Week 13 NB Infection Flashcards
1
Q
clinical findings of Down Syndrome
A
- Facial:
- Hyperlaxity
- upslanting palpebral fissure
- protruding tongue
- flat nasal bridge
- small ears
- Brushfield spots on the iris, short, wide
- Hand
- palmar simian creases
- growth retardation
- epicanthal folds
- wide gap 1st/2nd toe
- mental retardation
- Musckulo:
- hypotonia
- short neck
2
Q
Complications of Down syndrome
A
- Cardiac anomalies (40–50%)
- Ocular anomalies (20%)
- Myopia (70%)
- Serous otitis media (60–80%)
- Hearing loss (66–75%)
- Thyroid disease (15%)
- GI tract abnormalities: duodenal
- Stenosis and Hirschsprung disease (12%)
- Psychiatric disorders
- Delayed sexual development
- Leukemia (1%), 10–20 times higher than non-DS child
- Renal and urinary anomalies
- Eye issues: refractive errors,
- strabismus, nystagmus,
- blepharitis, cataracts, and
- glaucoma
- MSK abnormalities: reduced muscle strength, low bone density, atlantoaxial instability
- Autism (5–10%)
- Hearing screen
3
Q
NB with Down syndrome check:
A
- life-long multidisciplinary care
- ongoing screening for associated medical conditions
- Growth: use Down syndrome Foundation growth chart
- Cardiac disease:
- Echo at birth
- screen for mitral valve prolapse at adolescence
- Hearing:
- Screen at NB then, screen every 6 months up to 3 yrs
- Ophthalmologic:
- NB and yearly
- Thyroid:
- TSH as NB, repeat at 6 and 12 months and then yearly
- GI
- increased risk for celiac disease, constipation, hirsphrung
- Hematology:
- CBC/diff at birth; Hgb annually 1-13 years
- Atlantoaxial instability:
- screen cervical spine and hips at 3- 5 years
- Sleep study - sleep apnea
- diet/physical activity
- obesity
- skin
- eczema or psoriasis
4
Q
Down syndrome prenatal screening
A
- 1st trimester week 11 and 13
- Beta HcG
- US for nuchal translucency (folds back of neck; thicker neck = higher correlation)
- 2nd trimester week 15-19
- quad screening
- free cell DNA
5
Q
alcohol exposure in 1st trimester? 2nd? 3rd?
A
- 1: birth defects
- 2nd: miscarriage
- 3rd: affects weight, length, and brain growth
- Neurobehavioral effects occur throughout gestation
- binge drinking more harmful than 1 drink a day esp during organogenesis (early weeks)
6
Q
FAS effects
A
- IUGR
- increased rates of malformation
- chronic fetal hypoxia
- most severe effects
- birth defects, mental retardation → lifelong disabling behavioral problems
- 5% of all congenital anomalies fr from prenatal alcohol consumption
7
Q
FAS clinical findings
A
- CNS abnormalities
- microcephaly, structural brain abnormalities, developmental delays, mental retardation, poor motor control, attention deficits, hyperactivity, and muscle weakness
- ADD or ADHD
8
Q
FAS phenotypic features
A
- Underdeveloped/flat philtrum
- Thin upper lip
- Flat midface
- Short or an upturned nose
- Low nasal bridge
- Ear anomalies
- Railroad track ears
- Short palpebral fissures
- microcephaly, small jaw
- Ptosis
- Small tongue.
- epicanthal folds → extra fold of skin in the upper lid of the eye.
9
Q
for FAS, clinical suspicion with presence of:
A
- Facial dysmorphisms
- Intrauterine and/or postnatal growth retardation
- Structural brain anomaly
- Cognitive delays in older children
- **If clinical suspicion is present, recommend full multidisciplinary evaluation including genetics
10
Q
Alcohol Related Birth Defects
A
- Cardiac anomalies
- ASD
- VSD
- Tet fallot
- Skeletal
- Scoliosis
- Contractures
- Renal
- Hydronephrosis
- Dysplastic kidney
- Ocular
- Retinal abnormalities
- Strabismus
- Auditory
- Conductive
- Neurosensory hearing loss
- Pectus
- small globes (eyes)
11
Q
early on infection (when and orgs)?
A
- before 72 hrs of life
- higher M&M
- c/b group b strep, Ecoli, staph
11
Q
early on infection (when and orgs)?
A
- before 72 hrs of life
- higher M&M
- c/b group b strep, Ecoli, staph
12
Q
late onset infections
A
after 72 hrs-28 days
after 1st week of life
13
Q
all infants < 6 weeks old with rectal temp 100.4+
A
asap referral to ER for septic workup
14
Q
neonatal sepsis sx’s
A
- Temperature instability
- preterm: hypothermia
- term: febrile
- Respiratory distress
- Tachypnea
- Cyanosis
- Cardiovascular changes
- Hypotension
- Tachycardia, bradycardia
- Poor perfusion
- Neurologic symptoms
- Irritability
- lethargy
- Skin changes
- Rash
- Purpura
- Feeding difficulty
- Poor
- abdominal distension
15
Q
neonatal sepsis risk factors
A
- ROM > 12-24 hrs
- mom fever 99.5-100.4F
- chorioamnionitis
- sustained FHR > 160
- multiple obstetric procedures
- foul smelling liquor
- low APGAR < 5 at 1 min, < 7 at 5 min
16
Q
newborn scale of sepsis (SOS)
A
- Uses both clinical indicators and lab findings for scoring (20 lab, 35 clinical) max 55
- CBC with diff
- WBC
- Total neutrophils
- ANC
- platelet count
- ABG
- pH - if acidotic
- CBC with diff
- A score < 10:
- Healthy
- no sepsis
- A score > 10
- “sick baby”→ further diagnostic eval
17
Q
Neonatal Sepsis: Diagnostic Evaluation
A
- Gold standard: Blood, Urine, and CSF cultures
- CRP, PCT levels
- CXR, and films, joint x rays
- **There is no laboratory test that is 100% sensitive or 100% specific for sepsis. Normal results do not rule out infection or sepsis in the newborn.
18
Q
Group B strep prophylaxis
A
Treat prophylactically 4 hrs prior to birth and every 4 hrs until delivery if mom has + culture or history of positive
19
Q
Group B risk factors
A
- premature (< 37 wks)
- SGA
- Low APGAR
- ROM > 18 hrs - increase of chorionitis
- Maternal fever
- Prior infant with group b strep
20
Q
onset of GBS (early, late, late late)
A
- Early- onset GBS
- Within first 7 days of life
- 98% asx
- Late-onset GBS
- 1 - 3 months
- bacteremia, meningitis, bone infxn
- Late, late-onset GBS
- > 3 months of age and older
- More likely in NB born < 28 wks gestation or immune deficient
21
Q
positive or unknown GBS status of mother laboring:
A
at onset of labor, give IV penicillin then ampicillin then every 4 hours until baby is born.
if c section before ROM, don’t need antibiotics bc intact amniotic membranes
22
Q
GBS diagnostics
A
- same as sepsis
- culture
23
Q
antepartum tx of asymptomatic GBS positive mothers
A
NOT RECOMMENDED
get IV penicillin or ampicillin onset labor, q 4 hrs til born except during c section before ROM
24
Q
neonatal abstinence syndrome (NAS) onset
A
Usually within 2-3 days but can be delayed up to 28 days depending on ½ life of substance and last dose
25
Q
NAS sx/s
A
- may persists 4-6 months after birth
- High pitched cry
- Irritability
- Trouble sleeping
- Seizures
- Hypertonia
- Present up to 72 hrs - 28 days and sx’s persist up to 6 months
- Premature infants have immature neuro so less likely to experience NAS
26
Q
mothers and prenatal substance
A
- All mothers should be assessed for prenatal substance use-universally, every patient, every visit
27
Q
NAS: Symptoms and Diagnostics
A
- Signs reflect dysfunction in any of 4 domains:
- state control and attention
- motor and tone control
- sensory integration
- autonomic functioning
- Diagnostics on infant:
- Urine - detects 30 days
- Alcohol few hrs after last use
- Cocaine - 1-3 days after last use
- Opioids 2-4 days
- Weed - 1 month after last use
- Meconium & hair samples
- Collect first 48 hrs of life
- Can detect from 20 weeks on in pregnancy
- Mother’s report
- Consent issues
- Report to Child protection if present
- Urine - detects 30 days
28
Q
what tool to use to assess NAS and guide treatment
A
- “Modified Finnegan Score”
- score of < 8 = no withdrawal
- assess infant 2 hrs after birth then q 4 hrs
- include caregiver
29
Q
ESC Tool & Non pharm management
A
- Eating, Sleeping, Consoling Care
- Tx of NAS - supportive care
- focuses on infant function and comfort rather than reducing the signs and symptoms of withdrawal.
- Performed q 3-4 hours for first 4-7 days of life
- Non-pharmacologic management:
- 4 “S”- shush, suck, swing, swaddle
- Calm environment
- Rooming in
- Skin to skin
- If ^ doesn’t help, med considered
30
Q
NAS pharm therapy
A
- if non pharm doesn’t work
- Aimed at the short-term improvement of clinical symptoms
- Drug chosen from SAME class that was exposed to, then gradually weaned
- Ie: first line opioid w/drawal: morphine, methadone
- 2nd line: clonidine or phenobarbital
- Risks to consider before starting medications to treat NAS
- Longer length of stay
- Reinforce discomfort should be medicated
30
Q
NAS Discharge and Follow up considerations
A
- Monitor in hospital until symptoms managed and weaned from narcotic meds
- Close follow up → risk for neurodevelopmental concerns and to monitor social situation
- Stable home environment (substance use at home)
31
Q
Chlamydia: conjunctivitis
A
- Mild swelling to blood discharge with erythema eyes
- presents in 5-14 days
- mucopurulent eye exudate and eye swelling
- Dx: NAAT - swab nasopharyngeal and conjunctiva swabs
- exposure during delivery
32
Q
staccato cough
A
- inspiration/breath between each single cough
- from Chlamydia pneumonia
- Nasal congestion
- Crackles / rales
- CBC - eosinophilia
- CXR: hyperinflation with bilateral, symmetrical interstitial infiltrates
33
Q
chlamydia In NB treatment
A
- Treat both conjunctivitis and pneumonia with ORAL Erythromycin x 14 days
- Assess risk for hypertrophic pyloric stenosis in infants < 6 weeks
- call if projectile vomiting
- NO topical therapy (doesn’t work)
- Evaluate for N. Gonorrhoeae
- Educate mom on sx’s of conjunctivitis or pneumonia
34
Q
if mom is chlamydia positive and infant is asymptomatic
A
- *****No prophylaxis treatment is given for an asymptomatic infants with chlamydia positive mom
- because risk of pyloric stenosis when give infant erythromycin
- Educate mom on sx’s of conjunctivitis or pneumonia
35
Q
Gonorrheal Ophthalmia neonatorum
sx’s & Dx
A
- Purulent and profuse exudate, swelling of the eyelids within first 5 days of life
- Onset usually 2-5 days after birth
- ulceration, scarring = blindness
- dx: culture and gram stain, consider chlamydia co infection
36
Q
Gonorrhea: Ophthalmia Neonatorum Treatment
A
- Ceftriaxone 25-50 mg/kg, max 125 mg, IV/IM x 1
- Isolation for 24 hrs
- Evaluate for disseminated gonorrheal infection (DGI)
- Sx: fever , rash, arthritic joint pain
37
Q
Gonorrhea eye prophylaxis
A
every infant at birth
- 0.5% erythromycin ophthalmic ointment or 1% tetracycline ophthalmic ointment
38
Q
Sudden Infant Death Syndrome
A
- sudden and unexpected death of an infant < 1 yr
- cause was not obvious prior to investigation, without any underlying medical problems
- death remains unexplained despite a thorough investigation, including autopsy, death scene investigation, and review of the clinical history.
39
Q
leading cause of death in infants between 1 month and 1 year of age in the United States
A
SIDS
40
Q
SIDS risk factors
A
- Any sleeping position besides back
- prone, side
- Soft bedding
- Bed sharing with parents or other siblings.
- Exposure to tobacco smoke
- Premature or low birth weight
- Late or no prenatal care
- Young maternal age
41
Q
SIDS protective factors
A
- breastfeeding
- Pacifier use → stimulates breathing
- Room sharing for 6-12 months but co sleeping
- Immunizations.
- ceiling fan → cool environment
- The biggest risk reduction we can have is the safe sleep environments
- avoid smoking/alcohol/drug use
42
Q
how to correct gestational age for a premature infant?
ex: born 32 wks gestation, comes in at 16 weeks old
A
32 weeks - 40 weeks = 8 weeks premature
8 - 16 weeks = 8 weeks/2 months
