acquired problems of the newborn, hemolytic newborn disorders - ch.35, 36

Cold stress & stressful events for newborn → _________

Hypoglycemia

Newborn: accidental lacerations can be inflicted with a scalpel during cesarean birth or with scissors during _______

Episiotomy

Subcutaneous edema over the presenting part, often as a result of pressure on the fetal head pushing through a dilated cervix

Caput succedaneum

Collection of subperiosteal blood; DOES NOT cross the suture lines

Cepalhematoma

Brachial plexus injury: risks

• birth weight ________

• Vaginal breech birth

• Forceps or vacuum assisted birth

• Prolonged _______ stage of labor

>4000g, second

Arm adducted and internally rotated, MORO, BICEPS, RADIAL REFLEXES ABSENT ON AFFECTED SIDE

Extension at elbow, flexion of wrist

• upper arm paralysis caused by stretching or pulling the head away from shoulder

Erb palsy

Intracranial hemorrhage (ICH): newborn

More likely to occur in-

• ___________

• Vacuum- or forceps-assisted birth

• Coagulopathy

• Prematurity

• Chorioamnionitis

• Acidosis

• Hypotension

• RDS

• bicarbonate therapy

Large term

Signs of birth trauma:

• bruising

• Edema

• Abrasions

• Absence, limitation, or asymmetry of ________

• Impaired mobility

• ___________

• Acute pain

Movement, respiratory distress

________

• Jitteriness

• Apnea

• Tachypnea

• Hypotonia

• Decreased activity

• Cyanosis

Hypoglycemia

neonatal infections: UTERO (congenital infection)

HSV, CMV, rubella

Neonatal Sepsis: Risk factors

• _________

• _________

• Maternal fever (>100.4F)

  
  

Prematurity, prolonged ROM

Neonatal Sepsis:

Most common microorganisms responsible for early onset infection

Group B strep, E. coli

Neonatal Sepsis: Signs

• apnea, Tachypnea, grunting, nasal flaring, retractions, cyanosis, decreased oxygen saturation, metabolic acidosis

• Cardio: decreased CO, tachy/brady-cardia, arrhythmias, hypotension, decreased perfusion

• Neuro: _________, ___________, fever, ________, hypotonia, jitteriness, irritability, seizures, bulging fontanels, high-pitched or abnormal cry

• GI: __________, vomiting, diarrhea, abd distention, hypoactive bowel sounds

Temp instability, hypothermia, lethargy, feeding intolerance

Neonatal Sepsis: Interventions

• antibiotics (ampicillin, a aminoglycoside)

• Encourage ____________

• HAND HYGIENE

• Antibiotic eye ointment 1-2 hrs after birth

• Proper bathing, cord care

Breastfeeding

Cytomegalovirus (CMV)

• most common congenital viral infection

• Urine, saliva, ________

• ____, petechiae, _______, hepatosplenomegaly, IUGR, _________, chorioretinitis, ____________

Breast milk, rash, jaundice, microcephaly, Intracerebral calcifications

_________________

In first or early second trimester → fetal death, limb hypoplasia, damage to CNS, eye abnormalities

Varicella (chicken pox)

Varicella infection is more serious if mother develops between _____ and _____ after birth

5 days before, 2 days

Varicella

Mother exposed → infant must receive varicella ________

Zoster immune globulin

Causes: Miscarriage, fetal death, constellation of congenital anomalies

• cataracts, glaucoma

• HEARING LOSS

• cardiac defects

Rubella

HBV transferred through

Blood

Any infant born to a mother who is seropositive for HBV should receive ________ and hepatitis B immune globulin (HBIG) within _____ after birth

HBV vaccine, 12-h

HIV

contraindications:

Breastfeeding

HIV

best way to reduce incidence

Prevention

HIV

• before labor and rupture of membranes after 38 weeks gestation

Cesarean

HSV in infants

• localized infection affecting ____, ______, or ________

Skin, eyes, mouth

HSV in infants

Without treatment, ________ develops in 70% of infants with skin vesicles

CNS or disseminated disease

HSV T or F?

Active genital lesions → cesarean birth

T

Influenza complications

• _______

• Preterm birth

• Stillbirth

Miscarriage

Causes fetal loss, microcephaly, neurologic defects

Zika virus

Group B Streptococcus (GBS)

Leading cause of perinatal infections such as: bacteremia, ______, Chorioamnionitis, _____

In newborns: focal or ___________

Endometritis, uti, systemic disease

Group B Streptococcus (+)

Given during labor

Antibiotics

Group B Streptococcus: risk factors

• preterm labor

• Prolonged ROM

• Maternal fever

• ______________

• Chorioamnionitis

Intrauterine fetal monitoring

Group B Streptococcus

+ newborn given

Ampicillin, aminoglycoside, penicillin G

Can cause pneumonia, uti, meningitis in newborn

E. coli

Infections after 72-h of birth

• involves skin and soft tissue

• Common sign: CONJUNCTIVITIS with purulent eye discharge

S. aureus

S. aureus: signs

• ______

• _______

• Endocarditis

• _________

Abscesses, osteomyelitis, septic arthritis

Major source of S. aureus

Hands

Toxoplasmosis: classic triad

Hydrocephalus, chorioretinitis, cerebral calcifications

Reduce rates sith 0.5% erythromycin opthalmic ointment

Systemic: 7-days of IV antibiotic

Gonorrhea

_______ risk factors

• late or no prenatal care

• Infection with HIV

Syphilis

Syphilis contracted by

Placental, maternal lesions

Listeriosis

Food borne infection

Manifestations: sepsis-like,________, _________

Acute respiratory distress, pneumonia

Tobacco effect→

Low birth weight

Alcohol: Fetal Alcohol Syndrome

• dysmorphic facial features (short palpebral fissures, _______, smooth philtrum)

• Growth deficiency

• CNS abnormalities

Thin upper lip

Opioids: Neonatal abstinence syndrome (NAS) signs

• restlessness

• _______

• _______

• Increased muscle tone

• Irritability

• ________

• Exaggerated Moro reflex

• Seizures

Tremors, high pitch cry, increased DTRs

Marijuana effect →

Fetal growth restriction

Cocaine effect

Placental abruption

Opioids: Neonatal abstinence syndrome (NAS): CARE

• _________

• distressed → rock

• Watch for overstimulation signs (gaze aversion, yawning, sneezing, hiccups, arching, mottled color)

• For feeding→ sitting w/ chin tucked

• During feedings ___________

• ______________

Swaddle, avoid eye contact or talking, reduce environmental stimuli

Newborn hypoglycemia

lower limit for normal plasma glucose levels during the first 72 hours after birth often cited as ______ mg/dL.

40-45

Polycythemia: Increased number of red blood cells; results in increased viscosity of the blood, thereby impairing circulation.   ____________ :Results when the excessive RBC are hemolyzed

hyperbilirubinemia

used to refer to an Rhnegative mother’s formation of antibodies capable of destroying the RBC of an Rh-positive fetus; this occurs with exposure of the mother to Rh-positive blood during pregnancy, birth, abortion, trauma, or external cephalic version.

maternal sensitization

Maternal blood test, used to determine whether the mother has antibodies to the Rh antigen

Indirect Coombs test

Test performed on cord blood to determine whether there are maternal antibodies to the Rh  antigen in the fetal blood

coombs test

Hemolytic disorders occur when maternal antibodies attack fetal red blood cells (RBCs), leading to complications such as:​

• Hyperbilirubinemia​

• _______​

• Fetal anemia​

• Primary Causes:​

• ABO Incompatibility​

• Rh (D) Incompatibility​

jaundice

jaundice → phototherapy with eye shields, _________

feed to hydrate

Rh incompatibility

Risk for future pregnancies with Rh-positive fetus leading to hemolysis and _____________

erythroblastosis fetalis

Risk Factors for Sensitization in Rh-Incompatibility​

• Previous pregnancy with Rh-positive fetus​

• Blood transfusion with Rh-positive blood​

• ______ pregnancy, miscarriage, or abortion (>8 weeks gestation)​

• Invasive procedures (chorionic villus sampling, amniocentesis)​

• Placental abruption​

• External cephalic version​

• Maternal trauma​

ectopic

Management & Prevention of Rh-Incompatibility

Early Blood Typing and Rh Screening for all pregnant women.​

RhoGAM (Rh Immune Globulin) Administration:​

• At ___ weeks gestation (prophylactic).​

• Within 72 hours of delivery if the baby is Rh-positive.​

• After events causing fetal-maternal hemorrhage (miscarriage, invasive procedures, trauma).​

Effectiveness:​

• 90% effective in preventing maternal sensitization.​

• Works by destroying fetal RBCs in maternal circulation before immune response.​

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