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33 Cards in this Set
- Front
- Back
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What protects fetus from infections
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Placenta and amnion
Maternal immune system |
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Where does baby immunity come from?
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Passive immunity from mother (starts acquiring at 20 weeks and lasts until about 6 months)
Own immune system, active immunity becomes predominant at about 6 months |
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Congenital causes
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Infections that can go transplacental
Toxoplasmosis Other - (VZV) Rubella CMV Herpes, HepB/C, HIV Enteroviruses Syphilis |
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Congenital infections
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Maternal infection acquired during pregnancy
Earlier is usually worse Acute infection is usually worse that reactivation |
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How common is congenital CMV
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1% of newborns
But 9 of 10 are asymptomatic Symptoms: fetal demise, small for gestational age, CNS (microcephaly, calfications), skin, eye (chorioretinitis, cataracts), deafness, hepatitis, limb hypoplasia |
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Most common cause of sensorineural hearing loss in infancy?
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Congenital CMV
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Congenital infections which may seem asymptomatic at birth but reactivate?
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VZV
CMV HSV |
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Blue skin spots on a neonate?
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Can represent extramedullary hematopoeisis
One cause is congenital CMV depression of bone marrow |
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Risk of mother-child transmission of HIV
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Without any treatment
25% during pregnancy and delivery 40-50% with breastfeeding |
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Reducing vertical HIV transmission
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AZT during and after - 68% reduction
Elective CS further decreases (like 3% transmission rate) Single dose nevirapine for laboring mother then infant (nnRTI) is better than AZT |
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Peripartum infections
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From maternal colonizers
E. coli Group B strep HSV |
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Difference between adult and neonate HSV infection
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In neonates disseminated disease is much more common than locally controlled
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Presentations of neonatal HSV infection
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Skin-eyes-mouth
Disseminated - sepsis, jaundice, coagulopathy CNS only seizures, lethargy, fever Congenital microcephaly, skin scars |
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Is neonatal HSV dangerous
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Yes.
Mortality from all types except skin/eyes/mouth limited Also disability |
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Risks for neonatal HSV
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Maternal isolation of HSV
First episode Use of invasive monitors HSV of the cervix C-section reduces risk |
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Treating neonatal HSV
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IV acyclovir
Greatly improves outcomes, higher dose better (esp in disseminated) |
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Group B strep proph
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Test mothers in week 35-37
Give intrapartum abx for positive |
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Group B strep in neonate
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Onset < 1 week age
pneumonia, sepsis, meningitis Onset 1 week - 3 months sepsis and meningitis |
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Treating group B strep in neonates
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Gentamicin
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What viruses give babies respiratory infections?
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Respiratory syncitial virus
Parainfluenza Influenza Human metapneumovirus Can cause pneumonia/pneumonitis |
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H1N1 and kids
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Higher rates of symptomatic infection and deaths
Hit pregnancy women hard too |
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What causes auditory tube dysfunction
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viral URI
allergy hypertrophied tonsils/adenoids cleft palate |
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Different types of otitis media
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Otitis media with effusion (secretory)
chronic - persistant Suppurative otitis media chronic - recalcitrant |
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Pathophysiology of secretory otitis media
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Obstruction of auditory tube
Accumulation of transudate with negative pressure in middle ear Reduced tympanic membrane mobility |
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Patholphysiology of acute suppurative otitis media
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Obstruction of auditory tube
Recent colonization of nasopharynx with pathogenic bacteria Purulent exudate Positive pressure in middle ear -->bulging tympanic membrane |
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Etiology of acute suppurative otitis media
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Strep pneumo - 25%
H flu - 20% M. Catarrhalis - 15% No pathogen isolated in 25% |
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Epi of otitis media
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Peak age 6-18 months, rapid decline after age 2
83% of kids have had otitis media by age 3 Risk of recurrence related to age of first infection |
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Natural history of secretory otitis media
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30% resolve in two weeks
60% in one month 10% are persistent at 3 months |
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Morbidity of persistent secretory otitis media
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Anatomic - glue ear, cholesteatoma
Diminished hearing |
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Natural history of acute suppurative otitis media
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75% resolve in 5-10 days w/o therapy
Antibiotics shorten fever and otalgia Chronic suppurative develops in 10%, use of abx is mostly to prevent this |
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Complication of chronic suppurative otitis media
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Facial nerve paralysis
Mastoiditis which can lead to brain abscess Osteomyelitis of petroid ridge Venous sinus thrombosis, lateral sinus thrombosis hydrocephalus |
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Treating acute suppurative otitis media
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Observation
Pain control Abx augmentin cefpodox, cefurox, ceftriox amoxicillin clinda/azith w/ allergy Myringotomy |
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Treatment of persistent secretory otitis media
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Decongestants don't help
Abx for 2-3 weeks may give partial relief |
