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531 > Week 13 NB Infection > Flashcards

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
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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
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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
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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
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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)
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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
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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
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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.
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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
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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)
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11
Q

early on infection (when and orgs)?

A
  • before 72 hrs of life
  • higher M&M
  • c/b group b strep, Ecoli, staph
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11
Q

early on infection (when and orgs)?

A
  • before 72 hrs of life
  • higher M&M
  • c/b group b strep, Ecoli, staph
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12
Q

late onset infections

A

after 72 hrs-28 days

after 1st week of life

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13
Q

all infants < 6 weeks old with rectal temp 100.4+

A

asap referral to ER for septic workup

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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
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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
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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
  • A score < 10:
    • Healthy
    • no sepsis
  • A score > 10
    • “sick baby”→ further diagnostic eval
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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
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

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