Download ACUTE LIFE THREATENING EVENT

I
Injury
Accidental
*Sudden infant death Syndrome
*Deliberate
* Subendocardiac
*Fibroelastosis
*Long QT Syndrome
*Cardiac Anomaly
*Pulmonary Anomaly
*Neurological Anomaly
*
Congental Anomaly
*Gasteroenteritis
Infection
*Sever pneumonia
*Sepsis
FT baby 6days old, producte of home
vaginal delivary with PROM>24hr
,he had fever&vomting,poor sucking
laste 3days.O/E
;Lethargic,febrile(38C)
NN reflex weak
Pathways of ascending or intrapartum infection
Pathogenesis of hematogenous transplacental infections
It is the systemic inflammtory respones
to an infection process.
The most commen cause;
GBS , E-Coli ,L-monocytogenus
Other causes are ;(non-bactrial)
Viral , protozal , fungal
TRANSPLACEN
TAL
PERINATAL
POSTNATAL
CMV
Anerobic bacteria
Adenvirus
HSV
Chlamydia
Candida spp.
Mycobacterium
Tunerculosis
Enteric Bacteria
Coagulase Neg. Staphyloccoci
Rubella virus
GBS
CMV
T. Pallifdum
H. influenzae
Echovirus
VZV
HSV
Enteric bacteria
L. monocytogenes
Influenza virus ,A, B
Mycoplasma
Parainfluenza
Pseudomonas
RSV ,staphylococcus Aureus
Mycobacterium Tuberculosis
Etiologic Agents of Neonatal Pneumonia According to Timing of Acquisition
BACTERIA
EARLY ONSET
LATE ONSET,
MATERNAL ORIGIN
LATE ONSET,
NOSOCOMIAL
LATE ONSET,
COMMUNITY
GRAM POSITIVE
Clostridia
+
+
Enterococci
+
++
Group B streptococcus
+++
+
Listeria monocytogenes
+
+
Other streptococci
++
Staphylococcus aureus
+
+
++
Staphylococcus, coagulase +
negative
+
Streptococcus
pneumoniae
+
Viridans streptococcus
+
+
+
+++
++
++
GRAM NEGATIVE
Bacteroides
+
Campylobacter
+
+
Citrobacter
+
Enterobacter
+
Escherichia coli
+++
Haemophilus influenzae
+
+
Klebsiella
++
+
+
Neisseria gonorrhoeae
+
Neisseria meningitidis
+
+
Proteus
+
Pseudomonas
+
Salmonella
+
Serratia
+
+
OTHERS
Treponema pallidum
+
+
+
characteristic
Early onset
Late onset
Late.Late onset
Age of onset
Birth—7days
(<3days)
7---30 days
>30 days
Uncommon
Varies
Varies
Usual
Maternal-Obest Common
complications
Prematurity
Frequent
Organisum
source
Maternal genital Maternal genital Environment
Tract/Environr
tract
nent
site
Normal,Nursery NICU,Commun NICU,Commun
NICU,Commun ity
ity
ity
Maternal
Intrapartum fever(>38)
PRM(>18hr)
Chorioaminionits
PT labor(<37wk)
Neonatal
Male sex
PT& LBW
Cong—anomalies
Immunity defect
Galactosemia(E-Coli)
General;
Fever.temperature
instability
Poor feeding
GIT;
Diarreh,Vomiting
Abd-distention
Respiratory;
Apnea,RDS
Renal;
oliguria
CNS;
Irritability,lethargy,seizers
High pitch cry,hypotonia,
Full fontanel,
CVS;
Pallor,mottling,HR(
)
hypotention,
Hematology;
Jaundies,
pallor,petechia,purpura
Bleeding
sepsis workup;
*Culture; Blood—CSF—Urine
*CBC; WBC(<5000), ANC<1750, I : T>0,2
*CRP
*G.stain;CSF,Urine;Infected side
*Chest Xry
Once the pathogen has been identified & antibiotic
sensitivities determined, the most appropriate drug or drugs
should be selected.
For most gram-negative enteric bacteria, Ampicillin & an
Aminoglycoside or a 3rd-generation cephalosporin
(cefotaxime or ceftazidime) should be used.
Enterococci should be treated with both a penicillin
(Ampicillin or piperacillin) & an aminoglycoside because the
synergy of both drugs is needed. Ampicillin alone is
adequate for L. monocytogenes,
and penicillin suffices for GBS.
Clindamycin or metronidazole is appropriate for anaerobic
infections
Is determined by pattern of disease and the
organisms that are common for the age of infant&
the flora of the nursery.
Duration of Rx;
meningits(14—21days)
Pneumonia(7—10)
CVS;
CHD.myocaditis,PPHN
GIT;
Necrotizing enterocolitis
spontanousGITperforation
Hematology;
Nnpurpuric fulminans
Sever anemia
Immune mediated
neutropenia&thrombocytopenia
Respiratory;
RDS,lung hypoplasia
TEOF,aspiratin
pneumonia,
Metabolic;
Hypoglysemia
Galactosemia
CNS;
HIE.Infant botulism
ICH
The risk factors for death or for moderate or sever
disability include;
*Duration of seizeres >72hrs
*Coma
*Necessity for the use of inotropic agents
*Lukopenia
Clinical Manifestations of Transplacental Infections
MANIFESTATION
Intrauterine Growth Restriction
PATHOGEN
CMV, Plasmodium, rubella, toxoplasmosis, Treponema pallidum, Trypanosoma cruzi, VZV
Congenital Anatomic Defects
Cataracts
Rubella
Heart defects
Rubella
Hydrocephalus
HSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis
Intracranial calcification
CMV, HIV, toxoplasmosis, T. cruzi
Limb hypoplasia
VZV
Microcephaly
CMV, HSV, rubella, toxoplasmosis
Microphthalmos
CMV, rubella, toxoplasmosis
Neonatal Organ Involvement
Anemia
CMV, parvovirus, Plasmodium, rubella, toxoplasmosis, T. cruzi, T. pallidum
Carditis
Coxsackieviruses, rubella, T. cruzi
Encephalitis
CMV, enteroviruses, HSV, rubella, toxoplasmosis, T. cruzi, T. pallidum
Hepatitis
CMV, enteroviruses, HSV
Hepatosplenomegaly
CMV, enteroviruses, HIV, HSV, Plasmodium, rubella, T. cruzi, T. pallidum
Hydrops
Parvovirus, T. pallidum, toxoplasmosis
Lymphadenopathy
CMV, HIV, rubella, toxoplasmosis, T. pallidum
Osteitis
Rubella, T. pallidum
Petechiae, purpura
CMV, enteroviruses, rubella, T. cruzi
Pneumonitis
CMV, enteroviruses, HSV, measles, rubella, toxoplasmosis, T. pallidum, VZV
Retinitis
Rhinitis
CMV, HSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis, T. pallidum, West Nile
virus
Enteroviruses, T. pallidum
Skin lesions
Entroviruses, HSV, measles, rubella, T. pallidum, VZV
Thrombocytopenia
CMV, enteroviruses, HIV, HSV, rubella, toxoplasmosis, T. pallidum
Pathogen
manifestation
toxoplamosis
Microcephly ,Hydrocephalus,Deafnes,intracranial–
calcification ,hepato-spleenomegaly chorioretinitis
CMV
Microcephaly,periventricular-Ic-c, deafiess,LBW,Petchia
Purpura,hepatosplenomegaly,pneumonitis,chorioretinitis
Rubella
Cataract,heart defect, Hydrocephalus,microceplaly
,hepato-spleenomegaly,Deafnes,purpuriic rash
H.SIMPLEX
Encephalitis, keratoconjunctivitis, chorioretinitis, cataract,
Skin&mucocutaneous vesicles
Aggressive management of suspected maternal
chorioamnionitis with antibiotic therapy during
labor,along with rapid delivaryof the
infant,reduces the risk of early Nnsepsis.
Intrapartum chemoprophylaxsis reduced the
vertical transmission of GBS.
That is unexpected by history and
unexplained by a thorough
postmortem examination ,which
includes a complete
autopsy,investigation of the scene of
death, and review of medical history.
Maternal;
Infant;
Smoking,Drugs
Nutritional deficiency
Decreased age,education
Single marital status
IGR,increas parity
Low socioeconomic
status
Age(2-4mo),PT,Male
Pron sleep position
Growth failure
Recent(febrile) illness
Soft bedding
Objectives;
*Definition
*Risk Factors ;
Mternal &neonatal
l
*Diagnosis
*Treatment
*Prognosis
*Prevention
*DD
* Types & clinical
manifestation