Week 13 Conditions Affecting the Newborn Flashcards
How do you diagnose Chlamydia in newborn?
NAAT
Nasopharyngeal & conjunctival swab
Chlamydia PNA
Onset of symptoms
What is CXR like
how to diagnose
Onset: 2 to 4 months
CXR: Hyperinflation w/bilateral/symmetric interstitial infiltrates
Diagnosis: CXR, Respiratory secretion culture & symptoms
How do you treat Chlamydia conjunctivitis & PNA?
Erythromycin 50 mg/kg/day PO in 4 doses over 14 days
What is the risk of Erythromycin in infants?
What are you monitoring for?
<6 weeks = risk hypertrophic pyloric stenosis
Monitor:
- Tx failure
- Gonorrhea
What is the treatment for Gonorrhea?
Erythromycin ointment
or
Tetracycline ointment
Gonorrhea
Symptoms
Onset
Diagnosis
Treatment
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
What are major factors for neonatal sepsis?
How many major factors to be considered high risk for sepsis?
- Ruptured membranes >24 hours
- Maternal fever >100.4
- Chorionamnionitis
- Sustained fetal HR >160
- Multiple obstetric procedures
***only 1 major risk factor**
What are the minor risk factors for neonatal sepsis?
How many minor factors to be considered high risk?
- 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
The baby has a score >10 on the newborn scale of sepsis. What does this mean?
“sick baby” and need further diagnostic eval
What is the gold standard to rule out sepsis in an infant?
Blood, urine & CSF cultures
When would you treat chlamydia?
When the cultures come back positive; treat with erythromycin systemically
T/F
- Chlamydia PNA has a late onset and often is characterized by a “staccato” cough and hyperinflation with bilateral infiltrates
- The most common pathogens for early onset sepsis in a newborn include E. Coli, GBS, & staph
- Negative blood and CSF cultures r/o diagnosis of sepsis
- Yes
- Yes
- No
HSV
ONSET
Types
Onset: Birth to 4 weeks
- Localized Disease/SEM (skin eyes mouth)
- CNS
- Disseminated *most dangerous
HSV treatment and when?
Acyclovir IV Q8 hours
If there <8 weeks: as soon as HSV is suspected
What is the Education/follow up for HSV?
- 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
When do you treat GBS?
What do you treat with?
Treat at labor onset and every 4 hours until delivery
Penicillin G followed by ampicillin
- Majority of HSV infection in newborns is from HSV-1. Y/N?
- Risk of HSV transmission to infant at birth is greater if it is the mother’s first HSV outbreak Y/N?
- Localized HSV infection often presents at areas of skin trauma on the infant Y/N?
- Yes
- Yes
- Yes, like from fetal probe
- Disseminated HSV has highest risk of mortality Y/N
- Any infant presenting with a vesicular rash should be started on antiviral therapy with IV acyclovir until HSV can be r/o Y/N
- All pregnant women with positive GBS should receive IV PCN at the onset of labor to try to prevent transmission to newborn Y/N?
- YES
- YES; same with varicella
- YES
- Infants with GBS can present with signs of sepsis, respiratory distress, or meningitis Y/N?
- Early onset GBS occurs in 1st 2 weeks of life Y/N?
- yes
- yes; usually sooner than that
What are the 4 characteristic signs of neonatal abstinence syndrome?
- state control and attention
- Motor & tone gontrol
- Sensory integration
- Autonomic functioning (sneeze/yawning/nasal stuffy)
How can you diagnose neonatal abstinence syndrome? 4
- urine
- meconium
- hair dample
- mother’s report
Ok to test baby; CANNOT TEST MOTHER WITHOUT CONSENT
How do you monitor NAS?
Monitor symptoms using neonatal abstinence scoring system
Tools: Modified Finnegan Score OR Eating, Sleeping, Consoling Care tool (ESC)
What is the Modified Finnegan Scoring Tool and how do you use it
Neonatal Abstinence Syndrome
Assess Q2 hrs after birth then Q4 hours
Score <8 = no withdrawal
Guides tx
What is the ESC tool
How do you use it?
NAS; focus on infant fx & comfort rather than reducing withdrawal s/s
Q4 hrs for 1st 7 days of life
ECS encourages nonpharmacologic management which includes…
- 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
Discharge and f/u for babies with NAS
- monitor in hospital until managed and weaned from narcotics
- Close f/u d/t risk neurodevelopment concerns & monitor social situation
What are the facial dysmorphologies of FAS?
- Microencephaly
- epicanthal folds
- Low nasal bridge
- thin upper lip
- smooth philtrum
- small jaw
What are FAS birth defects 5
Cardiac (ASD)
Skeletal
Renal
Ocular
Auditory
How to diagnose FASD
Have clinical suspicion with presence of or mom admits:
- Facial dysmorphia
- Intrauterine or postnatal growth retardation
- structural brain anomaly
- cognitive delays in older chilren
- NAS is most frequently associated with opioid use during pregnancy Y/N?
- Premature infants have higher occurrence of NAS than FT infants Y/N?
- All infants with NAS require medication to manage withdrawal symptoms Y/N?
- yes
- False; premature infants have less because nervous system is more immature so they don’t have as much of a withdrawal response
- False; only if they are not responding to non-pharm interventions
- NAS symptoms present within the first 24 hours after birth Y/N?
- FAS is the most severe of all the FASDs Y/N?
- Binge drinking as been associated with worse FAS outcomes as compared to small amounts of alcohol throughout pregnancy Y/N?
- false; 48 to 72 hours
- yes
- yes; although any amounts is detrimental
- Alcohol related birth defects include ASD, kidney problems, and hearing loss Y/N?
- Almost all individuals with FASDs have some type of neurodevelopmental deficit Y/N?
- yes
- yes
What is the most common chromosomal abnormality among live born infants?
Trisomy 21 “Down Syndrome”
What are associated medical conditions with Trisomy 21?
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
Screening for Down Syndrome
Growth
Cardiac Disease
Hearing
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
Screening for Down Syndrome
Opthalmologic
Thyroid
Hematology
Atlantoaxial instability
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)
What is the leading cause of death in infants between 1month to 1 years of age in USA?
SIDS
What are the risk factors for SIDS?
- sleep position
- sleeping environment
- smoke exposure
- preterm birth and/or low birth weight (immature neuro system)
- young maternal age
- late or no prenatal care
how to prevent SIDS
Room share 6-12 months
pacifier before sleep
encourage BF
Cool environment
Immunizations
Avoid smoke/etoh/drugs
- Upslanting palpebral fissures, epicanthal folds, single palmar crease, and brushfield spots are common PE findings associated with trisomy 21 Y/N?
- Individuals with Trisomy 21 should been evaluated for mitral valve prolapse infancy Y/N?
- Cardiac anomalies, thyroid dysfx, obesity, and hip dysplasia are common in individuals with down syndrome Y/N?
- yes
- no; first echo is to look for structural abnormalities; adolescents because that’s when prolapse starts
- yes
