Term
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Definition
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Term
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Definition
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Term
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Definition
| gestational age + postnatal age |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| > or equal to 43 weeks gestation |
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Term
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Definition
low birth weight: < 2.5 kg
very low birth weight: < 1.5 kg
extremely low birth weight: < 1 kg |
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Term
| pharmacokinetic considerations in pediatric patients: absorption |
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Definition
higher gastric pH
higher pH causes weak acids (phenobarbital) to be harder to absorb
immature conjugation and transport of bile salts
biliary conjugation and bile salts help absorb lipophilic drugs
immature intestinal enzymes and efflux transporters
larger body surface area to body mass ratio
increased absorption of topically applied medications |
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Term
| pharmacokinetic considerations in pediatric patients: distribution |
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Definition
higher total body water = larger Vd for water soluble drugs
aminoglycosides are water soluble; larger Vd requires a larger dose to reach a therapeutic peak
lower plasma protein levels = increased free fraction of protein bound drugs = more active drug |
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Term
| pharmacokinetic considerations in pediatric patients: metabolism |
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Definition
phase I enzyme development:
P450 - caffeine, midazoleam, phenytoin are not metabolized as quickly
phase II enzyme development:
conjugation reactions - morphine, acetaminophen are not metabolized as quickly |
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Term
| pharmacokinetic considerations in pediatric patients: excretion |
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Definition
glomerular filtration rate increases rapidly with age
[image]
tubular secretion |
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Term
| newborn care: APGAR scoring |
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Definition
A = activity (muscle tone)
0: absent
1: arms and legs flexed
2: active movement
P = pulse
0: absent
1: below 100 bpm
2: above 100 bpm
G = grimace (reflex irritability)
0: no response
1: grimace
2: sneeze, cough, pulls away
A = appearance (skin color)
0: blue-gray, pale all over
1: normal, except for extremities
2: normal over entire body
R = respiration
0: absent
1: slow, irregular
2: good, crying |
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Term
| newborn care: "eyes and thighs" |
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Definition
erythromycin 0.5% ophthalmic ointment
prevention of gonococcal ophthalmia
vitamin K 0.5-1 mg IM
prevention of vitamin K deficient bleeding
small % of the population have vitamin K deficiency; recommended that all neonates get this to prevent bleeding |
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Term
| newborn care: hepatitis B |
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Definition
mother's hepatitis B status: positive
infant birth weight: any
hepatitis B vaccine: give immediately
hepatitis B immunoglobulin: give immediately
mother's hepatitis B status: unknown
infant birth weight: < 2 kg
hepatitis B vaccine: within 12 hours of birth
hepatitis B immunoglobulin: within 12 hours of birth
mother's hepatitis B status: unknown
infant birth weight: > 2 kg
hepatitis B vaccine: within 12 hours of birth
hepatitis B immunoglobulin: within 7 days of birth |
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Term
| neonatal intensive care: common neonatal disease states |
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Definition
neonatal seizures
neonatal abstinence syndrome (NAS)
respiratory distress syndrome (RDS)
apnea of prematurity
patent ductus arteriosus (PDA)
persisten pulmonary hypertension of the newborn (PPHN)
necrotizing enterocolitis (NEC)
neonatal sepsis |
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Term
| neonatal seizures: incidence |
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Definition
they are more likely to occur during the neonatal period that any other time int he human lifespan
incidence: 1-3.5 per 1000 births |
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Term
| neonatal seizures: etiology |
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Definition
hypoxic ischemic encephalopathy
hypoxic brain injury that occurs during delivery
ex. cord wrapped around infant's neck, stuck in birth canal
stroke (arterial or venous)
intracranial hemorrhage
may be from birth trauma
meningitis
metabolic disorders
hard to diagnosis unless there is a family member with the same disorder
drug withdrawal
neonatal seizure syndromes
similar to epilepsy but presents earlier int he neonatal period |
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Term
| neonatal seizures: treatment |
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Definition
first line agent = phenobarbital
is it really the best option?
phenobarbital has the most literature; controversial whether it is the best option (can cause respiratory depression)
second line agents:
fosphenytoin
midazolam
lidocaine
levetiracetam
topiramate
levetiracetam and topiramate have better side effect profiles but not a lot of literature out yet
topiramate may be neuroprotective and may be an advantage to these neonates |
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Term
| neonatal seizures: long term effects |
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Definition
| neuroapoptosis (killing brain cells) occurs with fosphenytoin, midazolam, and phenobarbital |
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Term
| neonatal abstinence syndrome: scope of the problem |
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Definition
illicit drugs: 4.5% of pregnant women reported recent use of illicit drugs
non-illicit drugs:
15.3% of pregnant women reported tobacco use
2.3% of pregnant women use SSRIs
~1% of pregnant women use prescription narcotics
~12,000 infants impacted in 2008 |
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Term
| neonatal abstinence syndrome: mechanism |
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Definition
signal transduction occurs when adenylate cyclase converts ATP to cAMP or when Ca enters the sensory neuron of the autonomic nervous system through voltage gated channels
release of glutamate or substance P
potassium influx re-polarizes the neuron
painful stimulus: AC converts ATP to cAMP -> influx of Ca and release of neurotransmitters; after it is released the cell is repolarized with K
opioids prevent AC from coming in and there is no release of the neurotransmitters
because of decreased neurotransmitters, the postsynaptic receptors increase their surface area to make it more likely that they will bind to a neurotransmitter (leads to tolerance)
additionally, alternative pathways can be made postsynaptically
when the opioids are taken away there is an exaggerated response to pain |
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Term
| neonatal abstinence syndrome: clinical presentation |
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Definition
75-100%
jitteriness
irritability
hyperactivity
hypertonicity
decreased sleep
shrill cry
excessive suck
25-75%
poor feeding
vomiting
diarrhea
sneezing
tachypnea
sweating
< 25%
fever
rare
seizures |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
IMMEDIATE |
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Definition
cocaine, methamphetamine, other stimulants
ADRs due to intoxication, not withdrawal (b/c drugs have such a short t1/2 that there isn't enough time to develop withdrawal symptoms)
symptoms occur immediately after birth and abate over several hours
nearly all infants experience symptoms
small percentage require treatment |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
EARLY |
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Definition
heroin
symptoms appear within hours and abate quickly
60-90% of neonates experience symptoms
most don't require treatment b/c it goes away relatively quickly |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
MEDIUM |
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Definition
SSRIs:
pronounced symptoms within 1-2 days of birth and abate over several days
30-60% of neonates experience symptoms
signs: EEG abnormalities, jerkiness, hyperreflexia, respiratory distress, shivering, hypothermia, high pitched cry, hypotonia, vomiting, screaming, trouble breathing, crying, posturing, tachypnea, seizures, agitation, tremor, trouble feeding, jitteriness, hypertonia, irritability
alcohol:
symptoms appear within 12-24 hours and persist for about 1 week
hypersensitivity to sensory stimulation and seizures are common in severely effected neonates
tobacco:
symptoms appear within 48 hours of life and abate slowly
greater number of cigarettes per day = greater signs of withdrawal |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
MEDIUM TO LATE |
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Definition
methadone:
symptoms appear late (~2-3 days) and abate slowly
reports exist describing onset of withdrawal at 4 weeks and persistence of symptoms up to 6 months
~80% of infants experience symptoms
~50% require treatmnet
t1/2 of methadone is long and variable
morphine is the DOC for treatmnet
buprenorphine:
symptoms appear ~2 days of life and peak 3 days
similar incidence of withdrawal and treatment to methadone
kinetically straight forward and no QT prolongation concern
morphine is the DOC for treatment |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
LATE |
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Definition
methadone + tobacco
methadone exposed mothers who are heavy smokers (> 20 cigarettes per day) have infants with higher peak scores
4-5 days vs 2 days |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
EXTRA LATE |
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Definition
long acting barbiturates
onset of 7-14 days of life and persistence of symptoms for several months
incidence difficult to estimate because of late onset; most of the time the infants are at home when they start presenting with symptoms |
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Term
neonatal abstinence syndrome: impact of pharmacokinetic properties on timing and duration of withdrawal
POLY-SUBSTANCE ABUSE |
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Definition
timing is unpredictable
reports suggest that 62% of illicit drug using women took a combination of heroin, cocaine, benzodiazepines, alcohol, marijuana, and methadone during pregnancy |
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Term
| neonatal abstinence syndrome: non-pharmacologic treatment |
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Definition
quiet, dark environment
swaddling
prone positioning
feeding (higher caloric needs b/c of jitteriness) |
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Term
| neonatal abstinence syndrome: pharmacologic treatment |
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Definition
morphine
methadone
buprenorphine
diazepam
phenobarbital
clonidine
receptor appropriate therapy is superior! |
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Term
neonatal abstinence syndrome: pharmacologic treatment
morphine |
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Definition
morphine is superior to phenobarbital
morphine has a shorter duration of therapy (8 vs. 12 days)
morphine had a trend towards fewer treatment failures (35% vs. 47%)
morphine had fewer NICU admissions (30% vs. 62%)
morphine t1/2 = 4-8 hours
morphine can stunt growth (decreased body weight, decreased brain weight, decreased cerebral width, decreased cerebellar weight, and decreased cerebellar width)
morphine can also cause neuroapoptosis in neonates
[image] |
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Term
neonatal abstinence syndrome: pharmacologic treatment
methadone |
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Definition
t1/2 = 19 +/- 14 hours
retrospective studies find equivalence to morphine
BBW: potentially fatal QT prolongation
difficult to determine when to wean and dosing
have to monitor EKGs!!! |
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Term
neonatal abstinence syndrome: pharmacologic treatment
buprenorphine |
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Definition
t1/2 = 20 +/- 8 hours
24 infants randomized to buprenorphine vs. oral morphine
mean lengths of treatment 23 days vs 38 days
mean length of stay 32 days vs. 42 days
solution prepared by mixing buprenorphine injection in 100% ethanol and diluting with simple syrup (final alcohol content 30%)
buprenorphine is promising but there isn't a good way to administer this drug |
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Term
neonatal abstinence syndrome: pharmacologic treatment
diazepam |
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Definition
potentially useful in poly-substance abuse
higher rate of treatment failure compared to morphine and phenobarbital
may not help with the receptor that the patient is withdrawing from, but can blunt some of the withdrawal symptoms |
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Term
neonatal abstinence syndrome: pharmacologic treatment
phenobarbital |
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Definition
inferior to morphine in trials
longer duration of therapy, more treatment failures
drug of choice for alcohol or barbiturate withdrawal (receptor appropriate therapy)
improves length of stay, symptoms, decreases opiate use when used as adjunctive treatment |
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Term
neonatal abstinence syndrome: pharmacologic treatment
clonidine |
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Definition
case series of 7 infants with methadone exposure
6/7 achieved control with no reported ADRs
clonidine vs. placebo as adjunct to opiates
shorter length of stay, lower treatment failures
no ADRs reported
neuroprotection?
in patients that are suffering from withdrawal (dangerous to the growing brain) can be protective to their developing brains |
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Term
| respiratory distress syndrome |
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Definition
caused by surfactant deficiency and pulmonary immaturity
clinical signs:
tachypnea, grunting, retractions, cyanosis, increased oxygen requirements
lungs are the last organ to develop in utero
in premature newborns, the lungs are often exposed to several sources of injury, both before and after birth
such exposures - as well as genetic susceptibility to problematic lung development - may cause direct airway and parenchymal damage and induce a deviation from the normal developmental path
depending on the timing and extent of the exposures, lung injury may range from early developmental arrest (new bronchopulmonary dysplasia) to structural damage of a relatively immature lung (old bronchopulmonary dysplasi)
premature infants born at a gestational age of 23-30 weeks (region shaded light red) - during the canalicular and saccular stages of lung development - are at the greatest risk for bronchopulmonary dysplasia
[image]
antenatal exposures: steroids, chorioamnionitis, intrauterine growth restriction
postnatal exposures: ventilator induced lung injury, oxidative stress, infections, steroids, pulmonary fluid overload, nutritional deficits
respiratory distress is due to surfactant deficiency and pulmonary immaturiry
canalicular stage (16-23 weeks gestation)
saccular stage (23-32 weeks gestation)
surfactant has not been produced yet
alveolar stage (32-38 weeks gestation)
full development of the lungs |
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Term
| respiratory distress syndrome: incidence of RDS by gestational age |
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Definition
[image]
the younger they are, the increased risk of respiratory distress |
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Term
respiratory distress syndrome: treatment
antenatal steroids |
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Definition
betamethasone 12.5 mg IM q24h x 2 doses
indicated for women in preterm labor at 23-24 weeks gestation
decreases incidence of RDS, intraventricular hemorrhage, and death
speeds up process of lung development |
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Term
respiratory distress syndrome: treatment
surfactant |
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Definition
surfactant coats the alveoli and decreases surface tension
preterm babies have decreased surfactant production
surfactant from the preterm lung contains as percent composition less saturated phosphatidylcholine, less of the surfactant proteins, and more phosphatidylinesitol
surfactant helps with gas exchange by decreasing surface tension on the alveoli
[image]
type II cells make surfactant
liquid can inactivate the type II cells and less surfactant is produced
surfactant products:
Curosurf - organic solvent of pig lung
Exosurf - synthetic
Infasurf - lipid extract of calf lung lavage
Survanta - lipid extract of calf lung + synthetic lipids
Exosurf is the only synthetic product, the rest are animal derived
animal derived products are more effective
after surfactant administration via an endotrachial tube it works very quickly
the chest x ray of a neonate 2.5 hours after administration of surfactant demonstrates marked improvement in lung function |
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Term
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Definition
cessation of breathing > or equal to 30 seconds
cessation of breathing > or equal to 20 seconds + bradycardia (HR < 100 bpm)
cessation of breathing (any duration) if hypoxemmia present (SaO2 < 85) |
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Term
|
Definition
hematologic:
anemia
CNS:
IVH, seizures, hypoxemia, hypo/hyperthermia, depressant drugs
respiratory:
obstruction, pneumothorax, hypercarbia
cardiovascular:
hypotension, heart failure, hypovolemia
GI:
reflux, abdominal distention
infection:
pneumonia, sepsis
metabolic:
hypoglycemia, hypocalcemiam, hyponatremia
idiopathic:
apnea of prematurity
sepsis is the #1 differential diagnosis for apnea of prematurity |
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Term
| apnena of prematurity: non pharmacologic treatments |
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Definition
respiratory support:
ventilator
CPAP
positioning:
supine vs. prone position |
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Term
| apnena of prematurity: pharmacologic treatment |
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Definition
| methylxanthines (theophylline/caffeine) |
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Term
apnena of prematurity: treatment
caffeine |
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Definition
increases central respiratory drive
improves respiratory muscle function
diuretic
neuroprotective? |
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Term
apnena of prematurity: treatment
caffeine vs. theophylline |
|
Definition
advantages of caffeine
broader therapeutic index
caffeine: 5-50
theophylline: 5-20
earlier onset of action
longer t1/2
once daily dosing vs. q8-12h
oral dosage better tolerated with less GI irritation
caffeine is the standard of therapy |
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Term
| Caffeine Therapy for Apnea of Prematurity |
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Definition
enrolled 2006 infants
gave caffeine citrate 20 mg/kg, then 5 mg/kg/day vs. placebo
if apnea persisted, daily dose could be increased to 10 mg/kg/day
results:
supplemental O2 requirements at 36 weeks lower
36% vs. 47%
ventilator was discontinued one week eariler
31 weeks vs 32 weeks
lower rate of death or neurodevelopmental disability
40.2% vs. 46.2%
rate of cerebral palsy (4.4% vs. 7.3%) and cognitive delay (33.8% vs. 38.3%) lower
use caffeine in all patients who are at risk of apnea of prematurity |
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Term
| patent ductus arteriosus (PDA) |
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Definition
[image]
PDA is a condition in which the ductus arteriosus does not close (the word "patent" means open)
the ductus arteriosus is a blood vessel that allows blood to go around the baby's lungs before birth
soon after the infant is born and the lungs fill with air, the ductus arteriosus is no longer needed
it usually closes in a couple of days after birth
PDA leads to abnormal blood flow between the aorta and pulmonary artery
instead of going to the lungs, the blood goes back into systemic circulation |
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Term
| patent ductus arteriosus (PDA): incidence |
|
Definition
term infants: 57 per 100,000 live births
preterm infants (<1500 gm): 1 in 3 live births
60-70% of preterm infants < 28 weeks gestation require medical or surgical treatment |
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Term
| patent ductus arteriosus (PDA): diagnosis |
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Definition
physical exam:
murmur
widened pulse pressures
bounding peripheral pulses
radiologic:
pulmonary edema
cardiomegaly
echocardiogram |
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Term
| patent ductus arteriosus (PDA): clinical consequences |
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Definition
short term:
pulmonary edema, hemorrhage
decreased urine output and drug clearance
intraventricular hemorrhage
spontaneous intestinal perforation, NEC
long term:
congestive heart failure
chronic lung disease
pulmonary hypertension?
neurodevelopment? |
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Term
| patent ductus arteriosus (PDA): treatment |
|
Definition
nothing - in a small % of patients it will close on its own
NSAIDs
surgical ligation |
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Term
patent ductus arteriosus (PDA): treatment
COX1 vs. COX2 |
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Definition
COX1 - constitutively expressed
produce prostaglandins for GI mucosal integrity, platelet aggregation, renal funcion
INHIBITION CONSTRICTS DA
COX2 - induce at inflammation site
produces prostaglandins for: pain and inflammation, mitosis and growth, renal function
inhibition does NOT constrict DA
[image]
indomethacin and ibuprofen are the 2 NSAIDs used (greater COX1 to COX2 ratio) |
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Term
patent ductus arteriosus (PDA): treatment
indomethacin vs. ibuprofen |
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Definition
MOA: inhibits prostaglandin synthesis throgh cyclooxygenase inhibition
equally efficacious
ADRs:
indomethacin - renal toxicity, platelet inhibition
ibuprofen - chronic lung disease, displaces bilirubin
vasoconstricting the DA (and other blood vessels in the body) = renal toxicity |
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Term
patent ductus arteriosus (PDA): treatment
surgical ligation |
|
Definition
consequences:
increased chronic lung disease
increased necrotizing enterocolitis
increased retinopathy or prematurity
increased intraventricular hemorrhage
increased cognitive delay
potential vocal cord paralysis |
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Term
| persistent pulmonary hypertension of the newborn (PPHN) |
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Definition
high pulmonary vascular resistance compared to the systemic vascular resistance
want to decrease PVR and increased SVR
PPHN is the failure of the normal circulatory transition that occurs after birth
it is a syndrome characterized by marked pulmonary hypertension that causes hypoxemia and extrapulmonary shunting of blood
pulmonary hypertension is a normal and necessary state for the fetus because the placenta, not the lungs, serves as the organ of gas exchange
normal cardiopulmonary transition:
a dramatic transition occurs at birth, characterized by a rapid fall in pulmonary vascular resistance and a 10 fold rise in pulmonary blood flow
[image]
oxygen from 1st breath -> NO diffuses from the endothelium to the smooth muscle cells -> cGMP is made -> decreased Ca -> relaxation
oxygen from 1st breath -> prostacylin made through arachidonic acid (COX) -> PGI2 diffuses from endothelium to smooth muscle and activates adenylate cyclase to convert ATP to cAMP -> decreased Ca -> relaxation
this is what should normally happen |
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Term
| persistent pulmonary hypertension of the newborn: incidence |
|
Definition
[image]
MAS = meconium aspiration syndrome
a newborn breathes a mixture of meconium (early feces) and amniotic fluid into the lungs around the time of delivery
incidence of PPHN is 2 in 1000 live birhts |
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Term
| persistent pulmonary hypertension of the newborn: management |
|
Definition
[image]
oxygen is the mainstay of therapy b/c it sets off both sides of the cascade
NO is another therapy (one side of the pathway) |
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Term
persistent pulmonary hypertension of the newborn: management
nitric oxide |
|
Definition
dose 22 ppm (aerosolized)
ADRs: methemoglobinemia
must be weaned off slowly in order to avoid rebound hypertension!
may stop their own production if given exogenously so must be weaned |
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Term
persistent pulmonary hypertension of the newborn: management
sildenafil |
|
Definition
[image]
PDE5 breaks down cGMP; if blocked will have increased cGMP = more relaxation of vascular smooth muscle
sildenafil MOA: phosphodiesterase 5 inhibitor which leads to vasodilation
ADRs: hypotension, ocular toxicity |
|
|
Term
persistent pulmonary hypertension of the newborn: management
milrinone |
|
Definition
[image]
PDE3 on the other side but works the same way (keep cAMP around longer)
milrinone MOA: phosphodiesterase 3 inhibitor which leads to vasodilation; also has inotropic actiivty
ADRs: hypotension |
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|
Term
persistent pulmonary hypertension of the newborn: management
epoprostenol (Flolan) |
|
Definition
[image]
exogenous prostacycline
may be given intravenously or inhaled
ADRs: hypotension |
|
|
Term
persistent pulmonary hypertension of the newborn: management
bosentan |
|
Definition
[image]
endothelin 1 is a vasocontrictor in utero; give something to block ET1
bosentan MOA: endothelin 1 receptor antagonist
ADRs: hypotension, hepatotoxicity
not a therapy of choice |
|
|
Term
persistent pulmonary hypertension of the newborn: management
adjunctive treatments |
|
Definition
pressors:
increases systemic pressures
possible benefit with norepinephrine
bring systemic pressure up with vasopressors (DA, NE); is not specific to systemic and can increase pulmonary pressure at the same time
surfactant:
beneficial in disease states where surfactant is inactivated - meconium aspiration, pneumonia, surfactant deficienty
sedation
decreases oxygen consumption and agitation
paralytics:
improve ventilator compliance
for very agitated patients who aren't in sync with the ventilator |
|
|
Term
persistent pulmonary hypertension of the newborn: management
refractory cases |
|
Definition
ECMO: extracorporeal membrane oxygenation
[image]
heart/lung bypass
takes the blood out, go through the oxygenator, back to the baby
have to prime it with blood (b/c the baby doesn't have enough to go through) and this increases the Vd; dosing changes of drugs? |
|
|
Term
| necrotizing enterocolitis: incidence |
|
Definition
1 in 1000 live births
occurs up to 7% of VLBW patients
underdeveloped intestinal motility and immune defenses
morality is 15-30% and even higher in lower birthweight infants |
|
|
Term
| necrotizing enterocolitis: pathophysiology |
|
Definition
[image]
immature intestinal barrier: decreased mucus, decreased IgA, low intercellular junction integrity and increased permeability
exaggerated inflammation and tissue injury -> intestinal necrosis |
|
|
Term
| necrotizing enterocolitis: clinical presentation |
|
Definition
feeding intolerance
abdominal distention
bilious emesis
bloody stools
hemodynamic instability |
|
|
Term
| necrotizing enterocolitis: treatment |
|
Definition
bowel rest
broad spectrum antibiotics
IV nutrition/fluid support
surgical intervention |
|
|
Term
| necrotizing enterocolitis: outcomes |
|
Definition
20-40% require surgical intervention
50% mortality rate in these patients
long term concerns:
disease recurrence
short bowel syndrome
ostomy/stoma
failure to thrive
neurodevelopmental delays |
|
|
Term
| necrotizing enterocolitis: prevention |
|
Definition
|
|
Term
necrotizing enterocolitis: prevention
probiotics |
|
Definition
oral supplement or food products containing sufficient number of viable microorganisms to alter microflora or the host
common strains:
Lactobacillus, Bifidobacterium, Streptococcus
don't know if it is completely effective or not
[image]
promote GI motility
provide vitamins and short chain fatty acids
promote immune function
probiotics may prevent:
acute infectious diarrhea
antibiotic associated diarrhea
atopic disease (eczema, allergic rhinitis, asthma)
colic
systemic infection
cancer
evidence for NEC:
11 trails including 2176 infants
the risk of NEC was lower (2.4% vs. 6.6%)
the risk of death was lower (3.5% vs. 8.5%)
many products, many strains in each product
not as regulated b/c it is a food product
minor concerns:
products/strains
dose
duration
administration
major concerns:
safety (sepsis reported)
identity
long term impact |
|
|
Term
| neonatal sepsis: common etiologies |
|
Definition
group B Streptococcus
leading cause of neonatal sepsis
Escherichia coli
Listeria monocytogenes |
|
|
Term
| neonatal sepsis: early onset |
|
Definition
before prevention strategies, approximately 80% of sepsis occurred int he first week of life
early onset neonatal sepsis occurs in the first 24-48 hours of life
vertical transmission
risk factors:
maternal vaginal colonization
maternal chorioamnionitis
prolonged rupture of membranes
preterm labor |
|
|
Term
| neonatal sepsis: intrapartum (during birth) antibiotic prophylaxis (IAP) |
|
Definition
all pregnant women should be screened at 35-37 weeks gestation
efficacy up to 90%
candidates:
delivery < 37 weeks gestation
intrapartum fever (>38C)
rupture of membranes > 18 hours
known colonization
group B strep bacteriuria
previous infant with invasive group B strep disease
agents: penicillin G or amipicillin
should be administered at least 4 hours prior to delivery for best efficacy
penicillin allergic patients: cefazolin, clindamycin, vancomycin |
|
|
Term
| neonatal sepsis: other risk factors |
|
Definition
chorioamnionitis:
maternal fever
maternal tachycardia
uterine tenderness
fetal tachycardia
premature rupture of membranes:
baseline risk of sepsis = 2%
24-47 hours of rupture = 7%
> 48 hours of rupture = 11% |
|
|
Term
| neonatal sepsis: diagnosis |
|
Definition
signs:
increased WBCs
left shift
decreased platelets
metabolic acidosis
hyperglycemia
increased CRP, ESR
positive cultures (blood, trach, urine)
symptoms:
lethargy
respiratory distress
apnea/bradycardia
feeding intolerance
temperature instability
coagulopathy
systemic hypoperfusion
[image] |
|
|
Term
| neonatal sepsis: empiric antibiotics |
|
Definition
ampicillin + gentamicin OR cefotaxime
gentamicin:
advantages - narrow spectrum, low rate of resistance
disadvantages - narrow therapeutic index, therapeutic drug monitoring, nephrotoxicity/ototoxicity
cefotaxime:
advantages - CNS penetration, no monitoring
disadvantages - high rate of resistance |
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|
