NEW BORN CARE AND INFECTIONS

Mothers ClassNew born care and Newborn Infections

Vivian C. BarreraDepartment of Family and Community Medicine

Perpetual Succour Hospital

Caring for a newborn is one ofthe greatest challenges a parentor caregiver faces. A new babyis completely dependent on loved onesto care for him or her

NEWBORN SCREENINGCONGENITAL HYPOTHYROIDISM

CONGENITAL ADRENAL HYPERPLASIA

GALACTOSEMIA

PHENYLKETONURIA

G6PD DEFICIENCYRA 9288 or Newborn Screening program of 2004

CONGENITAL HYPOTHYROIDISM

CONGENITAL ADRENAL HYPERPLASIA

excessive or deficient production of sex steroids

GALACTOSEMIARare genetic

metabolic disorder

incidence is about 1 per 60,000 births

Without treatment, mortality in infants is about 75%.

PHENYLKETONURIAis an inherited disorder that increases the levels of a substance called phenylalanine in the blood.

It is found in all proteins and in some artificial sweeteners.

If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems.

occurs in 1 in 10,000 to 15,000 newborns.

Most cases of PKU are detected shortly after birth by newborn screening

treatment is started promptly

G6PD DEFICIENCY

Persons with this condition do not display any signs of the disease until their red blood cells are exposed to certain chemicals in food or medicine, or to stress

Red cells break down when exposed to certain drugs or stress of infection

Dark urineEnlarged spleenFatiguePallorRapid heart rateShortness of breathYellow skin

color(jaundice

)Are African AmericanAre of Middle Eastern

decent, particularly Kurdish or Sephardic Jewish

Are maleHave a family history

of the deficiencyA form of this disorder

is common in whites of Mediterranean descent

Antimalarial drugsAspirinNitrofurantoinNonsteroidal anti-inflammatory drugs (NSAIDs)QuinidineQuinineSulfa drugsOther chemicals, such as those in mothballs, can also trigger an episode.

Neonatal Period ( 0 - 1st mos ) Vulnerable timeCompleting vulnerable

changesHigh morbidity and

mortality ratesU.S. Deaths in 1sy year of

life: 2/3 in neonatal period

No longer dependent on maternal circulation

Parental role in Maternal-Infant Attachment

Requires dedication because a newborn's needs are urgent, continuous, and often unclear

Mother is freaking out for?

Is it something worth freaking out?

NormalTemp: 36.5- 37.5 C

RR: 40- 60 cpm

HR: 100-180 bpm (70-80 bpm asleep)

Menstruation???

The NewbornAverage term newborn

weighs : 3.4 kg (7½ lb)

Boys are slightly heavier than girls are

Length : 50 cm (20 in)

head circumference :

35 cm (14 in),

OccasionalCoughingSneezingHiccupsRegurgitation

The following are considered NORMAL:

I AM GOING HOME WITH MY BABY!

Discharge Instructions

Daily bath Clean base of umbilicus 2-3x

a day (70% alcohol)

Expose baby to early AM

sunlight daily for 15-20 mins.

Discharge Instructions

Exclusive

breastfeeding

Burp baby after

feeding

No abdominal binders, no

powder, lotion,

cologne, oil and

manzanilla

Newborn’s Basic Needs

Lots of feeding

clothing

Lots of sleep

Lots of Cleaning Up

FEVER IN NEONATES

Fever is a prominent symptom of many different disease

processes

Neonates and young infants may manifest fever as the only sign of significant underlying infection.

A rectal temperature of 38ºC (100.4ºF) generally is regarded as fever in the neonate 0 to 28 days of age.

FEVER IN NEONATES

HYPERTHERMIA IN THE NEWBORN TRANSITORY FEVER OF THE NEWBORN,

DEHYDRATION FEVER

Temp: 38-392nd -3rd day of life Risks factors:

Breast fed infant whose intake is lowOverdressedExposure to high temperatures

ManifestationsInfants may lose weightDiminish urine outputDepressed fontanelInfant takes fluid avidly

HYPERTHERMIA IN THE NEWBORN TRANSITORY FEVER OF THE NEWBORN,

DEHYDRATION FEVER

Should be evaluated for local or systemic infection

Treatment“:Addtional nursing formula NOT pure water

Check TEMPLoosen up clothings

Cool environment

WHAT TO DO?

Call a friend

Presence of fever should be evaluated

laboratory evaluationCBC, Blood Culture, UA , CSF CXR and Stool Cx Admission

Visit an M.D.

General AppearanceMyoclonus Is brief, involuntary twitching of a muscle or

a group of muscles.

It describes a medical sign and, generally, is not a diagnosis of a disease.

Brief twitches are perfectly normal us

EDEMAProduce superficial

appearcance of good nutrition

(+) PittingGeneralized

Prematurity Hypoproteinemia Non immune hydrops Congenital nephrosis Hurlers syndrome Unknown cause

1 or more extremities: initial sign of turners syndrome

HYPOCALCEMIA (TETANY)Common complication of VLBW pre term

infantsCan lead to fractureMajor cause :

inadequate intake of calcium to meet the requirement for growth

Prolonged parenteral nutritionVit D and calcium mal absorptionIntake of unsupplemented human milkUrinary calcium losses from chronic diuretic

use.

RASHES

called a milk spot or an oil seed

is a keratin-filled cyst that can appear just under the epidermis or on the roof of the mouth

commonly associated with newborn babies

found around the nose, eyes, and genitalia

In children milia often disappear within 2 to 4 weeks.

Milia

Erythema toxicumCommon Harmless

RashAppears within 1-

2days after birth goes away on its

own within a week

Not contagious,does not require any

medical treatment

tiny bumps that are firm, yellowish or white, and surrounded by a ring of redness.

Sometimes these bumps are filled with a fluid that looks like (but isn't) pus.

Sometimes there are no bumps at all — only a splotchy redness

The rash usually appears on the baby's face, chest, arms, and legs

It may be concentrated on only one area of the body

it may cover much of the child's skin,

although it usually does not affect the palms or soles of the feet

TRANSIENT NEONATAL PUSTULAR MELANOSIS

BENIGN idiopathic skin condition mainly seen in newborns

• has distinctive features characterized by vesicles, superficial pustules, and pigmented macules

present at birth. occur on the chin,

neck, forehead, chest, buttocks, back, and, less often, on the palms and soles

The vesicles and pustules rupture easily and resolve within 48 hours.

The brown macules may persist for several months

NO SPECIFIC THERAPY is indicated for transient neonatal pustular melanosis

Acne Neonatorum

Main cause not known

But it could be due to the increased sensitivity of the infant's sebaceous glands to maternal hormones during pregnancy

Peaks at around 2 months

Rarely needs treatment.

NEW BORN INFECTIONS

Signs to Look forMany infections cause similar symptoms. Call

your child's doctor or seek emergency medical care if your new baby shows any of these possible signs of infection:poor feedingbreathing difficultylistlessnessdecreased or elevated temperatureunusual skin rash or change in skin colorpersistent cryingunusual irritability

Group B Streptococcal Disease A common type of bacterium that can cause

a variety of infections in newborns. Some of the most common are sepsis,

pneumonia, and meningitis. Babies usually get the bacteria from their

mothers during birth — many pregnant women carry these bacteria in the rectum or vagina, where they can easily pass to the newborn if the mother hasn’t been treated with antibiotics.

Group B streptococcal DiseaseBabies with GBS often show symptoms of

infection within the first week of life, although some develop symptoms weeks or months later.

Depending on the infection (pneumonia or sepsis, for example), the symptoms might include trouble breathing or feeding, a high temperature, listlessness, or unusual crankiness

ListeriosisSerious infection affecting pregnant women

and newbornsCan lead to diseases such as pneumonia,

sepsis, and meningitis in newborns. Most people encounter the bacteria by eating

contaminated food Bacteria are found in soil and water and can

end up on fruits and vegetables, as well as in foods that come from animals, such as meat and dairy products

.

ListeriosisFood that isn't properly cleaned, pasteurized,

or cooked may give someone listeriosisBabies can acquire bacteria from their

mothers if the mother contracts listeriosis while pregnant.

In severe cases, listeriosis may lead to premature delivery or even stillbirth.

Babies born with listeriosis may show signs of infection similar to those of GBS

It is important to follow general sanitary rules and keep a clean food preparation area while cooking to avoid becoming infected

with listeriosis.

Wash your hands properly before, during and after meal preparation.

Clean/wash all foods before eating or cooking them.

Cook foods thoroughly before consuming.

Never eat/drink unpasteurized foods/milk or juices.

Eat ready-to-eat foods as soon as possible.

Do not eat hot dogs or lunch meats unless they are heated until they are STEAMING HOT.

Wash all surfaces and hands after handling hot dogs, lunch meats and deli meats.

Do not eat refrigerated, smoked seafood.

Do not eat refrigerated meat spreads. Canned spreads are generally okay.

MENINGITISis an inflammation of the membranes surrounding the brain and spinal cord.

It can be caused by viruses, fungi, and bacteria, including Listeria, GBS, and E. coli.Newborns can pick up one of these pathogens during birth or from their surroundings, particularly if they have weakened immune systems that would make them more susceptible.

SYMPTOMSpersistent crying,

irritability,

sleeping more than usual,

lethargy,

refusing to take the breast or bottle,

low or unstable body temperature,

jaundice, pallor,, breathing problems, rashes, vomiting, or diarrhea.

As the disease progresses, babies' fontanels, or soft spots, may begin to bulge.

HOW IS IT DIAGNOSED AND TREATED

A serious infection in newborns.

If it is suspected, a doctor will do a lumbar puncture

Treatment of meningitis depends on what caused it.

Infants with bacterial and fungal meningitis receive antibiotics, while viral meningitis may be treated with antiviral medication.

All infants with meningitis usually spend time in the hospital for monitoring and intense supportive care.

SEPSISIs a serious infection that involves the spread of

germs throughout the body's blood and tissues.

It can be caused by viruses, fungi, parasites, or bacteria.

Some of these infectious agents are acquired during birth, while others are picked up from the environment.

As with meningitis, the symptoms of sepsis are not specific and vary from child to child.

lower heart rate,

breathing problems

,

jaundice,

trouble feeding,

low or unstable

body temperature,

lethargy,

extreme fussiness

How is it diagnosed and treated?To diagnose or rule out sepsis

Blood testExamine cerebrospinal fluid and other body

fluids to look for bacteria or other pathogens.

They typically look for sepsis and meningitis in the same work-up.

Once a positive diagnosis is made, the child will receive a course of antibiotics

during a stay in the hospital.

CONJUNCTIVITIS(PINK EYE) Some newborns

develop an inflammation of the eye's covering membranes

appears as redness and swelling in the eye,

usually accompanied by a discharge.

Both bacterial and viral infections can cause

conjunctivitis in newborns.

HOW IS IT DIAGNOSED AND TREATED?

The infection can be very contagious, so the doctor may also suggest that other children in the family limit contact with the baby.

If a more serious type of conjunctivitis is suspected, hospitalization may be necessary

CANDIASIS

An overgrowth of the common yeast candida, found on everyone's body, leads to the fungal infection candidiasis.

In newborns, it usually shows up as diaper rash, but babies can also develop oral thrush in the mouth and throat.

It causes cracks in the corners of the mouth and white patches on the tongue, palate, lips, and insides of the cheeks.

Newborns who get thrush have often picked up the fungus from the mother's vagina during delivery or during breastfeeding.

HOWIS IT DIAGNOSED AND TREATED?

Sometimes the doctor will take a swab of one of the patches in the mouth

examine it for signs of the fungus. In most cases, this isn't necessary and

treatment is started based on the appearance of the mouth lesions alone.

Thrush can be treated with liquid antifungal medicine.

CONGENITAL INFECTIONS

Many infections that affect newborns are transmitted from mother to infant, either during pregnancy or delivery.

Because the baby is born with them, they're known as congenital infections.

They are most often caused by

viruses and parasites.

It's more likely that babies will be born with an infection if their mothers become infected for the first time with a particular germ while pregnant. However, transmission to the baby doesn't always occur, so many babies born to mothers with these infections don't have the infection themselves. Other newborns may not initially show signs of disease, but may later exhibit its effects.

Congenital infections include

HIV (which causes AIDS)

Rubella

(german

measles)

Chickenpox;

SY

Philis

HErpes

Toxoplasmosis;

and cytomegalovirus (CMV),

The risk these infections pose to an infant often depends on when the mother is exposed to the germ

Complicationsheart diseasebrain damageDeafnessvisual impairmentMiscarriage

Large or small headSmall body sizeSeizuresProblems with the

eyesSkin rashesJaundiceEnlarged abdominal

organsA heart murmur.

Infection later in the pregnancy may lead to less severe effects on the fetus but can still cause problems with the

infant's growth or development

How are they diagnosed and treated?

When Troubled?VISIT NEAREST

HEALTH FACILITY

PREVENTION IS BETTER THAN

CUREA good prenatal check

up = Better baby outcome

Good day!