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39 Cards in this Set
- Front
- Back
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How is the immune system of the newborn different for an adults? |
- no specific adaptive immunity - T-cell independant response is weak (b-cell) for the first 24mo of age - lack of T-cell independant presponse limits response to polysaccharide antigens - need conjugated vaccines - common to have "Transient hypogammaglobulinemia of infancy" - right after birth really low IgG and IgM levels (3-8weeks), when maternal Igs are broken down, and infant is starting rpoduce their own |
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How does the mom protect the fetal from an immune prospective? |
- at 28 wks gestation there are transplacental maternal IgG antibody - after birth immune factors in breast milk |
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What are serious bacterial infections in infants? |
meningitis, sepsis, bone and joint, uti, pneumonia, enteritis |
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What is a toxic appearance? |
clinically looks like sepsis syndrome (lethargy, poor perfusion, marked hypoventilation or hyperventilation, cyanosis etc.) |
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What do you do if an infant 0-3mo has a toxic appearance? |
Full septic workup (CBC + blood culture, urinalysis + urine culture, LP, CXR (if resp symp), stool micro + culture (if GI symp) empiric IV Abx |
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What are common life threatening infections (bacterial and viral) that occur perinatally (28 days)? |
Bacteria: - BGS (common) - E. Coli (common) and other gram - enteric - Listeria monocytogenes, S. aureus, group A streptococcus, Klebsiella pneumoniae Virus: - HSV - Enteroviruses and parechoviruses |
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What empiric tx for the toxic appearing neonate? |
If suspected meningitis: Ampicillin + cefotaxime If no meningitis: Ampicillin + gentamicin/cefotaxime If suspects HSV: acyclovir |
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How is GBS acquired and how does it present <7days and >7days? |
<7 days: - vertical - meningitis, pneumonia, sepsis > 7 days: - vertical or horizontal - meningitis, sepisis, osteomyelitis, soft tissue infection |
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Tx for GBS in infant? |
IV ampicillin (or pen) +- gentamicin for 2-3 weeks. (no allergenic alternative) |
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How are GBS infections prevented? |
- universal maternal screening at 35-37 wks gestation - penicillin G to mom at least 4 hours before delivery (given every 4 hours up until deliver) |
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if mom is allergic to penicillin what is given as prophylaxis for GBS? |
cefazolin |
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give GBS antibiotic prophylaxis if: |
- pos screen - previous infant with GBS - GBS bacteriuria during preg - delivery at < 37 wks gestation (not screened yet) - membranes ruptured for > 18 hours - intrapartum fever (>38) - Intrapartum nucleic acid amplification test positive |
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Clinical manifestations of HSV in infants? |
- vesicles on skin, eyes, mouth (2nd week) - appears well, but dissemination can occur (2wks) and septic babies likely suffer neurological consequences - encephalitis in 3 wk, Fever, ↓ LOC, seizures, usually have neurological consequences NOTE: skin lesions may not always be present despite disseminated disease or encephalitis |
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Dx HSV ? |
PCR or culture and LP is needed |
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Tx of confirmed HSV? |
IV acyclovir 60 mg/kg/day (2 weeks if mucocutaneous, 3 if disseminated or encephalitis) oral acyclovir for 6mo improves neuro outcomes if encephalitis |
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What is the approach to the well appearing febrile neonate (0-28 days of life)? |
same as toxic appearing (full septic work up and empiric therapy) |
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What would make you think an 29-90day old baby is at low risk of infection? |
all of: - previous healthy term infant - non-toxic appearance - no focal infection (or otitis media only) - Peripheral leukocyte count 5.0 – 15.0 x10^9/L - Absolute band count ≤ 1.5 x10^9/L - urine < 10 WBC / field stool (test if diarrhea) < 5 wbc/field |
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What is the risk of a serious bacteria infection if: 1) <=28 days and toxic 2) <= 28 days and non-toxic 3) >28 days and toxic 4) >28 days and non-toxic |
1) 25-35% 2) 3-6% 3) 10-20% 4) <1% |
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What serious infections are common from 29-90days of life? |
Vertical: - GBS (common) - ecoli (common) and other gram - enteric - listeria monocytogenes Horizontal: - strep. pneumoniae - N. meningitidis - Staph. aureus - GAS |
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empiric abx choice for infant 29-90 days? |
no meningitis: Ampicillin + cefotaxime meningitis: Ampicillin + cefotaxime ± vancomycin |
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clinical approach to the febrile infant aged 29-90 days that meets low risk criteria? |
clinical hx/P.E. + blood work + urinalysis to determine low risk, then outpatient, close follow up, admit if condition deteriorates |
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Clinical approach to the febrile infant aged 29-90 days that is not low risk? |
FSWU + IV abx |
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Approach to fever without a source in children 3-36 months old who don't have a toxic appearance |
- urinalysis+culture (if <6mo male, <12mo female) - CBC + culture (if unimmunized or >39oC) - CXR (if symp) - acetaminophen + Return if fever persists >48 hours or conditiondeteriorates |
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Most common infection in children 3-36 months old |
viral (no 1) bacterial: - s.pneumoniae (no 2), S. aureus, GAS, N. mening |
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empiric abx choice for kids 3-36 mo? |
no meningitis: cefuroxime or cefotaxime meningitis: ceftriaxome + vancomycin |
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What are the main causes of acute bacterial meningitis: 1) 0-28days 2) 29-90 days 3) > 90 days |
1) GBS, E. coli (other gran - enteric), Listeria monocytogenes 2) 1+3 3) s. pneumoniae, N. meningitidis |
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S & S of acute bacterial meningitis in infants: |
symp: Fever, poor feeding, vomiting, irritability,lethargy, inconsolable crying signs: Bulging anterior fontanelle, Diminished activity, “septic appearance”, Petechial rash |
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S & S of acute bacterial meningitis in kids: |
symp: Fever, headache, vomiting, back/neck pain, photophobia,confusion, disorientation signs: Neck stiffness, Kernig & Brudzinski signs, Focal neurological signs, Petechial rash |
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kernig sign: |
flex knee to 90 then extend knee (+ if pain) |
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brudzinski's neck sign: |
flex neck (+ if knees and hips flex) |
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management of acute bacterial meningitis: |
- empirical abx based on age (<28 = cefotaxime + ampicillin, 29-90 = cefotaxime + amipicillin +/- vancomycin, 90 + = cetriaxone + vancomycin) - monitor fluids and electrolytes (ADH secretion) - prohyplactic abx if H. influenzae B or N. mening to close contacts - long term: hearing, neurocognative dev |
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When would you suspect streptococcal toxic shock syndrome? |
hypotension + 2 or more of: - renal or hepatic abnormalities - DIC - RDS - scarlet fever rash - soft tissue necrosis OR S. pyogenes from sterile body site VZV is a risk factor |
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tx of streptococcal toxic shock syndrome? |
Abx: penicillin + clindamycin Supportive (IV fluid, inotropes) IV IG |
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Skin & mucosal features of Streptococcus pyogenes |
- strawberry tongue - red throat - skin peel on hands - scarlet fever |
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S & S of cong. CMV infection : |
At birth (10-15%): - Brain: microcephaly, periventricular calcifications, retardation (brain atrophy and white matter disfunction) - sensorineural hearing loss - chorioretinitis - Hepatosplenomegaly, thrombocytopenia No signs at birth (85-90%) but may have delayed: - sensorineural hearing loss - or cognitive/developmental problems (less common) |
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Risk factors among women of childbearing age to get CMV? |
- Low SES - exposure to young kids - direct/indirect transmission |
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CMV Dx: |
urine or saliva within 2-3 weeks of birth |
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CMV tx: |
Ganciclovir/valganciclovir if <28 days and symptomatic (prevents hearing loss) follow up w/ hearing and dev assessments |
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How do you prevent perinatal HIV transmission |
- screen mom for HIV - if positive antiretroviral therapy: triple ART start 2nd trimester, then IV zidovudine during labor - 6 wks zidovudine to infant C-section if VL >1000 copies/mL Feed: exclusively formula (unless resources poor then mom on ART and baby and breast feed) |
