Postmaturity

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Postmaturity

• Labour tends to be induced to avoid problems of
  postmaturity, however if dates not accurate may
  still occur
• Possible complications
• Growth disturbances
• Asphyxia
• Meconium aspiration syndrome

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Problems of the Term Newborn

• Respiratory
• Cardiac
• Sepsis
• Digestive
• Jaundice
• Anemia, polycythemia, hemorrhage
• Renal
• Endocrine
• Neurologic

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Respiratory Distress in the Newborn

• Respiratory
• Cardiac
• Infectious
• Neurologic
• Metabolic
• Gastrointestinal
• Hematological
• Musculoskeletal

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Respiratory Problems in the Term Newborn

• Transient tachypnea of the newborn
• Pneumonia
• Meconium aspiration
• Pulmonary air leaks
• Congenital malformations
• Persistent pulmonary hypertension
• Pulmonary hemorrhage

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Transient Tachypnea of the Newborn

• Failure to clear lung fluid
• Associated with
• Absent labour (planned C/S or C/S without labour)
  or
• Short labour or
• Initial weak or absent respirations
• Improves with time

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Pneumonia

• Can initially be difficult to distinguish from
  TTN/RDS
• Group B Strep 1
• Consolidation may appear after a few days

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Meconium Aspiration Syndrome

• Meconium-stained amniotic fluid
• Intrauterine insult may lead to gasping
• Meconium aspirated
• Pneumonitis
• Airway occlusion
• Pulmonary air leak syndrome
• May lead to persistent pulmonary hypertension

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Congenital Malformations

• Anomalies anywhere along airways
• Nose to alveoli
• Extrinsic or intrinsic
• Atresias
• Cysts
• Diaphragmatic hernia

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Persistent Pulmonary Hypertension

• Associated with
• Asphyxia
• Meconium aspiration
• Sepsis
• Right to left shunting through PDA (i.e.
  persistent fetal circulation)
• Treatment
• Oxygenation, ventilation
• Maintain blood pressure
• Pulmonary vasodilators

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Congenital Heart Disease Presentations

• Cyanosis
• Congestive heart failure
• Murmurs
• Dysrhytmias

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Sepsis Risk factors

• Preterm rupture of membranes
• e.g. weeks
• Prolonged rupture of membranes
• gt18 hours
• Maternal group B strep carriage
• Maternal GBS bacteriuria
• Previous infant with GBS infection
• Chorioamnionitis

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Neonatal Sepsis

• THINK OF IT!
• Signs may be subtle, non-specific
• Incidence bacterial sepsis 1-5/1000 live births
• Commonest organisms
• Group B streptococcus
• Gram negatives (E coli, Klebsiella)
• Enterococcus, H flu, staph species
• Listeria
• Work up and treat if suspect sepsis
• Use broad spectrum antibiotics

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Ophthalmia neonatorum

• 1st days - differentiate chemical vs infected
• 2nd-3rd wk - viral or bacterial
• Gonococcal
• within 5 days of birth
• gram negative intracellular diplococci
• if suspect, Penicillin asap
• highly contagious
• Chlamydia
• 5-14 days
• conjunctival scraping
• topical antibiotics

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Congenital Infections

• CMV
• 5-25/1,000 live births
• Asymptomatic vs severe symptoms
• Microcephaly, thrombocytopenia,
  hepatosplenomegaly, chorioretinitis
• Sequelae of hearing loss and developmental delay
• Rubella
• 0.5/1,000
• Cataracts, rash, congenital heart disease,
  developmental delay

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Congenital Infections

• Toxoplasmosis
• 0.5-1.0/1,000
• Hydrocephalus, cranial calcifications,
  chorioretinitis
• Syphilis
• 0.1/1,000
• Snuffles, osteochondritis/periostitis, rash
• Herpes Simplex Virus
• Vesicles, keratoconjuntivitis, CNS findings
• Viral sepsis

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Congenital syphilis

• Treat mother no matter what stage of pregnancy
• If adequate maternal treatment and no signs of
  infection in newborn, give one dose IM penicillin
• If inadequate maternal treatment, give 10 days of
  IV penicillin

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Neonatal herpes simplex

• Only about 1/3 mothers have overt signs
• Infection can be disseminated or local
• Usually present at 5-10 days of age
• If suspect
• Cultures, PCR
• Treat with Acylovir

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Maternal hepatitis B carrier

• Give baby hepatitis vaccine as soon as possible
  after birth (first 12 hours)
• Bath
• Universal precautions
• Immune globulin in first 7 days

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HIV

• Virus can be transmitted transplacentally,
  intrapartum, or postpartum
• Screen mothers
• Treat mothers with antiretrovirals
• Treat babies with AZT for 6 wks
• Universal precautions
• Look for other infections (HepB/C)
• No breastfeeding in developed world