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Download Maternal/Fetal/Neonatal Interactions III
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A healthy neonate was born to a GBS + mother that was given Amp only 3 hours prior to delivery. Since you know that was not effective treatment, you decide to do a CBC with diff just to be on the safe side. The WBC, Hct, and diff were all PERFECT, but the platelets were only 55,000. You wisely decide to examine the maternal labs and find that the mother also has thrombocytopenia. When you ask the mom about her thrombocytopenia she responds, “Oh, that’s because I have …” Immune Thrombocytopenic Purpura • Neonatal autoimmune thrombocytopenia is due to maternal antiplatelet antibodies crossing the placenta. • The infant is at increased risk for intracranial (1%) or visceral hemorrhage with platelet counts less than 50,000. • Steroids and/or IVIG are used only when there is active bleeding or a very low platelet count. Platelet transfusions are not helpful! • The neonatal thrombocytopenia will resolve once there are no more maternal antibodies in the fetal circulation. A neonate born to a mother with uncontrolled hypertension (chronic or pregnancy induced) is at risk for … Maternal Hypertension • Intrauterine Growth Restriction (IUGR) – Damage to the placenta’s blood vessels causes a decrease in placental O2 and nutrient exchange • Oligohydramnios – Hypotension in the fetus causes decreased kidney blood flow and therefore decreased urine output Drug and Effects • It’s Quiz Time! • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Respiratory depression • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Ebstein’s anomaly • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Phocomelia • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Anuria Hypoplasia of the skull Hypotension • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Microcephaly Microphthalmia Hypoplastic ears Truncus arteriosis Absent thymus Developmental delay • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Neural Tube Defects • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Placental abruption IUGR • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Depressed nasal bridge Hypoplastic distal phylanges Stippled epiphyses Hemorrhage • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Flat philtrum Thin upper lip Midface hypolasia Short palpebral fissures Growth delay Developmental delay • Lithium • Cocaine • Alcohol • Warfarin • Thalidomide • ACE Inhibitors • Valproic Acid • Isotretinoin • Magnesium Sulfate • Tobacco Withdrawals What screening test do you do if you suspect withdrawal in a newborn due to hyperactivity and irritability? Urine Toxicology within 24 hours Meconium Toxicology Withdrawals Neonatal Abstinence Syndromes are the postnatal withdrawal effects in an infant after in utero chronic drug exposure Different drugs have different (but very similar) withdrawal symptoms! Withdrawals Hyperactivity, irritability, and hypoglycemia Alcohol withdrawal Withdrawals Hyperactivity, irritability, hyperphagia, and poor suck/swallow coordination Barbiturate Withdrawal Withdrawals Irritability, tremors, jitteriness, hypertonia, loose stools, and emesis (with or without seizures) Opioid Withrawal What treatment would you use if indicated? Swaddling, pacifier, minimal stimulation, etc. Methadone, Morphine, “Tincture of Opium”, or Phenobarbitol Do NOT use Narcan with chronic maternal narcotic use or you will induce rapid Withdrawals What about cocaine? No known abstinence syndrome exists Do not treat cocaine “withdrawal”. Do consider maternal use of multiple drugs if the newborn shows signs of withdrawal in a cocaine + mom.
