WHAT IT MEANS or WHY YOU DO IT

Transcription

1 WHAT IT MEANS or WHY YOU DO IT Dr. Patrick Sauer Billings Clinic Pediatrics Objective Increase understanding of prenatal tests Increase understanding of routine newborn procedures Increase knowledge to answer parents questions Routine Prenatal Visits S.T.D. Screens Chlamydia GC Hepatitis B HIV RPR?Hepatitis C 1

2 Chlamydia Infection Higher incidence in child bearing age Risk to infant Conjunctivitis (20 50%) Pneumonia (5 30%) Montana 2013 = 3818 cases per year Yellowstone County = 648 cases per year Gonorrhea Primary cause of infant blindness in the past Low risk in pregnant women Transmission rate = 30 40% Montana = 224 (2013) Yellowstone county = 42 Be sure Neisseria Gonorrhea Increased transmission rate of HIV & Syphilis. Eye Prophylaxis Started to prevent GC Effective for GC & Chlamydia Not effective if mom has active GC infection Apply to lower conjunctival sac and massage should be administered within the first hour of life 2

3 Syphilis - RPR Rapid Plasma Regin s infants / week were treated with arsenic Transplacental Transmission Primarily 2 nd half of pregnancy % (untreated) 1 2% (adequate treatment) 3

4 Syphillis 3 rd trimester sick in just a few weeks Infects liver, skin, mucous membranes and brain IN 2008, zero infections in Montana, 127 in Texas 2013 Montana = 8 Yellowstone County = 1 BE SURE test is NOT false positive. HIV Positive Transmission rate untreated 25 40% C/Section has lower transmission risk 50% What is viral load? C/Section with prenatal, perinatal and post natal treatment has decreased transmission by 85% Hepatitis B 6 / 1000 births are to Hepatitis B moms Untreated transmission rate up to 90% Protocol will decrease risk to 2% Prevents primary form of liver cancer 4

5 Hepatitis B Protocol Mom Θ Hepatitis B Vaccine Mom - Vaccine plus HBIG Mom? STAT Hep B Screen or Vaccine plus HBIG Group B Strep Screen Gestational Age = 36 weeks Technique = vaginal and rectal CDC guidelines 75% GBS sepsis in full term infants. GBS History Primary cause of sepsis starting in 1970 s. Previous organism was Staph. Texas trial of penicillin shots for every baby. Risk factors VS Universal screening 5

6 Maternal GBS Status Risk of Sepsis / Meningitis / Death Technique + or Treatment with time interval to delivery Also late onset disease Maternal Blood Type & Rh Information needed to screen newborn Screening needed Mothers O Mothers Rh- Cord Blood Screen, including Coombs Improves outpatient management of jaundice Routine Newborn Procedures or Screens Vitamin K Eye Prophylaxis Transcutaneous Bilirubin Cord Rh, Blood Type & Coombs Hearing Screen Newborn Metabolic Screen 6

7 COOMB S TEST Mom (oh no) Baby P L Produce A Antibodies C E N T A COOMB S TEST Mom = O or Rh negative Mom Baby P A L A C RBC s B E N T Rh positive A COOMB S TEST Mom Baby P L Antibodies A RBC Attack C E N T A 7

8 COOMB S TEST Mom P L A C E N T A AB AB AB RBC Destroyed and Bilirubin Increases COOMB S TEST AB RBC + Anti-Antibody Anti AB Clump of RBC s AB RBC + Coomb s Coomb s test is ALWAYS. Weakly means NOTHING. 8

9 Newborn Hematology Blood Type & Rh Platelet Count Hemoglobin / Hematocrit Tcb or Lab Bilirubin All newborns have elevated bilirubin Why check prevent kernicterus Kernicterus cannot be fixed Risk Factors for Elevated Bilirubin Early discharge Poor nursing Delayed passage of meconium Enterohepatic circulation 9

10 Risk Factors for Elevated Bilirubin Risk Factors Prematurity IDM / LGA Rh / ABO Siblings with phototherapy Increased bruising Tcb or Lab Bilirubin When to order Tcb Routine 24h Anytime the baby looks jaundice Check for risk factors Check Coombs test results Tcb or Lab Bilirubin Compare to hourly graph May order lab bili anytime Check bilicheck website 10

11 Vitamin K Purpose to prevent neonatal bleeding 1 / 1000 serious episode 1 / 10,000 catastrophic episode Bleeding related to no Vitamin K Early maternal medication 1-2 days breast fed Late liver disease, malabsorption 1mg Vit K at least effective for 1 month Dangers of Vitamin K 1930 s Neonatal Bleeding / Anemia Be sure Vitamin K is given Check maternal platelet count Is the infant well or sick? APT test Maternal vs NB blood Kleinhauer-Betke Fetal / Maternal Tx Newborn Metabolic Screening Original Screen PKU Galactosemia Congenital Hypothyroidism Cystic fibrosis 11

12 Newborn Metabolic Screening Congenital Hypothyroidism No treatment = severe retardation Treat ASAP 1 / 4000 Newborn Metabolic Screening PKU No treatment = severe retardation PA Tyrosine Dopamine Treatment is dietary Newborn Metabolic Screening Congenital Adrenal Hyperplasia (CAH) Cholesterol androgens No Cortisone No Aldosterone (30%) May die in 2-3 weeks without treatment 12

13 Newborn Metabolic Screening Galactosemia No treatment = severe retardation Missing enzyme Simple dietary treatment Newborn Metabolic Screening Cystic Fibrosis Can t change diagnosis Prenatal planning Avoid malnutrition Future is significantly more positive Newborn Metabolic Screening Organic acids / Fatty acids May have sudden death May have no symptoms Physical / Developmental issue 13

14 Hearing Screen 2-3 infants / 1000 births have hearing loss Most referrals are okay Early intervention helps speech Risk factors are helpful 50-60% genetic 25% pregnancy related 15-25% idiopathic Montana NBHSI ,071 98% screen by 1 month (In hospital birth 99 out of hospital 42. Midwife 39) 83% diagnosed by 3 months 50% early intervention 21 cases hearing loss 10 cases - permanent 14