Neonatology Infection, seizures, Injuries

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Neonatology II (Infection, seizures, Injuries)

• By
• DR. Fayza AlSiny.

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NEONATOLOGY

• OBJECTIVE
• Neonatal sepsis.
• Neonatal seizures.
• Neonatal injuries.

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Neonatal Sepsis

• Definition
• According to the onset
  Early onset
  birth7days. Late
  onset 8--- 28 days.
  Nosocomial 1st.week-
  discharge.

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Classification according to organism
Early Late Nosocomial
GBS typeI,II,III GBSIII Staph.epidermis
E.coli E.coli Staph.aureus
Kelebsilla Liesteria monocytogenus Candida
Liesteria monocytogenus Herps simplex Psudomonas aerginosa
Non typeable H.influnza _____________ E.coli
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NNS, predisposing factors

• Maternal causes(vertical transmission)
• TORCH
• PROM
• UTI
• Colonization(GBS, Herpes, NG)
• Complicated delivery, multiple births.
• The Centers for Disease Control and Prevention
  (CDC) has recommended routine screening for
  vaginal strep B for all pregnant women. This
  screening is performed between the 35th and 37th
  week of pregnancy (anytime other than this time
  will not be significant to show if a woman is
  carrying GBS during the time of her delivery

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PROM Lac-test

• A study has determined that a high lactate
  concentration in the leaking amniotic fluid is a
  strong indicator that a woman who experiences
  PPROM will also go into labor within the next 48
  hours.This association may lead to a quantitative
  "Lac-test" which could aid the doctor's decision
  of whether or not to keep a woman who reports
  PPROM in the hospital.
• If chorioamnionitis is present at the time of
  PPROM, antibiotic therapy is usually given to
  avoid sepsis, and delivery is indicated. If
  chorioamnionitis is not present, prompt
  antibiotic therapy can significantly delay
  delivery, giving the fetus crucial additional
  time to mature

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NNS, predisposing factors cont

• Fetal causes
• Prematurity/LBW
• Male
• Resuscitation /ETT , UVC , UAC
• Hospitalisation, crowding , inadequate
  infection control.
• VP shunt , indwelling catheter.
• Alteration in skin m.m.

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NNS clinical manifestations

• General
• fever, hypothermia, not doing well, poor
  feeding , sclerema.
• CNS
• irritability, lethargy, tremors,
  seizures, hyporeflexia, irregular respiration ,
  full fontanel, high pitched cry.

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NNS clinical cont.

• CVS
• pallor, mottling, cold clammy skin,
  tachycardia, hypotension, bradycardia.
• Respiratory system
• apnea, dyspnea, tachypnea, retraction,
  flaring, grunting, cyanosis.

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NNS clinical cont.

• GIT
• vomiting, diarrhoea, abdominal distension,
  hepatomegaly.
• Renal oliguria.
• Haematology
• jaundice, pallor, petichiae, purpura,
  bleeding tendency, splenomegaly.

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NNS investigations

• CBC, differential.
• CRP, ESR.
• Cultures blood,CSF, urine, gastric aspirate, ETT
  aspirate.
• CXR.

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NNS treatment

• Ampicillin plus aminoglycoside ( gentamycin,
  Amikacin).
• 3rd generation cephalosporin (cefotaxim,
  ceftazidim).
• Antistaph (cloxacillin or vancomycin)
• NB duration of therapy is 7-10 days
• In meningitis, GBS 14 d/G-ve 21 d.

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NNS, prevention

• Aggressive treatment of maternal
  chorioamnionitis.
• Control of nosocomial infection by hand washing
  avoid overcrowding.

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NEONATAL SEIZURES

• Definition
• Paroxysmal involuntary movement due to
  disturbance of brain function.

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NEONATAL SEIZURES CONT.

• Classification
• Focal seizures.
• Multifocal clonic seizures.
• Tonic seizures.
• Myoclonic seizures.
• Subtle seizures chewing , blinking, nystagmus ,
  paddling.

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NEONATAL SEIZURES cont.

• Aetiology
• Hypoxia. HIE.
• Metabolic disturbances (hypoglycemia,
  hypocalcemia , hypomagnesmia , hypo
  hypernatremia).
• Inborn errors of Metabolism.
• Infections congenital acquired.
• Traumatic.

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NEONATAL SEIZURES cont.

• Aetiology cont.
• Structural abnormalities.
• Hemorrahge.
• Maternal drugs.

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NEONATAL SEIZURES cont.

• Investigation
• Glucose,Ca ,Mg .
• UreaElectrolytes Na.
• Lumber puncture CSF
• wbc?(bacterial,viral) Rbcs ?
  Hmg.
• Ammonia level.

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NEONATAL SEIZURES cont.

• Investigation
• ABG-acidosis.
• Lactate/ Pyruvate ratio.
• Drug screen.
• Imaging US, CT, MRI.
• Karyotyping.
• EEG.

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NEONATAL SEIZURES cont.

• Management
• Primary cause.
• Anticonvulsants
• phenobarbitone
• phenytoin

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NEONATAL SEIZURES cont.

• Jitteriness vs. seizures
• Simple tremors.
• Stopped by holding the extremities.
• Enhanced by sensory stimulation.

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III Birth Injuries

• Definition

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III Birth Injuries

• Risk factors
• macrosomia.
• Prematurity.
• CPD( cephalopelvic disproportion ).
• Dystocia .
• Prolonged labour.
• Breech.

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III Birth Injuries

• Cranial injuries
• -Cephalohematoma - Clinically
• -
  Jaundice
• -
  Management
• -
  Prognosis

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III Birth Injuries

• Intracranial Hge (IVH).
• Risk factors
• BW lt 1500 gm (90).
• Hypoxic Ischemic injury.
• Pnemothorax.
• Hypo/hyper tension.
• Coagulopathy.
• Thrombocytopenia.
• Vit.K deficiency.

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III Birth Injuries

• Intracranial Hge (IVH) cont,
• -site.
• -Clinical presentation.
• -Diagnosis U/S Grade I,II,III,IV.
• -Management I, II? Recover
• grade III,IV?hydrocephalus
• ------gtV-P shunt.

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III Birth Injuries

• Subdural Hge.
• -Term.
• -Clinical manifestations.
• -Diagnosis.
• -Management

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III Birth Injuries

• Peripheral Nerve Injuries
• - Erb?s palsy ( C5-6 ).
• Clinically
• loss of abduction, external
• rotation , supination , loss of
  bicep reflex
• abnormal Moro reflex.
• Management physiotherapy, neurosurgery

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III Birth Injuries

• Fractures.
• Clavicle
• -asymmetrical Moro.
• -crepitus .
• -discoloration.
• -immobilization

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THANK YOU