By Fayza AlSiny MD بسم اللةالرحمن الرحيم بسم اللةالرحمن...
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Transcript of By Fayza AlSiny MD بسم اللةالرحمن الرحيم بسم اللةالرحمن...
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