in newborns is from HSV-1. Y/N?
  2. Risk of HSV transmission to infant at birth is greater if it is the mother’s first HSV outbreak Y/N?
  3. Localized HSV infection often presents at areas of skin trauma on the infant Y/N?
A
  1. Yes
  2. Yes
  3. Yes, like from fetal probe
18
Q
  1. Disseminated HSV has highest risk of mortality Y/N
  2. Any infant presenting with a vesicular rash should be started on antiviral therapy with IV acyclovir until HSV can be r/o Y/N
  3. All pregnant women with positive GBS should receive IV PCN at the onset of labor to try to prevent transmission to newborn Y/N?
A
  1. YES
  2. YES; same with varicella
  3. YES
19
Q
  1. Infants with GBS can present with signs of sepsis, respiratory distress, or meningitis Y/N?
  2. Early onset GBS occurs in 1st 2 weeks of life Y/N?
A
  1. yes
  2. yes; usually sooner than that
20
Q

What are the 4 characteristic signs of neonatal abstinence syndrome?

A
  1. state control and attention
  2. Motor & tone gontrol
  3. Sensory integration
  4. Autonomic functioning (sneeze/yawning/nasal stuffy)
21
Q

How can you diagnose neonatal abstinence syndrome? 4

A
  • urine
  • meconium
  • hair dample
  • mother’s report

Ok to test baby; CANNOT TEST MOTHER WITHOUT CONSENT

22
Q

How do you monitor NAS?

A

Monitor symptoms using neonatal abstinence scoring system

Tools: Modified Finnegan Score OR Eating, Sleeping, Consoling Care tool (ESC)

23
Q

What is the Modified Finnegan Scoring Tool and how do you use it

A

Neonatal Abstinence Syndrome

Assess Q2 hrs after birth then Q4 hours

Score <8 = no withdrawal

Guides tx

24
Q

What is the ESC tool

How do you use it?

A

NAS; focus on infant fx & comfort rather than reducing withdrawal s/s

Q4 hrs for 1st 7 days of life

25
Q

ECS encourages nonpharmacologic management which includes…

A
  • 4 “S”:
    • shush (repetive noises),
    • suck (pacifier),
    • swing (repetitive motion),
    • swaddle (d/t problems with sensory integration they like to be snug)
  • Calm environment
  • Rooming in
  • Skin to skin
26
Q

Discharge and f/u for babies with NAS

A
  • monitor in hospital until managed and weaned from narcotics
  • Close f/u d/t risk neurodevelopment concerns & monitor social situation
27
Q

What are the facial dysmorphologies of FAS?

A
  • Microencephaly
  • epicanthal folds
  • Low nasal bridge
  • thin upper lip
  • smooth philtrum
  • small jaw
28
Q

What are FAS birth defects 5

A

Cardiac (ASD)

Skeletal

Renal

Ocular

Auditory

29
Q

How to diagnose FASD

A

Have clinical suspicion with presence of or mom admits:

  • Facial dysmorphia
  • Intrauterine or postnatal growth retardation
  • structural brain anomaly
  • cognitive delays in older chilren
30
Q
  1. NAS is most frequently associated with opioid use during pregnancy Y/N?
  2. Premature infants have higher occurrence of NAS than FT infants Y/N?
  3. All infants with NAS require medication to manage withdrawal symptoms Y/N?
A
  1. yes
  2. False; premature infants have less because nervous system is more immature so they don’t have as much of a withdrawal response
  3. False; only if they are not responding to non-pharm interventions
31
Q
  1. NAS symptoms present within the first 24 hours after birth Y/N?
  2. FAS is the most severe of all the FASDs Y/N?
  3. Binge drinking as been associated with worse FAS outcomes as compared to small amounts of alcohol throughout pregnancy Y/N?
A
  1. false; 48 to 72 hours
  2. yes
  3. yes; although any amounts is detrimental
32
Q
  1. Alcohol related birth defects include ASD, kidney problems, and hearing loss Y/N?
  2. Almost all individuals with FASDs have some type of neurodevelopmental deficit Y/N?
A
  1. yes
  2. yes
33
Q

What is the most common chromosomal abnormality among live born infants?

A

Trisomy 21 “Down Syndrome”

34
Q

What are associated medical conditions with Trisomy 21?

A

Cardiac: Tetrology of fallot; ASD, common AV canal

Growth: Failure to thrive in beginning then obesity

Hearing

GI: Constipation; celiac disease, gut motility

Musculoskeletal: hip dysplasia

Leukemia: 10-20% higher then gen population

35
Q

Screening for Down Syndrome

Growth

Cardiac Disease

Hearing

A

Growth: Down Syndrome foundation for growth

Cardiac Disease: Echo at birth; Screen mitral valve prolapse at adolescence

Hearing: Screen Q6 months up to 3 years

36
Q

Screening for Down Syndrome

Opthalmologic

Thyroid

Hematology

Atlantoaxial instability

A

Opthalmologic: Screen as newborn & annually

Thyroid: Screen Newborn, 6 months, 12 months & annually (hypothyroidism)

Hematology: CBC at birth; Hgb annually 1 to 13 years old

Atlantoaxial instability: screen c-spine & hips (hip dysplasia)

37
Q

What is the leading cause of death in infants between 1month to 1 years of age in USA?

A

SIDS

38
Q

What are the risk factors for SIDS?

A
  • sleep position
  • sleeping environment
  • smoke exposure
  • preterm birth and/or low birth weight (immature neuro system)
  • young maternal age
  • late or no prenatal care
39
Q

how to prevent SIDS

A

Room share 6-12 months

pacifier before sleep

encourage BF

Cool environment

Immunizations

Avoid smoke/etoh/drugs

40
Q
  1. Upslanting palpebral fissures, epicanthal folds, single palmar crease, and brushfield spots are common PE findings associated with trisomy 21 Y/N?
  2. Individuals with Trisomy 21 should been evaluated for mitral valve prolapse infancy Y/N?
  3. Cardiac anomalies, thyroid dysfx, obesity, and hip dysplasia are common in individuals with down syndrome Y/N?
A
  1. yes
  2. no; first echo is to look for structural abnormalities; adolescents because that’s when prolapse starts
  3. yes

Women's health (10 decks)

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