AHN 548 Exam 1. All Questions and answers. VERIFIED.

AHN 548 Exam 1. All Questions and answers. VERIFIED. Congenital infections- essentials of dx and typical features - -can be acquired in utero, perinatally and postnatally -Can be asymptomatic in newborn period -clinical sx complexes include IUGR, chorioretinitis, cataracts, cholestatic jaundice, thrombocytopenia, skin rash and brain calcifications -Dx: PCR, antigen and antibody studies and culture CMV (Congenital) - -MOST COMMON TRANSMITTED IN UTERO Sx: hepatosplenomegaly, petechiae, growth restriction, microcephaly, direct hyperbili, thrombocytopenia, intracranial calcifications and chorioretinitis, HEARING LOSS TX: Ganciclovir therapy 6mg/kg IV q12h for 6 weeks for symptomatic neonates affecting the CNS and prevent hearing loss progression Rubella (Congenital) - -risk of fetal infection and congenital defects as high as 85% in mothers infected during 1st trimester. SX: microcephaly, encephalitis, cardiac defects (PDA and pul art stenosis and arterial hypoplasia), cataracts, retinopathy, and micropthalmia, hepatosplenomegaly, thrombocytopenia and deafness Dx: characteristic clinical illness in mother, inc serum rubella-specific IgM or culture of pharyngeal secretions Varicella (Congenital) - -Congenital varicella is rare Sx: limb hypoplasia, cutaneous scars, microcephaly, cortical atrophy, chorioretinitis and cataracts Perinatal caricella -- neonate should receive varicella-zoster immune globulin or IVIG, or if that's not done -- acyclovir. Toxoplasmosis (congenital) - -Most infants initially asymptomatic Sx: mental retardation, visual impairment, learning disabilities, growth restriction, jaundize, chorioretinitis, sz, hepatosplenomegaly, adenopathy, cataracts, maculopapular rash, thrombocytopenia, pneumonia Dx: positive toxoplasma-specific IgA, IgE, or IgM in first 6mo of life Tx: spiramycin for mom to prevent transmission to fetus. Neonatal tx- pyrimethamine and sulfadiazine with folinic acid. Sources: cat feces, ingestion of raw/undercooked meat Fetal damage most severe in 2-6th month gestation. Parvovirus B19 (Congenital) - -If infected during pregnancy- results in severe anemia, myocarditis, nonimmune hydrops, or fetal death. If fetus survives, long term outcome is good. Congenital syphilis - -Active primary and secondary maternal syphilis leads to transplacental passage to fetus in nearly 100% of cases. Fetal infection can reult in stillbirth or prematurity. Sx: mucocutaneous lesions, lymphadenopathy, hepatosplenomegaly, bony changes, hydrops (newborns often asymptomatic) Herpes Simplex (Perinatal) - -acquired during transit through infected birth canal Sx days 5-14: localized (skin, eye, mouth) or disseminated (shock, pneumonia, hepatitis) disease Sx days 14-28: CNS- lethargy, fever, sz Dx: viral cultures from vesicles, PCR Tx: acyclovir 60mg/kg/d divided q8h- 14days if localized, 21 days if disseminated or CNS. Mom needs c/s if active genital disease If mom has active lesions at delivery, neonate needs eye, oropharynx, nasopharynx, rectum and blood HSV PCr- if colonized, treatment with acyclovir x10days (if no active lesions on infant) Hepatitis B & C (Perinatal) - -Infected at time of birth, intrauterine transmission rare If mother haspositive HBsAg, then the infant should receive HBIG. and hep B vaccine asap after birth. If mom not tested before birth, run test after, give Hep B vaccine within 12hours, and if pos, HBIG too. Enterovirus infection (Perinatal) - -Pos maternal hx of diarrhea, fever and/or rash. Sx: appears in first 2 weeks- fever, lethargy, irritability, diarrhea and/or rash. Can p/w meningoencephalitis, myocarditis, hepatitis, pneumonia, shock and DIC Dx: PCR TX: no identified therapy, good prognosis except those with hepatitis, myocarditis or disseminated dz HIV infection (Perinatal) - -Can be acquired in utero at time of delivery or via breast milk Known mothers with HIV should be treated with zidovudine therapy as early as 14weeks gestation. Infant for first 6 weeks of life beginning within 12hours. Best prevention combination: c/s, zidovudine and avoidance of breastfeeding. Unknown mothers- prophylaxis with 2-3 rx. Infants asymptomatic, test HIV DNA PCR at 48hrs, 2weeks, 1-2 months, and 2-4 months. Vitamkin K deficiency bleeding in newborn - -Frequently exclusively breastfed, otherwise clinically well infant Bleeding from mucous membranes, GI tract, skin or internal (intracranial) Prolonged PT normal PTT normal fibrinogen and platelet count Clotting factor deficiency (II, VII, IX, and X). DDx: DIC and hepatic failure Tx: 1mg vitamin K SC or IV. avoid IM if pt is actively bleeding Thrombocytopenia - -Generalized petechiae; oozing at cord or puncture sites Thrombocytopenia (platelets usually 50,000/ml) In an otherwise well infant, suspect isoimmune thrombocytopenia- mother's iGG antibody leads to platelet destruction- may need to treat with IVIG to mom or infant. Tx: transfuse platelets (10ml/kg increases platelet count by 70,000/ml), in preterm infants at r/f IVH, transfuse for counts 40-50,000. Anemia - -HcT 40% at term birth Acute blood loss- signs