Week 13 Perinatal Disorder Flashcards
Toxoplasmosis: Description and Epidemiology
Cat feces
Undercooked meat
Ingestion of contaminated soil
Toxoplasmosis: Clinical findings
Prematurity and low Apgar scores Jaundice Anemia Hepatosplenomegaly Chorioretinitis Microcephaly
Toxoplasmosis: Diagnostic Studies
CT brain: Calcification or hydrocephalus
CSF: high protein, low glucose and evidence of T. Gondii
Serum Immunoglobulins: Antibodies against Toxoplasmosis
Toxoplasmosis: Management, prognosis and prevention
Pyrimethamine, sulfadiazine with folic acid supplement
Infants with severe involvement at birth have impaired: vision, hearing, cognitive function
Prevention: gloves, and avoid contaminants
Congenital Rubella: Description and Epidemiology:
RNA virus. Contact transmission. Virus infects the placenta and is transmitted to the fetus
Congenital Rubella: Clinical Findings
Maternal infection before 16 weeks gestation, negative rubella titers in mother, 50% of infected women are asymptomatic
PE: Hearing loss, congenital heart disease, mental retardation, cataract or glaucoma, microcephaly and “blue berry muffin” skin lesion.
Congenital Rubella: Diagnosis studies
nasopharyngeal secretions, conjunctiva, urine, stool, CSF
Measure serum immunoglobulins
Congenital Rubella: Managment and Prevention
Monitoring and intervention for developmental, hearing, vision and medical needs
Women of all child bearing age need to immunized
CMV: Description and Epidemiology
Member of the herpes virus. Transmitted with virus containing secretions and blood
CMV: Clinical findings
H & P: maternal infection, SGA/IUGR, hepatosplenomegaly, jaundice, petechial rash, chorioretinitis, cerebral calcifications, microcephaly
CMV: Diagnostic Studies
Viral cell cultures from urine, saliva, or other body fluids
Proof of congenital infection requires obtaining specimens within 3 weeks of birth
CMV: Management, prognosis, and prevention
Greatest risk are susceptible pregnant women exposed to urine and saliva from CMV infected children at daycares
Handwashing!
Ganivclovir to decrease progression of hearing impairment
Monitor urine for 18-24 months
The outcome of congenital CMV infection is poor (high morbidity rate): psychomotor retardation, microcephaly, hearing loss, seizures, chorioretinitis, optic atrophy, mental retardation, learning disabilities.
Group B Streptococcus: Description and epidemiology
Leading cause of sepsis in infants from birth to 3 months
Gram-positive diplococcus that forms colonies in maternal GU GI tract
GBS acquired by infants through vertical transmission
Group B Streptococcus: Clinical Findings
History: infants < 37 weeks gestation, ROM >18 hours, maternal fever during labor >100.4 F, previous delivery of a sibling with invasive GBS, maternal chorioamnionitis
PE: Poor feeding, temp instability, cyanosis, apnea, tachypnea, grunting, flaring, retractions, seizures, lethargy, bulging fontanelle, rapid onset deterioration
Group B Streptococcus: Diagnostic studies
blood culture,
CSF or both
Group B Streptococcus: Management, prognosis, and prevention
PCN and aminoglycoside until GBS differentiated from E. coli or Listeria sepsis or meningitis
Screen all pregnant women at 35-37 week OB. GBS + women need IV PCN or ampicillin at onset of labor and every 4 hours until birth
Listeriosis: Description and Epidemiology
Gram positive Rod
Soil, streams, sewage, certain foods, silage, dust and slaughterhouses
Mexican cheese, whole and 2% milk, uncooked hotdogs, undercooked meat, raw veggies, shellfish
Listeriosis: Clinical Findings
H & P: brown-stained amniotic fluid, generalized sx of sepsis, whitish posterior pharyngeal and cutaneous granulomas, disseminated erythematous papules on skin
Listeriosis: Diagnostic Studies:
Blood, CSF, meconium, and urine are cultures
CSF: high protein, decreased glucose, and high leukocyte account
Listeriosis: Management and Prognosis
IV Ampicillin and aminoglycoside (gent) as initial therapy
Transplacentally acquired listeriosis usually results in SAB
Survivors on listeriosis: mental retardation, paralysis, and hydrocephalus
Congenital Varicella: Description and Epidemiology
Herpes Virus
Congenital Varicella: Clinical Findings
H & P: Hx of maternal chickenpox infection, limb atrophy, scarring of the skin, eye manifestation
Congenital Varicella: Diagnostic Studies
Immunofluorescent staining of vesicular scrapings
Congenital Varicella: Management, Prognosis, Prevention
VZIG
Acyclovir
Vaccination of nonpregnant women
Gonorrhea: Description and Epidemiology
Organism lives in exudate and secretions of infected mucous membranes
Gonococcal infection of the newborn are primarily acquired during delivery
Gonorrhea: Clinical Findings
H & P: History of maternal gonococcal infections: Finding of conjunctivitis
Gonorrhea: Diagnostic studies
a culture of eye exudate
Gonorrhea: Management and prevention
Single dose of IM ceftriaxone 25-50 mg/kg not exceeding 125 mg) for prophylaxis of infants born to mothers with active infection
Gonorrheal conjunctivitis can lead to blindness
Eye ointment: 1% silver nitrate, 1 % tetracycline or erythromycin 0.5%
Chlamydia: Description and Epidemiology
Infection occurs in 50% of infants born vaginally to infected mothers
Chlamydia: Clinical Findings
H & P: History of maternal chlamydia infections, conjunctivitis within a few to several weeks after birth, infant commonly afebrile with normal activity level
Pneumonia 2-19 weeks after birth
Chlamydia: Diagnostic Studies
Cell cultures
Chlamydia: Management and Prevention
Oral erythromycin suspension 50 mg/kg/day divided by 4 doses for 10-14 days for conjunctivitis and pneumonia
Appropriately treat of the pregnant woman before delivery
Syphilis: Description and Epidemiology
Routine maternal serological testing required in all states
Syphilis: Clinical Findings
H & P: Maternal infection and positive serologic testing; majority of infants are asymptomatic at birth, hepatosplenomegaly; persistent rhinorrhea, maculopapular or bullous dermal lesions, FTT, restlessness, fever
Syphilis: Diagnostic Studies
Vernereal Disease Research Lab VDRL
Rapid Plasma Repair RPR
Syphilis: Management and Prevention
10 consecutive days of crystalline PCN 100-150,000 units/kg/day IV
Then Procain PCN G 50,000 units/ KG IM for 10 days
If more than 1 day missed entire course must be restarted
Untreated congenital syphilis can lead to multiorgan involvement
Herpes Simplex Virus: Description and Epidemiology
3 Categories:
Disseminated disease: Present with sx suggestive of bacterial sepsis plus hepatitis, encephalitis, pneumonitis, DIC
CNS disease: Seizures and encephalitis
Local: Disease restricted to skin, eyes and mouth
HSV transmitted with direct contact during birth
Herpes Simplex Virus: Clinical Findings
H&P: Mom has lesions and delivered vaginally. Vesicles in skin, eyes, and mouth are found.
S/S: Encephalitis, pneumonia or sepsis
Herpes Simplex Virus: Diagnostic Studies
Tissue cultures from exudate 24-48 hours after birth
Rapis ID tests: PCR, DNA from CSF
Herpes Simplex Virus: Management, Prognosis, Prevention
Antiviral therapy in final weeks of pregnancy for women with a hx of HSV
Acyclovir 20 mg/kg/dose IV every 8 hours for 14 days
Cesarean delivery before ROM in any woman with active infection
Acyclovir IV or ophthalmic drugs for the infected infant
Cocaine: Infant Findings
Low Birthweight, IUGR, prematurity, fetal distress meconium staining Anomalies of GU and GI Feeding difficulties liability of mood
Cocaine: Management, complications and Prevention
Offer quiet environment with decreased stimuli
Mothers who use cocaine should not breastfeed
Prenatal cocaine exposure has been linked to:
changes in IQ
Neurobehavioral dysfunction
hyperactivity
aggression
short attention span
Heroin and Methadone exposure:
Tremors and hyperirritability Limbs rigid and hyperreflexia Skin abrasions secondary to hyperactivity Tachypnea Poor feeding Diarrhea Vomiting High-pitched cry Fist sucking Low birth weight or SGA
Withdrawl begins 24-48 hours of life, withdrawal from methadone takes longer than with heroin
Heroin and Methadone Management, complications and Prevention
Supportive Management: Swaddling, frequent feedings, protection from external stimuli
increased risk of SIDS
Meds: phenobarbital, tincture of opium and methadone can be used in severe SX
Alcohol: Diagnostic Criteria
4 Digit Diagnostic Code
Growth Deficiency (Pre and postnatal despite adequate nutrition Characteristic facial features: shortened palpebral fissures, thin upper lip, flattened philtrum and flat mid face Evidence of brain dysfunction: microcephaly, structural abnormalities of the neurologic conditions such as seizures, behavioral and cognitive problems
Breast feeding should be avoided for 2-3 hours after consumption of alcohol
Narcotics: Effects on Fetus and Newborn
Fetus: Increased rate of SAB and still births, IUGR
Newborn: High-pitched cry, tremulousness, sleeplessness, difficulty feeding, sweating, nasal stuffiness, sneezing, vomiting, cramping and diarrhea
Onset: 48 hours to 4 days after birth
Long-term effect: Increase risk for learning and behavioral problems
Narcotics: Management and Therapy
Management: Neonatal Abstinence Scoring System
Abstinence Score <8: supportive measurements
Abstinence Score >8: and unresponsive to supportive measures: START phenobarbital
Other meds: tincture of opium, methadone, chlorpromazine. DO NOT paregoric
Breastfeeding ok while on methadone maintenance
Marijuana: Effects on fetus and newborn
Fetus: No clear effect
Newborn: decreased visual responsiveness, increased tremors and startles
Long-term: increased incidence of learning deficits and behavior problems
Marijuana: Managment
Supportive care: swaddling, swinging, frequent feeding and low lights
Breast feeding not contraindicated
Tabacco: Effects on Fetus and newborn
Fetus: Growth restrictions, increased mortality: abruption, placenta previa, prematurity, respiratory distress, SAB
Newborn: Passes through breast milk, but no effects have been described
Long-term: increased risk of SIDS, aggressive type behavioral problems
