Newborn Disorders

Common Abnormal Conditions in the

Neonatal Period
Outline
Sepsis Neonatorum
Respiratory Distress Syndrome
Transient Tachypnea of the Newborn
Meconium Aspiration
Perinatal Asphyxia
Hypoxic Ischemic Encephalopathy
NBS in the Philippines


Neonatal Infectious Disease
Sepsis neonatorum

Early onset versus Late onset

Bacterial, Fungal

Viral - Toxoplasmosis, Rubella, CMV,
Hepatitis,Enteroviruses

Early onset sepsis
90% symptomatic w/in 24 hours of
life
Risk factors : maternal GBS infection, PROM
>18 hours, chorioamnionitis, maternal fever
>38C; prematurity, LBW <2500g
Clinical presentation varied
MC is respiratory distress
EOS : maternal flora
LOS : nosocomial, CA

In preterm infants : MC in LBW
CONS, S. aureus, Entero., Kleb,
etc
Evaluation
Complete PE
Labs : Blood CS, CBC APC, Na, K, CSF, CXR,
APL, etc

Treatment
Broad spectrum antibiotic coverage
Empiric
Definitive
Length of treatment course:
organism, response of patient
7-14 (21 days)

Supportive treatment : mechanical
ventilation, volume and pressor
support
Other medications ie bicarbonate, Pb
Risk Factors for LOS
In Infants <1500 grams :
BW <750 grams
Presence of CVC
Delayed enteral feeds
Prolonged hyperalimentation
Mechanical ventilation
Complications of Prematurity PDA, BPD, NEC
Anaerobic Infections
In the Phil : Neonatal tetanus
Cl. Tetani; WHO est 59,000
deaths due to neonatal tetanus
(2008)

Hypertonia, muscle spasms,
inability to feed, dehydration
Treatment : Tet toxoid 500 U IM
Pen G 100-300,000 U/kg/day 10-
14 days
Supportive care : MV
Requires standard tetanus
immunizations after recovery
Fungal infections
Candidiasis : C. albicans
Oral : Nystatin oral, Gentian violet,
Miconazole
NICU : Fluconazole

Invasive : brain, renal UTZ; eye check
up
Viral and Other Infectious Etiologies
Vertical transmission : Congenital vs
Perinatal infections
Maternal History
Complete PE
Laboratory evaluations
Serology
Imaging modalities
Congenital Toxoplasmosis
4 Recognized patterns
1. Subclinical
2. Neonatal symptomatic disease
3. Delayed onset
4. Sequelae or Relapse in infancy
through adolescence of a previously
undiagnosed infection
Specific symptoms
Neurologic
Ophthalmologic
Organomegaly
Hyperbilirubinemia, persistent conjugated
Thrombocytopenia
Rash
Rare : erythroblastosis fetalis, hydrops,
myocarditis, pneumonitis, nephritis

Diagnosis
Serology : IgM, IgA
PCR
Histology
Isolation of parasite : T. gondii is an
obligate intracellular protozoan. Cats are the only
hosts.
CT w/o contrast : calcifications
Treatment
Pyrimethamine
Sulfadiazine
Prednisone
Long term ( through 1 year old )
Survival for those not severely afflicted


CMV
DS enveloped DNA virus
Lifelong infection
Herpesvirus family
Abundant cytoplasm with
intranuclear and cytoplasmic
inclusions
Present in all secretions
CMV more common in HIV-1 disease
Congenital early symptomatic :
fulminant
multi-organ involvement, blueberry muffin spots
preterm, IUGR, jaundiced; microcephaly, calcifications
developmental disabilities, hearing loss
neurologic disabilities
Asymptomatic congenital : developmental
disabilities, deafness, dental defects


Perinatal acquired CMV
1. intrapartum exposure in the maternal genital
tract
2. postnatal exposure to infected BM
3. postnatal exposure to infected blood
4. nosocomial via urine or saliva

Preterm infants are at greater risk to develop
acute infection
CMV pneumonitis
Transfusion acquired CMV
4-12 weeks post transfusion
must use CMV seronegative donors
filtered, leucoreduced
Diagnosis
CMV PCR
CMV IgG and IgM
CMV antigen, shell vial
Treatment : Ganciclovir,
Valganciclovir
Read on the other Neonatal
infections :
HIV
Hepatitis
TB

Source : Nelson, Del Mundo
THANK YOU AND GOOD DAY