Download 2010 4 13_Back to basics neonatology for 4th yr MS_Part 4 2010

Postmaturity
 Labour
tends to be induced to avoid
problems of postmaturity, however if
dates not accurate may still occur
 Possible



complications
Growth disturbances
Asphyxia
Meconium aspiration syndrome
Problems of the Term
Newborn
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




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
Respiratory
Cardiac
Sepsis
Digestive
Jaundice
Anemia, polycythemia, hemorrhage
Renal
Endocrine
Neurologic
Respiratory Distress in the
Newborn
 Respiratory
 Cardiac
 Infectious
 Neurologic
 Metabolic
 Gastrointestinal
 Hematological
 Musculoskeletal
Respiratory Problems in the
Term Newborn
 Transient
tachypnea of the newborn
 Pneumonia
 Meconium
aspiration
 Pulmonary air leaks
 Congenital malformations
 Persistent pulmonary hypertension
 Pulmonary hemorrhage
Transient Tachypnea of the
Newborn
 Failure
to clear lung fluid
 Associated with:



Absent labour (planned C/S or C/S without
labour) or;
Short labour or;
Initial weak or absent respirations
 Improves
with time
Pneumonia
 Can
initially be difficult to distinguish
from TTN/RDS
 Group
B Strep #1
 Consolidation
days
may appear after a few
Meconium Aspiration
Syndrome
 Meconium-stained
amniotic fluid
 Intrauterine insult may lead to gasping
 Meconium aspirated
 Pneumonitis
 Airway occlusion
 Pulmonary air leak syndrome
 May lead to persistent pulmonary
hypertension
Congenital Malformations
 Anomalies


anywhere along airways:
Nose to alveoli
Extrinsic or intrinsic
 Atresias
 Cysts
 Diaphragmatic
hernia
Persistent Pulmonary
Hypertension
Associated with:
 Asphyxia
 Meconium aspiration
 Sepsis
 Right to left shunting through PDA (i.e.
persistent fetal circulation)
 Treatment:
 Oxygenation, ventilation
 Maintain blood pressure
 Pulmonary vasodilators

Congenital Heart Disease:
Presentations

Cyanosis

Congestive heart failure

Murmurs

Dysrhytmias
Sepsis: Risk factors
 Preterm

rupture of membranes
e.g. weeks
 Prolonged

rupture of membranes
>18 hours
 Maternal
group B strep carriage
 Maternal GBS bacteriuria
 Previous infant with GBS infection
 Chorioamnionitis
Neonatal Sepsis


THINK OF IT!
 Signs may be subtle, non-specific
 Incidence bacterial sepsis = 1-5/1000 live births
 Commonest organisms:
• Group B streptococcus
• Gram negatives (E coli, Klebsiella)
• Enterococcus, H flu, staph species
• Listeria
Work up and treat if suspect sepsis
 Use broad spectrum antibiotics
Ophthalmia neonatorum


1st days - differentiate chemical vs infected
2nd-3rd wk - viral or bacterial

Gonococcal:
 within 5 days of birth
 gram negative intracellular diplococci
 if suspect, Penicillin asap
 highly contagious

Chlamydia:
 5-14 days
 conjunctival scraping
 topical antibiotics
Congenital Infections

CMV:
 5-25/1,000 live births
 Asymptomatic vs severe symptoms
 Microcephaly, thrombocytopenia,
hepatosplenomegaly, chorioretinitis
 Sequelae of hearing loss and developmental delay

Rubella
 0.5/1,000
 Cataracts, rash, congenital heart disease,
developmental delay
Congenital Infections

Toxoplasmosis:
 0.5-1.0/1,000
 Hydrocephalus, cranial calcifications,
chorioretinitis

Syphilis:
 0.1/1,000
 Snuffles, osteochondritis/periostitis, rash

Herpes Simplex Virus:
 Vesicles, keratoconjuntivitis, CNS findings
 ‘Viral’ sepsis
Congenital syphilis
 Treat
mother no matter what stage of
pregnancy
 If
adequate maternal treatment and no
signs of infection in newborn, give one
dose IM penicillin
 If
inadequate maternal treatment, give
10 days of IV penicillin
Neonatal herpes simplex
 Only
about 1/3 mothers have overt signs
 Infection
 Usually
 If


can be disseminated or local
present at 5-10 days of age
suspect:
Cultures, PCR
Treat with Acylovir
Maternal hepatitis B carrier
 Give
baby hepatitis vaccine as soon as
possible after birth (first 12 hours)
 Bath
 Universal
 Immune
precautions
globulin in first 7 days
 Virus
HIV
can be transmitted
transplacentally, intrapartum, or
postpartum
 Screen mothers
 Treat mothers with antiretrovirals
 Treat babies with AZT for 6 wks
 Universal precautions
 Look for other infections (HepB/C)
 No breastfeeding in developed world