Diseases in the newborn child

Question 1

How common is it for a child to become jaundiced within the first week of life?

Answer 1

50-60 % of children become jaundiced within the first week of life.

Question 2

What is kernicterus?

Answer 2

Kernicterus is a bilirubin-induced brain dysfunction. Unconjugated bilirubin crosses the blood-/brain
barrier and acts neurotoxic (mainly in the basal ganglia).

Question 3

What should be suspected if jaundice within first day of life or there is rapidly increasing bilirubin levels?

Answer 3

Suspect hemolysis due to immunization.

Question 4

True or false: ABO-immunization is common in pregnancies, but rarely cause any prenantal symptoms.

Answer 4

True. It occurs 15-20% of pregnancies, but rarely causes prenatal symptoms.

Question 5

What are fetal consequences of serious Rh-immunization?

Answer 5

Erythroblastosis foetalis: Serious anemia → heart failure in the fetus.

Hepatoslenomegaly: Extramedullary hematopoiesis. Liver failure lead to low albumin.

Hydrops foetalis: Heart failure and low albumin leads to edema. Ascites, pericardial effusion, pleural effusion, subcutanous edema.

Question 6

What are the causes of physiologic jaundice?

Answer 6

Degradation of fetal hemoglobin.
Immature liver (low activity of conjugating enzymes).

Question 7

When does physiologic jaundice usually disappear?

Answer 7

In 4-7 days.

Question 8

What is the treatment for breastfeeding jaundice?

Answer 8

Breastfeeding jaundice is a benign condition and resolves itself within 12 weeks of life. (Photo-therapy is indicated in cases of “not enough breastfeeding” jaundice.)

Question 9

In what ways can pathological jaundice in newborn be treated?

Answer 9

Oral hydration – breast milk.
Phototherapy.
Immunoglobuline.
Exchange transfusion.

Question 10

What are indications for exchange transfusion as treatment against jaundice in newborns? Is this type of therapy common?

Answer 10

Indications include serious anemia and hydrops fetalis - like in Rh-immunization.
It is seldom used as therapy in Norway (about 9-10 cases per year need exchange transfusion).

Question 11

Besides exchange transfusion, what treatment is used when managing antibody mediated jaundice in newborns?

Answer 11

Intravenous immunoglobulin.

Question 12

What are causes of conjugated jaundice > 2 weeks in newborns?

Answer 12

Conjugated jaundice: Bile duct atresia. Neonatal hepatitis. Prolonged total parenteral nutrition.

Question 13

What are the main types of newborn infections based on when and how it is acquired?

Answer 13

Transplacental infections.
Ascending infection.
Intrapartum infections.
Postnatal infections.

Question 14

What is a congenital infection?

Answer 14

Maternal infection with transplacental hematogen transmission in utero.

Question 15

When should a congenital infection be suspected?

Answer 15

Fetal growth restriction (FGR)
Enlarged liver and spleen
CNS symptoms/signs
Microcephaly, hydrocephalus, intracerebral calcifications, cataract, chorioretinitis, deafness
Trombocytopenia and anemia
Skin hemorrhages
Jaundice/neonatal hepatitis (conjugated)

Question 16

What are some viral agents that may cause congenital infections?

Answer 16

Rubella
Cytomegalovirus
Parvovirus
Varicella
Herpes
Enterovirus
Hepatitis B and C
(Syphilis is caused by a bacterial agent and toxoplasmosis by a parasite, but may cause congenital infections.)

Question 17

What are risk factors of congenital herpes?

Answer 17

Premature rupture of membranes, prematurity and traumatic lesions.

Question 18

True or false: Neonatal herpes simplex is a common disease in Norway.

Answer 18

False. Incidence of 1-3 per year.

Question 19

What is characteristic of neonatal herpes infection skin-eye-mouth disease?

Answer 19

Vesicles in skin, mouth and/or conjunctiva.
Age of onset 5-11 days.
All cases have vesicles at onset of disease.
The mortality and disability are 0 %.

Question 20

What is characteristic of congenital herpes infection?

Answer 20

Vesicles. Scarring of skin. Brain damage. Microcephaly.

Disability is 100 %, mortality is unknown.

Question 21

How is neonatal herpes infection diagnosed and treated?

Answer 21

Diagnosis: PCR from vesicles or spinal fluid. Serology.

Treatment: At first intravenous acyclovir, followed by 6 months of treatment with oral acyclovir to reduce the risk of recurrence.

Question 22

Are congenital CMV infection most commonly symptomatic or asymptomatic?

Answer 22

Asymptomatic infections are most common - but may cause deafness.

Question 23

What is the most important non-genetic cause of deafness?

Answer 23

Congenital CMV infections in newborn children.

Question 24

How are CMV infections in newborn children diagnosed?

Answer 24

PCR based on saliva, urine or blood.
Serology of maternal blood.
Liver and hematological blood tests.
Eye examination. 
Ultrasound or MRI.
Auditory test.
Lumbar puncture can by considered.

Question 25

How common is it that a maternal HBV infection is transmitted vertically to her child? How high percentage of HBV infected newborns become chronic carrier (without intervention)?

Answer 25

If mother is HBsAg and HBcAg positive at least 70-90% of the children will be infected perinatally. 90 % become chronic carriers.

Question 26

What are symptoms of toxoplasmosis in newborns?

Answer 26

``` Most cases (90 %) are asymptomatic. The most common symptoms are chorioretinitis, hydrocephalus and intracranial calcifications. Other symptoms and findings include growth retardation, microcephalia, seizures, feeding difficulties and hypotermia. ```

Question 27

What are the most common agents in early onset neonatal sepsis? What antibiotics are used to treat early onset neonatal sepsis?

Answer 27

Group B streptococci. E. coli and other gram negative bacteria. Antibiotics: Penicillin G + gentamicin (aminoglycoside).

Question 28

What are the most common agents in late onset neonatal sepsis? What antibiotics are used to treat late onset neonatal sepsis?

Answer 28

Hospital acquired infections: Mainly S. aureus and S. epidermidis. Gram negative bacteria. (Late onset) group B streptococci. Abtibiotics: Cefolatin + Aminoglycoside. Cefotaxim (kidney failure) + Vancomycin (against S. epidermidis).

Question 29

What are risk factors of neonatal sepsis?

Answer 29

``` Premature rupture of membranes. Prematurity. Maternal fever, such as in chorioamniotitis. Total parenteral nutrition. "Long lines." ```

Question 30

True or false: Fever in neonatal sepsis is an uncommon symptom.

Answer 30

True.

Question 31

True or false: Because an early onset neonatal sepsis with group B streptococci often is dramatic, a screening program is used to detect those in risk of infection is used in Norway.

Answer 31

False. There is no consensus about screening, although GBS sepsis of early onset often i dramatic.

Question 32

What are the differences between transient tachypnea and wet lung in newborn children?

Answer 32

They are probably the same condition, however ... Chest X-ray shows interlobar fluid in wet lung, but is normal in transient tachypnea. Transient tachypnea is usually brief, whereas wet lung slowly resolves itself (could take hours to days).

Question 33

How is meconium aspiration syndrome treated?

Answer 33

Oxygen CPAP/ventilator Surfactant Treat Persistent Pulmonary Hypertension in the Neonate (PPHN) and other complications.

Question 34

What are causes of pulmonary hypoplasia?

Answer 34

Primary causes. Reduced amniotic fluid: Kidney agenesis, kidney dysplasia, polycystic kidney disease. or premature rupture of membranes. Space occupying process in chest: E.g. diaphragmatic hernia.

Question 35

What are common

Answer 35

Immaturity Respiratory: RDS, Broncopulmonary dysplasia (BPD)/Chronic lung disease (CLD) Intraventricular hemorrhage Periventricular leukomalacia (PVL) Infections: Staphylococci epidermidis, candida Gastrointestinal: Necrotizing enterocolitis (NEC) Retinopathi of prematurity (ROP)

Question 36

How is respiratory distress syndrome?

Answer 36

Prophylaxis: Prenatal steroids. Treatment: Surfactant. Gentle ventilation. Ventilator/CPAP/High flow. (Spontanous improvement.)

Question 37

What are problems with the diagnostic criteria for bronchopulmonary dyplasia (BPD)?

Answer 37

Need of oxygen and gestational age as part of diagnostic criteria.

Question 38

What are consequences of grade 4 intraventricular hemorrhage?

Answer 38

Mortality is 50 %. | 60-100 % develop cerebral palsy.

Question 39

What are causes of periventricular leukomalacia?

Answer 39

The causes are unclear, but might include hypoxemia (and ischemia), hypotension and hypocapnia, as well as pre- and perinatal infection/inflammation.

Question 40

What is the prognosis of periventricular leukomalacia?

Answer 40

Cystic PVL is strongly associated with development of cerebral palsy. Diffuse PVL is associated with cognitive and behavioral problems.