By Fayza AlSiny MD

بسم بسم اللةالرحمن اللةالرحمن الرحيمالرحيم

Neonatology II (Infection, seizures, Injuries)

By

DR. Fayza AlSiny.

By Fayza AlSiny MD

NEONATOLOGY

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

By Fayza AlSiny MD

Neonatal Sepsis:

Definition:

According to the onset: Early onset : birth—7days. Late onset : 8--- 28 days. Nosocomial: 1st.week- discharge.

By Fayza AlSiny MD

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

By Fayza AlSiny MD

NNS, predisposing factors

• Maternal causes(vertical transmission)

TORCH

PROM

UTI

Colonization(GBS, Herpes, NG)

Complicated delivery, multiple births.

By Fayza AlSiny MD

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.

By Fayza AlSiny MD

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.

By Fayza AlSiny MD

NNS clinical cont.

• CVS:

pallor, mottling, cold clammy skin, tachycardia, hypotension, bradycardia.

• Respiratory system:

apnea, dyspnea, tachypnea, retraction, flaring, grunting, cyanosis.

By Fayza AlSiny MD

NNS clinical cont.

• GIT:

vomiting, diarrhoea, abdominal distension, hepatomegaly.

• Renal: oliguria.

• Haematology:

jaundice, pallor, petichiae, purpura, bleeding tendency, splenomegaly.

By Fayza AlSiny MD

NNS investigations

• CBC, differential.

• CRP, ESR.

• Cultures: blood,CSF, urine, gastric aspirate, ETT aspirate.

• CXR.

By Fayza AlSiny MD

NNS treatment

1. Ampicillin plus aminoglycoside ( gentamycin, Amikacin).

2. 3rd generation cephalosporin (cefotaxim, ceftazidim).

3. Antistaph (cloxacillin or vancomycin)

NB: duration of therapy is 7-10 days

In meningitis, GBS 14 d/G-ve 21 d.

By Fayza AlSiny MD

NNS, prevention

• Aggressive treatment of maternal chorioamnionitis.

• Control of nosocomial infection by hand washing & avoid overcrowding.

By Fayza AlSiny MD

NEONATAL SEIZURES

Definition: Paroxysmal involuntary movement due to

disturbance of brain function.

By Fayza AlSiny MD

NEONATAL SEIZURES CONT.

Classification:1. Focal seizures.

2. Multifocal clonic seizures.

3. Tonic seizures.

4. Myoclonic seizures.

5. Subtle seizures “chewing , blinking, nystagmus , paddling”.

By Fayza AlSiny MD

NEONATAL SEIZURES cont.

Aetiology:• Hypoxia. HIE.• Metabolic disturbances: (hypoglycemia,

hypocalcemia , hypomagnesmia , hypo & hypernatremia).

• Inborn errors of Metabolism.• Infections: congenital & acquired.• Traumatic.

By Fayza AlSiny MD

NEONATAL SEIZURES cont.

Aetiology: cont.

• Structural abnormalities.• Hemorrahge.• Maternal drugs.

By Fayza AlSiny MD

NEONATAL SEIZURES cont.

Investigation:

• Glucose,Ca ,Mg .• Urea&Electrolytes :Na.• Lumber puncture : CSF wbc(bacterial,viral) Rbc’s Hmg.• Ammonia level.

By Fayza AlSiny MD

NEONATAL SEIZURES cont.

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

By Fayza AlSiny MD

NEONATAL SEIZURES cont.

Management:• Primary cause.

• Anticonvulsants:

phenobarbitone

phenytoin

By Fayza AlSiny MD

NEONATAL SEIZURES cont.

Jitteriness vs. seizures:1. Simple tremors.

2. Stopped by holding the extremities.

3. Enhanced by sensory stimulation.

By Fayza AlSiny MD

III Birth Injuries

Definition:

By Fayza AlSiny MD

III Birth Injuries Risk factors:1. macrosomia.2. Prematurity.3. CPD.4. Dystocia.5. Prolonged labour.6. Breech.

By Fayza AlSiny MD

III Birth Injuries Cranial injuries: -Cephalohematoma : - Clinically

- Jaundice

- Management

- Prognosis

By Fayza AlSiny MD

III Birth Injuries

Intracranial Hge (IVH). Risk factors :1. BW < 1500 gm (90%).2. Hypoxic Ischemic injury.3. Pnemothorax.4. Hypo/hyper tension.5. Coagulopathy.6. Thrombocytopenia.7. Vit.K deficiency.

By Fayza AlSiny MD

III Birth Injuries

Intracranial Hge (IVH) cont,

-site. -Clinical presentation.

-Diagnosis :U/S Grade I,II,III,IV. -Management: I, II Recover

grade III,IVhydrocephalus ------>V-P shunt.

By Fayza AlSiny MD

III Birth Injuries

Subdural Hge. -Term.

-Clinical manifestations.

-Diagnosis.

-Management

By Fayza AlSiny MD

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

By Fayza AlSiny MD

III Birth Injuries

Fractures. # Clavicle:

-asymmetrical Moro.

-crepitus .

-discoloration.

-immobilization

By Fayza AlSiny MD