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Flashcards in Neonatal case conference, brandau Deck (43):
1

newborn infant not thriving, what is on top of Ddx until proven otherwise

sepsis

2

what hour of membrane rupture raises chance of problems occuring

18 hours or more

3

what is definition for neonatal sepsis

clinical syndrome in neonate characterized by systemic signs of infection with bacteremia in first mo of life

4

how is meningitis related to sepsis

sequela of bacteremia and usually shares common cause and pathogenesis

5

What are the two patterns of disease with neonatal sepsis

early and late onset

6

What is time of onset with early onset sepsis? source? clincal presentation?

0-6 days
mothers genital tract
fulminante, multisystem with pneumonia

7

what is time of onset in late onset sepsis? source? clinical presentation?

7-90 days
mothers genial tract of postnatal environment
slowly progressive or fulminant, focal meningitis frequent

8

what are the gram + organisms assoc with sepsis

group B stresp Ealry and late onset
Staph aureus late onset
coagulase neg staph late onset
listeria monocytogenes

9

what are the gram - organisms assoc with sepsis

E coli (early and late)

10

what are common clincal signs of neonatal bacterial sepsis

fever (hyperthermia)
resp distress
jaundice
hepatomegaly
anorexia
cyanosis
vomiting
lethargy

11

What is gold standard for Dx neonatal sepsis

blood cultures

12

What is most commonly used biomarker for sepsis

CRP c reactive protein

13

If infant is not doing well and CRP comes back normal limits, is sepsis ruled out

pretty much

14

What labs do you want on apneic infant not doing well

cultures, blood, CSFm ABG, CXR, glucose, electrolytes, BUN, creatinine
CRP

15

gentamycin can have negative effects on what systems of a neonate

ears and kidneys

16

CSF shows mononuclear pleocytosis (330)
EEG showed multifocal epileptic potentials consistent with encephalitis
CRP 5 (Normal <10)
what type of process?
intial Tx?

viral
empirical Tx with amoxicillin, gentamicin, acyclovir, loading dose of phenobarbital

17

how can enterovirus neonatal be transmitted

antenatally, intrapartum and post natally
can be transplacentally or ascending infection

18

What are common presenting features of neonatal enterovirus sepsis

fever, irritability, poor feeding, lethargy
nonspecific rash
half have evidence of hepatitis or jaundice

19

How to Tx enterovirus in neonate

IV Ig
dopamine and milrinone started for dec CO and arrhythmias
extracorporeal membrane oxygenation

20

what age group are pediatric patients

<18

21

premature is under what age

<37 weeks

22

a neonate is how old

1 day-1 mo

23

what is gray baby syndrome

chloramphehenicol
antibiotic for severe R infections
cause abdominal distension, vomiting, diarrhea, resp distress, hypotension, progressive shock and gray color

24

What does thalidomide cause

phocomelia
congenital abnormalities, polyneuritis, nerve damage, mentl retardation

25

what does sulfonamide cause in neonates

kernicterous
displaces bilirubin from protein binding sites, bilirubin depisits in crain resulting in encephalopathy

26

what is gastric pH in full term infant at birth

6-8 at birth and drops to 1-3 in 24 hours

27

how is gastric pH affected in premature infants

have immature acid secretion, so pH remains elvated

28

how is gastric emptying changed in premature infants

slowed and prolonged. can increase drug absorption at site

29

how are gestational age and gastric aborsorption related** look up to see if correct

inverese relationship

30

Why is IM drug injection not as effective in neonates

muscle mass, poor perfusion, peripheral vasomotor instability
insufficeint muscle contractions

31

drug absorption in skin relies on what

directly related to degree skin hydration and relative absorptive area
inversely related to thickness of stratum corneum

32

what is total body water in a premature infant and full term vs adult

premature 85%
full term 78%
adult 60%

33

why do you have to use higher doses in infants

have higher total body water and extracell fluid volume

34

why is protein binding decreased in infants

decreased protein concentration, lower binding capacity, decreased affinity for drug binding
competition for certain binding sites by endogenous compounds

35

how long can it take for drug elimination pathways take in infants

1 mo to 1 year

36

what are common baterial pathogens of neonatal sepsis

Group B strep
E coli
listeria

37

what antibiotics can we use in neonates

ampicillin, gentamicin
third generation cephalosporin
Acyclovir

38

how does ampicillin work

inhibits bacterial cell wall synthesis
inhibits PBP, inhibits final transpeptidation of peptidoglycan syntehsis. leads to bacterial cell wall lysis

39

how does acyclovir work

inhibits viral DNA synthesis and viral replication

40

what is the pathophys of viral myocarditis. 3 phases

acute phase- inflammatory cell invasion of myocardium and myocardial necrosis and apoptosis
T cell invasion- most destructive 7-14 days post innoculation
Healing phase- myocardial fibrosis, continued inflammation and persistent viremia may lead to left ventricular dysfunction and dilation

41

How do you Tx acute phase neonatal myocarditis

inotropes
afterload reduction- milrininone
mechanical ventialation
extracorporeal membrane oxygenation
Immune Therapy (IV Ig, Immunosuppressive agents)

42

What IV Ig do you give neonates for sepsis

sterile solution of human Ig 98% gamma, trace IgA and IgM

43

What are indications for Extracorporeal membrane oxygenation ECMO

primary pulm HTN
meconium aspiration syndrome
resp distress syndrome
gorup B strep sepsis
asphyxia
congenital diaphragmatic hernia