Ch 35 Acquired Newborn Issues Flashcards by Diana Hallis

What is TORCH syndrome?

Any group of infections in newborns due to one of the TORCH infectious agents having crossed the placenta during pregnancy

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What does the TORCH acronym stand for?

T - toxoplasmosis
O - other agents
R - rubella
C - cytomegalovirus 
H - herpes simplex

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What is another name for rubella?

German measles

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What is the etiology of toxoplasmosis?

Toxoplasma gondii

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Most healthy people who contract toxoplasmosis have what symptoms?

Are asymptomatic OR have flu like symptoms such as malaise, fever, headache, muscle pain, lymphadenopathy

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What percent of the world’s population is infected with toxoplasma gondii?

About 1/3 but it often goes unrecognized

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What are the consequences of toxoplasma gondii crossing the placenta and infecting the fetus?

Hydrocephalus
Microcephaly
Intracranial calcifications
Retinochoroiditis
Strabismus
Blindness
Epilepsy
Psychomotor and mental retardation
Petechiae

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What causes the petechiae in baby’s born with toxoplasma gondii infection?

Thrombocytopenia and anemia

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What infections are included in the “other” part of TORCH

Neonatal syphilis and parvovirus b19

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What are complications of neonatal syphilis?

Miscarriage
Stillbirth
Prematurity
Low birth weight
or death shortly after birth

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What can syphilis cause in the living newborn?

Deformed bones
Severe anemia
Enlarged liver and spleen
Jaundice
Blindness/deafness
Meningitis
Skin rashes

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What are major diseases caused by parvovirus b19 in the fetus?

Hydrops fetalis

Congenital anemia

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What are major diseases caused by parvovirus b19 in normal children?

Fifth disease

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What are major diseases caused by parvovirus b19 in normal adults?

Arthropathy

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What are major diseases caused by parvovirus b19 in patients with increased erythropoiesis?

Transient aplastic crisis

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What are major diseases caused by parvovirus b19 in immunocompromised patients?

Persisten anemia

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About 50% of pregnant women are immune to…

Parvovirus b19

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What is fifth disease?

A mild rash caused by Parvo b19

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What is a rare complication of a pregnant mother becoming infected with Parvo b19?

Baby may severe anemia and mother will have a miscarriage

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A miscarriage resulting from Parvo b19 most commonly happens during what trimester?

1st

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When does congenital rubella syndrome usually occur?

During the first 3 months of pregnancy

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What are symptoms of congenital rubella syndrome?

Cloudy/white appearance to eyes (cataracts)
Deafness
Heart defects
Developmental delay

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What is the treatment for congenital rubella sydrome?

There is none. Therapy focuses on addressing complications

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Babies with congenital CMV that have signs at birth include:

Rash
Jaundice
Microcephaly
Low birth weight
Heptasplenomegaly
Seizures
Retinitis

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In the most severe cases of congenital CMV...

Cause death of unborn baby / pregnancy loss

Symptoms of congenital CMV can occur...

later during infancy or childhood

What are the long term health problems associated with congenital CMV?

``` Deafness Developmental and motor delay Vision loss Microcephaly Seizures ```

Which woman are at greater risk for contracting CMV?

Those with frequent contact with young children

How can women in frequent contact with young children reduce their risk?

Reducing contact with SALIVA and urine from babies and young children

Most neonatal herpes infections occur...

As a result of asymptomatic cervical shedding of virus after a primary episode in the third trimester

When should a c section be performed in a patient with HSV?

If active infection at time of delivery

What is congenital herpes associated with?

Preterm labor and low birth weight infants

When should HSV infection be suspected in a newborn?

A newborn with irritability, lethargy, fever, or poor feeding at one week of age

How is congenital herpes diagnosed?

``` Cultures of: Blood Cerebrospinal fluid Urine and fluid from eyes Nose and mucus membranes ```

How is HSV infection in newborns treated?

Parenteral acyclovir

What are the 3 subtypes of HSV infections in newborns?

1) eye, skin or mouth 2) encephalitis without skin/eye 3) disseminated infection that involves multiple sites

What are the locations of HSV infection that the third type can be found?

``` CNS Lung Liver Adrenal glands Eyes Mouth ```

What syndromes can toxoplasma gondii cause in the neonate?

Hydrocephalus diffuse intracranial calcification Choriorenitis

What syndromes can the rubella virus cause in neonates?

blueberry muffin skin | interstitial pneumonitis

How long does it take for sepsis to manifest after infection acquired perinatally?

24-72 hrs

What is the neonatal mortality rate of sepsis?

2-40%

What are the most common pathogens that cause neonatal sepsis?

``` GBS Haemophilus influenza Listeria monocytogenes E Coli Strep pneumoniae ```

What is late onset sepsis?

Occurs in the first 7-30 days of life as a consequence of infection acquire postnatally

Late onset sepsis may include what routes on infection?

Vertically transmitted infection or acquired infection

What are the most common pathogens responsible for late onset sepsis?

Staph, klebsiella, enterococci, e coli, pseudomonas, and yeast

What are early clinical signs of sepsis?

``` Lethargy Poor feeding Poor weight gain Irritability A change from previous assessments ```

What are respiratory signs of sepsis?

``` Apnea Bradycardia Tachypnea grunting nasal flaring retractions decreased o2 sat acidosis ```

What are cardiovascular signs of sepsis?

``` Decreased CO tachycardia bradypnea arrhythmia hypotension decreased perfusion ```

What are CNS signs of sepsis?

``` Temperature instability Hypothermia Fever Lethargy Hypotonia Irritability Seizures Bulging fontanels high pitch or abnormal cry ```

What are GI signs of sepsis?

``` Feeding intolerance Abdominal distention Vomiting Diarrhea Hypoactive bowel sounds ```

What are skin signs of sepsis?

Jaundice Pallor Petechiae

What are metabolic signs of sepsis?

Hypoglycemia, hyperglycemia, metabolic acidosis

What are hematologic signs of sepsis?

Thrombocytopenia | Neutropenia

What is erythroblastosis fetalis?

Condition cause by specific antibodies of the mother, directed against red cell antigens of the fetus.

What is another name for erythroblastosis fetalis?

hemolytic disease of the newborn

What is another name of hemolytic disease of the newborn?

erythroblastosis fetalis

What type of antigens are responsible for erythroblastosis fetalis?

RhD antigens

What is hydrops fetalis?

abnormal amounts of fluid build up in tow or more body areas of a fetus or newborn

What are the two types hydrops fetalis?

Immune and non immune

What is immune hydrops fetalis caused by?

Hemolytic disease of the newborn

What is non-immune hydrops fetalis caused by?

TORCH, heart or lung problems, thalassemia, genetic defects such as Turner's syndrome

Which type of hydrops fetalis is worse?

Non immune hydrops fetalis, frequently fatal

What is thalassemia?

Inherited blood disorder that causes your body to have less hemoglobin than normal

A baby with hydro fetalis may have abdominal distention due to...

a swollen liver

What does the indirect Coombs test measure?

The number of antibodies in the MATERNAL blood

What is done if a RH- mother is not iso-immunized?

Repeat antibody screen is done around 28 weeks and patient is give rhogam

What is another name for rhogam?

anti-Rh gamma globulin

what is another name for anti-Rh gamma globulin?

Rhogam

What abnormal antigens does the indirect Coombs test the mother's blood for?

Rh, Kell, Duffy, etc

Fetal tests for hydrops fetalis includes...

Percutaneous umbilical cord blood sampling (PUBS), | amniocentisis, amniotic fluid analysis, ultrasound

What does PUBS stand for?

percutaneous umbilical blood sampling

What is another name of PUBS?

cordocentesis

What should be done first in erythroblasis fetalis?

Ultrasound ASAP in frist trimester to determine gestational age

After the initial ultrasound, what is next for erythroblasis fetalis?

serial ultrasounds and amniotic fluid analysis to monitor fetal progress

What are indications that a complication is occurring in erythroblasts fatalis?

High levels of bilirubin in the amniotic fluid or baby's blood OR if ultrasound reveals hydrops fetalis

In erythroblasis fatalis, if bilirubin levels remain normal that pregnancy can...

Be followed to term and spontaneous labor.

What happens if the amniotic fluid reveals high bilirubin levels? (in erythroblastis fetalis)

Fetal transfusions at 10-day to 2-week intervals up until 32-34 weeks. Then the fetus must be delivered.

What do high bilirubin levels mean in a patient with erythroblastis fetalis?

Impending intrauterine death

What is the treatment for erythroblastis fetalis?

Exchange infusion

What does an exchange infusion do?

Removes bilirubin Removes anitbodies Removes sensitized cells which are liable to be hemolyses Increase RBCs and reduce anemia

Type O- blood will not trigger an immune response except in the case of...

Rh disease

What type of blood is used for fetal blood transfusion until the baby is born?

O-

ABO incompatibility is more severe in ...

African American infants

Which is more severe, ABO hemolytic disease or Rh hemolytic disease of the newborn?

Rh hemolytic disease of the newborn

Why is ABO incompatibility less serious?

Fewer antibodies cross the placenta in ABO versus Rh | Fewer ABO antibodies than Rh antigens

Ch 35 Acquired Newborn Issues Flashcards

(85 cards)