Introduction to Newborn Care/Congenital infections

Question 1

• All mothers have a blood type and antibody screen in pregnancy
• only type O mothers have IgG antibody which crosses sthe placenta
• this can lead to Incompatibility between mother and newborn
• Present in 12% of all pregnancies but evidence of fetal sensitization (positive direct coombs) occurs in only 3-4%

Answer 1

ABO incompatibility

Question 2

what should be focsed on during neonatal resusitation?

Answer 2

• warm, dry, stimulate
• provide positive pressure ventilation
• more extensive resusitation as needed

Question 3

what does the apgar score rate?

Answer 3

• respiration, crying
• reflexes, irritability
• pulse, heart rate
• skin color of body and extremities
• muscle tone

Question 4

• Estimate gestational age of the baby based on neuromuscluar and physical exam characteristics on exam
• use with estimates of gestational age based on LMP and prenatal ultrasound
• helpful when there is no prenatal care

Answer 4

Ballard Score

Question 5

what is analzyed during the growth assessment?

Answer 5

• Length
• head circumference
• weight

Question 6

what eye prophylaxis is given to prevent neonatal conjunctivitis

Answer 6

0.5% erythromycin ointment within 1 hour of birth

Question 7

Classic onset

• bleeding between 2 days- 1 wk in GI tract, skin, nose, umbilical stump, circ site

Late onset

• Bleeding in infants 2 wks-6months
• catastrophic brain and gut
• decreased incidence with Vitamin K but not 0 (can be seen in newborns with malabsorption syndromes)

Answer 7

Vitamin K deficiency bleeding

Question 8

• Identifies asymptomatic congenital diseases that have improved outcomes with treatment
• blood collected on all newborns between 24-48 hrs of life
• 50 disorders are included on the NBS (state specific)

Answer 8

Neonatal Blood Screen

Question 9

• 1-3:1000 congenital hearing loss
• diagnose before 3 months
• provide services before 6 months

Answer 9

Hearing screen

Question 10

• pulse oximetry in right hand and either foot
• pre and post ductal differential
• any newborn with SpO2 < 95% or > 3% difference between pre and post ductal sat= positive screen
• cyanotic blind spot

Answer 10

CCHD screen

Question 11

• incidence is high: 0.5% to 2.5% of fetuses and newborn infants (significant number asymptomatic)
• clincial features in common but can be distinguished by history and physical findings

Answer 11

congential infections

Question 12

with congenital infections TORCH should be considered. What does it stand for?

Answer 12

• Toxoplasmosis
• other (HIV, enterovirus, parvovirus, varicella, hepatitis, syphilis, zika)
• Rubella
• Cytomegalovirus
• Herpes simplex

Question 13

• Parasitic infection
• infection primarily acquired through eating raw or undercooked meat or exposure to cat stools
• infected women generally asymptomatic
• first trimester fetal infection more severe
• third trimester fetal infection more common

Answer 13

Toxoplasmosis

Question 14

what would an infection with toxoplasmosis look like?

Answer 14

many infants asymptomatic at birth but begin to show symptoms over time

• Classic triad: Chorioenteritis, intracranial calcifications, hydrocephalus
• Other signs: jaundice with HSM, fever, rash, petechiae, lymphadenopathy, pneumonitis, vomiting diarrhea, microcephaly
• visual impairment, mental retardation, deafness

Question 15

how do you diagnose and treat toxoplasmosis?

Answer 15

dx: toxoplasma-specific IgM
tx: treat pregnant women and symptomatic and asymptomatic infants- sulfadiazine and pyrimethamine (anti-malarial drug)

Question 16

• due to bacterium treponema pallidum
• transmisson through transplacental infection of fetus
• direct contact with lesions during or after delivery can also transmit spriochete
• transplacental infection can occur throughout pregnany at any stage of maternal infection

Answer 16

syphilis

Question 17

clinical symptoms of early congenital syphilis

Answer 17

• intrauterine infection can cause stillbirth, hydrops or preterm birth
• many asymptomatic at birth
• rash: vesicular or bullous on face, diaper area, dark red copper spots on palms and soles
• snuffles, and fissures in the lips
• jaundice with HSM
• Untreated infants, including those who are asymptomatic can develop late manifestations after 2 years

Question 18

who should be evaluated in terms of syphilis?

Answer 18

evaluate infants and mothers with + treponemal test and:

• untreated or inadequately treated syphilis
• syphilis during pregnancy not treated with PCN
• failure of antibody titers to decrease after treatment
• syphilis treated < 1 month prior to delivery

Question 19

• Transmission occurs from exposure to maternal blood during labor and delivery
• transmission is as high as 90% in those exposed at birth without vaccination
• more than 90% of infants who are infected perinataly will develop chronic infection
• may have symptomatic infection with jaundice, lethargy, failure to thrive, abdominal distension and clay colored stools

Answer 19

Hep B infection

Question 20

• risk of perinatal transmission 5-6%
• spontaneous viral clearance is possible, 20% will clear virus by 2 years of age
• most children with chronic infection are asymptomatic, although liver failure is possible
• Breastfeeding is still possible, antibody testing at 18months will identify children with infection

Answer 20

Hepatitis C

Question 21

• all pregnant women should be on antiretroviral drug regimens
• timing of vertical transmission is uncertain
• can be transmitted through breastfeeding
• if the status is unknown birth parent should have the rapid test done during labor and delivery
• can be transmitted through breastfeeding
• prenatal and intrapartum zidovudine (AZT) reduces the rate of transmission

Answer 21

HIV

Question 22

• IUGR
• scarring skin lesions, dermatomal distribution
• limb hypoplasia
• ocular deficits: chorioretinitis, cataracts
• CNS: seizures, mental retardation, microcephaly
• mortality after birht 30% without VZIG
• mother and infant should be isolated until mother’s vesicles have dried
• pumped breast milk can be fed to infant as long as mother has no active lesions

Answer 22

congenital varicella syndrome

Question 23

• extremely rare in US
• all pregnant women screened for susceptibility
• infection in first 20 weeks of pregnancy lead to structural fetal defects
• infection in third trimester not associated with increased risk of fetal defects

Answer 23

Rubella

Question 24

how does congenital rubella present?

Answer 24

• can result in miscarriage or fetal date or CRS

classic congenital rubella syndrome (CRS)

• CHD (PDA or branch pulmonary stenosis), myocarditis
• eye defects: cataracts, glaucoma, microphtalmia
• auditory: SNHL
• neurologic: microcephaly, encephalitis, developmental disabilities
• IUGR
• jaundice with HSM
• skin: thrombocytopenic purpura, blueberry muffin rash
• language delay, strabismus, deafness, neonatal hepatitis

classic triad: cataract, cardiac abnormalities, deafness

Question 25

* most common congenital infection * only 10% are symptomatic at birth * primary maternal or reactivation of latent infection can result- but symptomatic is more likely with primary maternal infection * PCR from amniotic fluid is the most sensitive test for fetal infection * transplacental passage of the virus, contact with secretions at the time of birth, ingestion of infected breast milk or tranfusion

Answer 25

CMV

Question 26

Symptoms of CMV

Answer 26

* IUGR/SGA * Jaundice (direct hyperbilirubinemia) with HSM * thromobcytopenia (petechiae, purpura) * hearing loss (40% won't be detected within first month) * developmental delays (epilepsy, CP, visual impairment, can occur in later infancy and early childhood) * **asymptomatic infection- most with CMV will not have symptoms and no long-term sequelae** * microcephaly | **blueberry muffin rash just like rubella**

Question 27

diagnosis and treatment of CMV

Answer 27

diagnosis * salivary CMV PCR with confirmatory urine * test for congenital infection in first 3 weeks of life. Later testing may identify acquired CMV infection Congenital CMV treatment * must start within the first month of life * oral valgancyclovir for 6 months * for life threatening- IV ganciclovir is used

Question 28

* Transmission can occur in utero (5%), perinatally (85%) or postnatally (10%) * most newborns are delivered to women who have asymptomatic or unrecognized infections * contact with infected lower genital tract at time of delivery * ascending infection to the fetus even when membranes are apparently intact * post-natal infection * can be from type I or II but mostly from two

Answer 28

herpes simplex virus

Question 29

* most devastating form of HSV infection * presents like sepsis, involves multiple organs including CNS-especially liver and lungs, respiratory and hepatic failure, DIC

Answer 29

Disseminated Disease

Question 30

* Encephalitis: seizuers, lethargy, temperature instability * mortality 15%, morbidity 40-80%

Answer 30

CNS disease with or without SEM

Question 31

* Herpetic lesions on skin, eye or mucous membrane * must have LP to exclude CNS involvement * 2/3rds with disseminated or CNS disease have skin lesions, may not be present at the time of onset of symptoms

Answer 31

Skin, Eye and Mucous Membrane (SEM) disease

Question 32

* infection during pregnancy can lead to fetal death * half of pregnant women are immune to * fetal loss occurs in < 10% of non-immune women who become infected during 1st half of pregnancy * if infected before 20 weeks- fetal loss (11%) * if infected after 20 weeks- fetal loss < 1% * there are reports of third trimester maternal infection leading to hydrops fetalis and fetal death

Answer 32

Parvovirus 19

Question 33

most frequent newborn rash 1. small erythematous macules or papules--> pustules on erythematous bases 3-5 days after birth. does not involve the palms or soles- individual lesions may spontaneously disappear 2. self-limted. usually resolves spntaneously in 1-2 weeks

Answer 33

erythema toxicum