Week 13 Conditions Affecting the Newborn

Question 1

How do you diagnose Chlamydia in newborn?

Answer 1

NAAT
Nasopharyngeal & conjunctival swab

Question 2

Chlamydia PNA

Onset of symptoms

What is CXR like

how to diagnose

Answer 2

Onset: 2 to 4 months

CXR: Hyperinflation w/bilateral/symmetric interstitial infiltrates

Diagnosis: CXR, Respiratory secretion culture & symptoms

Question 3

How do you treat Chlamydia conjunctivitis & PNA?

Answer 3

Erythromycin 50 mg/kg/day PO in 4 doses over 14 days

Question 4

What is the risk of Erythromycin in infants?

What are you monitoring for?

Answer 4

<6 weeks = risk hypertrophic pyloric stenosis

Monitor:

• Tx failure
• Gonorrhea

Question 5

What is the treatment for Gonorrhea?

Answer 5

Erythromycin ointment

or

Tetracycline ointment

Question 6

Gonorrhea

Symptoms

Onset

Diagnosis

Treatment

Answer 6

S/S: Purulent, profuse & swelling eyelids

Onset: Faster and harder than CT, 2 to 5 days after birth

Diagnosis: Culture & Gram stain

Treatment: Ceftriaxone IV/IM & isolate

Question 7

What are major factors for neonatal sepsis?

How many major factors to be considered high risk for sepsis?

Answer 7

• Ruptured membranes >24 hours
• Maternal fever >100.4
• Chorionamnionitis
• Sustained fetal HR >160
• Multiple obstetric procedures

***only 1 major risk factor**

Question 8

What are the minor risk factors for neonatal sepsis?

How many minor factors to be considered high risk?

Answer 8

• Ruptured membrane >12 hours
• Foul smelling liquour
• Maternal fever >99.5
• Low APGAR <5 at 1 min & <7 at 5 mins
• Prematurity
• Multiple gestations

***2 minor risk factors to be considered high risk

Question 9

The baby has a score >10 on the newborn scale of sepsis. What does this mean?

Answer 9

“sick baby” and need further diagnostic eval

Question 10

What is the gold standard to rule out sepsis in an infant?

Answer 10

Blood, urine & CSF cultures

Question 11

When would you treat chlamydia?

Answer 11

When the cultures come back positive; treat with erythromycin systemically

Question 12

T/F

1. Chlamydia PNA has a late onset and often is characterized by a “staccato” cough and hyperinflation with bilateral infiltrates
2. The most common pathogens for early onset sepsis in a newborn include E. Coli, GBS, & staph
3. Negative blood and CSF cultures r/o diagnosis of sepsis

Answer 12

1. Yes
2. Yes
3. No

Question 13

HSV

ONSET

Types

Answer 13

Onset: Birth to 4 weeks

1. Localized Disease/SEM (skin eyes mouth)
2. CNS
3. Disseminated *most dangerous

Question 14

HSV treatment and when?

Answer 14

Acyclovir IV Q8 hours

If there <8 weeks: as soon as HSV is suspected

Question 15

What is the Education/follow up for HSV?

Answer 15

• Isolation & contact precautions
• Early intervention to r/o disseminated disease that doesn’t how up until later life
• Referral Opthalmology & audiology (med complications)
• Close neurodevelopmental f/u

Question 16

When do you treat GBS?

What do you treat with?

Answer 16

Treat at labor onset and every 4 hours until delivery

Penicillin G followed by ampicillin

Question 17

1. Majority of HSV infection in newborns is from HSV-1. Y/N?
2. Risk of HSV transmission to infant at birth is greater if it is the mother’s first HSV outbreak Y/N?
3. Localized HSV infection often presents at areas of skin trauma on the infant Y/N?

Answer 17

1. Yes
2. Yes
3. Yes, like from fetal probe

Question 18

1. Disseminated HSV has highest risk of mortality Y/N
2. Any infant presenting with a vesicular rash should be started on antiviral therapy with IV acyclovir until HSV can be r/o Y/N
3. All pregnant women with positive GBS should receive IV PCN at the onset of labor to try to prevent transmission to newborn Y/N?

Answer 18

1. YES
2. YES; same with varicella
3. YES

Question 19

1. Infants with GBS can present with signs of sepsis, respiratory distress, or meningitis Y/N?
2. Early onset GBS occurs in 1st 2 weeks of life Y/N?

Answer 19

1. yes
2. yes; usually sooner than that

Question 20

What are the 4 characteristic signs of neonatal abstinence syndrome?

Answer 20

1. state control and attention
2. Motor & tone gontrol
3. Sensory integration
4. Autonomic functioning (sneeze/yawning/nasal stuffy)

Question 21

How can you diagnose neonatal abstinence syndrome? 4

Answer 21

• urine
• meconium
• hair dample
• mother’s report

Ok to test baby; CANNOT TEST MOTHER WITHOUT CONSENT

Question 22

How do you monitor NAS?

Answer 22

Monitor symptoms using neonatal abstinence scoring system

Tools: Modified Finnegan Score OR Eating, Sleeping, Consoling Care tool (ESC)

Question 23

What is the Modified Finnegan Scoring Tool and how do you use it

Answer 23

Neonatal Abstinence Syndrome

Assess Q2 hrs after birth then Q4 hours

Score <8 = no withdrawal

Guides tx

Question 24

What is the ESC tool

How do you use it?

Answer 24

NAS; focus on infant fx & comfort rather than reducing withdrawal s/s

Q4 hrs for 1st 7 days of life

Question 25

ECS encourages nonpharmacologic management which includes…

Answer 25

* 4 “S”: * shush (repetive noises), * suck (pacifier), * swing (repetitive motion), * swaddle (d/t problems with sensory integration they like to be snug) * Calm environment * Rooming in * Skin to skin

Question 26

Discharge and f/u for babies with NAS

Answer 26

* monitor in hospital until managed and weaned from narcotics * Close f/u d/t risk neurodevelopment concerns & monitor social situation

Question 27

What are the facial dysmorphologies of FAS?

Answer 27

* Microencephaly * epicanthal folds * Low nasal bridge * thin upper lip * smooth philtrum * small jaw

Question 28

What are FAS birth defects 5

Answer 28

Cardiac (ASD) Skeletal Renal Ocular Auditory

Question 29

How to diagnose FASD

Answer 29

Have clinical suspicion with presence of or mom admits: * Facial dysmorphia * Intrauterine or postnatal growth retardation * structural brain anomaly * cognitive delays in older chilren

Question 30

1. NAS is most frequently associated with opioid use during pregnancy Y/N? 2. Premature infants have higher occurrence of NAS than FT infants Y/N? 3. All infants with NAS require medication to manage withdrawal symptoms Y/N?

Answer 30

1. yes 2. False; premature infants have less because nervous system is more immature so they don't have as much of a withdrawal response 3. False; only if they are not responding to non-pharm interventions

Question 31

1. NAS symptoms present within the first 24 hours after birth Y/N? 2. FAS is the most severe of all the FASDs Y/N? 3. Binge drinking as been associated with worse FAS outcomes as compared to small amounts of alcohol throughout pregnancy Y/N?

Answer 31

1. false; 48 to 72 hours 2. yes 3. yes; although any amounts is detrimental

Question 32

1. Alcohol related birth defects include ASD, kidney problems, and hearing loss Y/N? 2. Almost all individuals with FASDs have some type of neurodevelopmental deficit Y/N?

Answer 32

1. yes 2. yes

Question 33

What is the most common chromosomal abnormality among live born infants?

Answer 33

Trisomy 21 “Down Syndrome”

Question 34

What are associated medical conditions with Trisomy 21?

Answer 34

Cardiac: Tetrology of fallot; ASD, common AV canal Growth: Failure to thrive in beginning then obesity Hearing GI: Constipation; celiac disease, gut motility Musculoskeletal: hip dysplasia Leukemia: 10-20% higher then gen population

Question 35

Screening for Down Syndrome ## Footnote Growth Cardiac Disease Hearing

Answer 35

Growth: Down Syndrome foundation for growth Cardiac Disease: Echo at birth; Screen mitral valve prolapse at adolescence Hearing: Screen Q6 months up to 3 years

Question 36

Screening for Down Syndrome Opthalmologic Thyroid Hematology Atlantoaxial instability

Answer 36

Opthalmologic: Screen as newborn & annually Thyroid: Screen Newborn, 6 months, 12 months & annually (hypothyroidism) Hematology: CBC at birth; Hgb annually 1 to 13 years old Atlantoaxial instability: screen c-spine & hips (hip dysplasia)

Question 37

What is the leading cause of death in infants between 1month to 1 years of age in USA?

Answer 37

SIDS

Question 38

What are the risk factors for SIDS?

Answer 38

* sleep position * sleeping environment * smoke exposure * preterm birth and/or low birth weight (immature neuro system) * young maternal age * late or no prenatal care

Question 39

how to prevent SIDS

Answer 39

Room share 6-12 months pacifier before sleep encourage BF Cool environment Immunizations Avoid smoke/etoh/drugs

Question 40

1. Upslanting palpebral fissures, epicanthal folds, single palmar crease, and brushfield spots are common PE findings associated with trisomy 21 Y/N? 2. Individuals with Trisomy 21 should been evaluated for mitral valve prolapse infancy Y/N? 3. Cardiac anomalies, thyroid dysfx, obesity, and hip dysplasia are common in individuals with down syndrome Y/N?

Answer 40

1. yes 2. no; first echo is to look for structural abnormalities; adolescents because that's when prolapse starts 3. yes