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. Problems of the Term Newborn. Respiratory Cardiac Sepsis Digestive Jaundice

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Postmaturity

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Postmaturity

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


Problems of the term newborn

Problems of the Term Newborn

Respiratory

Cardiac

Sepsis

Digestive

Jaundice

Anemia, polycythemia, hemorrhage

Renal

Endocrine

Neurologic


Respiratory distress in the newborn

Respiratory Distress in the Newborn

Respiratory

Cardiac

Infectious

Neurologic

Metabolic

Gastrointestinal

Hematological

Musculoskeletal


Respiratory problems in the term newborn

Respiratory Problems in the Term Newborn

Transient tachypnea of the newborn

Pneumonia

Meconium aspiration

Pulmonary air leaks

Congenital malformations

Persistent pulmonary hypertension

Pulmonary hemorrhage


Transient tachypnea of the newborn

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


Pneumonia

Pneumonia

Can initially be difficult to distinguish from TTN/RDS

Group B Strep #1

Consolidation may appear after a few days


Meconium aspiration syndrome

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


Congenital malformations

Congenital Malformations

Anomalies anywhere along airways:

Nose to alveoli

Extrinsic or intrinsic

Atresias

Cysts

Diaphragmatic hernia


Persistent pulmonary hypertension

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


Congenital heart disease presentations

Congenital Heart Disease: Presentations

Cyanosis

Congestive heart failure

Murmurs

Dysrhytmias


Sepsis risk factors

Sepsis: Risk factors

Preterm rupture of membranes

e.g. weeks

Prolonged rupture of membranes

>18 hours

Maternal group B strep carriage

Maternal GBS bacteriuria

Previous infant with GBS infection

Chorioamnionitis


Neonatal sepsis

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


Ophthalmia neonatorum

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


Congenital infections

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


Congenital infections1

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


Congenital syphilis

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


Neonatal herpes simplex

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


Maternal hepatitis b carrier

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


Postmaturity

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


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