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IDENTIFICATION AND CLASSIFICATION OF

NEONATE WITH INFECTIONS

PRESENTED BY:
K. SUREKHA

Definition of immunity
Immunity is a biological term that describes a state of having sufficient biological

defenses to avoid infection, disease, or other unwanted biological invasion.

TYPES OF IMMUNITY

PREDISPOSING FACTPRS FOR NEONATAL INFECTIONS


Low birth weight / prematurity Contaminated environment in uterus Infected birth passages

Congenital anomalies
Hospital procedures Artificial feeding

CLASSIFICATION OF NEWBORN INFECTIONS


Intrauterine infections: it refers to infection acquired in utero. The TOURCH a group of infections (syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus)

belonging to this category.

Cont
Perinatal infections: in refers to infection that is

acquired just before pregnancy and during delivery


from the mother. Such an infection occurs from the organisms colonizing the birth passage. Early neonatal infection: should be limited to perinatal infection with manifestations occurring within 72 hours of birth.

Cont
Late onset neonatal infection: it is sepsis occurring after 8th day of birth. Post neonatal infection: it refers to infections occur after 28 days of delivery. The organisms responsible for post neonatal infections are Staphylococcus areus, klebsialle Proteus, E.coli,

salmonella pseudomonas, Candida albicans.

Based on the causative organisms

Bacterial infections Viral infections

Protozoa infections
Fungal infections

HIV AND AIDS

HIV AND AIDS


In 2009, the World Health Organization (WHO) estimated that there are 33.4 million people worldwide living with HIV/AIDS, with

2.7 million new HIV infections per year and


2.0 million annual deaths due to AIDS

CONT

At the end of 2010, there were 3.4 million children living with HIV around the world. An estimated 390,000 children became newly infected with HIV in 2010.

Definition:
An infectious disease of the immune system
caused by a human immunodeficiency virus

(HIV). AIDS is characterized by a decrease in


the number of helper T cells, which causes a severe immunodeficiency that leaves the body susceptible to a variety of potentially fatal infections.

The dictionary.com

Definition:
A disease of the immune system characterized by increased susceptibility to opportunistic infections, as pneumocystis carinii pneumonia and candidiasis, to certain cancers, as Kaposi's sarcoma, and to neurological disorders caused by a

retrovirus.
-PUB MED

HUMAN IMMUNODEFICIENCY VIRUS

Rotes of transmission of HIV:


Blood

Breast milk

Semen

Preejeculate

Vaginal fluid

Risk factors of pediatric AIDS include:


Mothers who addicted with intravenous drugs. Mothers who indulge in prostitution. Mothers who are heterosexual with bisexual husbands. A history of blood transfusion with blood or its products including factor-8 concentrates with in preceding 5 years. A history of residence in certain geographical areas that are inhabited considerably with aids patients.

Timing of maternal infant transmission


Intrauterine: 25-40% Intrapartum: 60-75%. Added risk of breast -feeding: 12-14%.

MATERNAL TRANSMISSION OF HIV

CLINICAL

MANIFESTATIONS:

Differences in pediatric and adult HIVinfection: Overall progression of disease is more rapid in children Immune system is more immature with adults. CD4+ counts Recurrent invasive bacterial infections are more common in children Disseminated CMV, Candida, Herpes Simplex and Varicella Zoster are more common LIP occur almost exclusively in children

CNS infections are common


Peripheral neuropathy, Myopathy is rare in children.

WHO - CLINICAL STAGING SYSTEM


CLINICAL STAGE I Asymptomatic General Lymphadenopathy

CONT.
CLINICAL STAGE II Diarrhea >30 days Sever persistent or recurrent diarrhea outside neonatal period. Weight loss failure to thrive

Persistent fever >30 days


Recurrent sever bacterial infection other than

Septicemia or Meningitis. (e.g. Osteomylitis, Abscess,


Bacterial Pneumonia-non tubercular)

CONT.
CLINICAL STAGE III

AIDS defining opportunistic infections.


Sever failure to thrive.

Progressive Encephalopathy.
Malignancy.

Recurrent Septicemia or Meningitis.

MANAGEMENT
Zudovidine(ZDV,AZT)- 90-180mg/m2 6-8 hr Lamivudine(3TC) -4mg/kg BD Didanosine (ddL) 90-150 mg/kg 12 hrly Stavudine(d4D)-1mg/kg 12 hrly Abacavir(ABC)-8mg/kg 12hrly Zalcitabine(ddc)-0.005-0.01mg/kg 8 hrly

IMMUNIZATION
HIV-exposed children should be immunized according to the routine national immunization schedule with the following notes: BCG should not be given in symptomatic HIVinfected children. HiB vaccine should be given to all who are confirmed HIV-infected on the basis of 2

CONT
Positive DNA PCR tests done at 6 weeks of age. Additional vaccines such as

Pneumcoccal, Varicella, Hepatitis A, Influenza Virus etc. may be given as necessary.

Vitamin A supplementation should be as per the UIP

schedule.

NURSING MANAGMENT
Acceptable, Feasible,
Affordable, Sustainable and Safe, avoidance

OPHTHALMIC
NEONATRUM

Definition
Ophthalmic neonatorum was the term used to describe a hyper

acute purulent conjunctivitis, usually caused by gonococcus, in


the first 10 days of life. -WHO Ophthalmic neonatrum was the term used that any hyper acute purulent conjunctivitis occurring during the first 10 days of life, usually contracted during birth from infected vaginal discharge of the mother. -MedicalDictionary

Cont
Neonatal conjunctivitis is swelling (inflammation) or infection of the tissue

lining the eyelids in a newborn.


According to Pub Med

Causes:
Non infectious Infectious

pathophysiology
Inflammation of conjunctiva

Blood vessel dilation & chemosis

Absence of tears at birth

A newborn with gonococcal ophthalmic neonatorum.

Swelling and purulent drainage

Hyperemic & Chemosis of conjectiva

Diagnostic studies:
Culture of the drainage from the eye to look for bacteria or viruses

Slit-lamp examination to look for damage to


the surface of the eyeball

Prophylaxis
Antenatal Natal Postnatal measures 1% tetracycline / 0.5% erythromycin / silver nitrate solution ointment. Ceftriaxone 50mg/kg IM or IV

NURSING CARE:
Principles of cleanliness at childbirth Clean hands

Clean perineum
Nothing unclean introduced vaginally

Clean delivery surface


Cleanliness in cord clamping and cutting

Cleanliness for cord care

CONGENITAL
SYPHILIS

DEFINITION
Congenital syphilis occurs when the spirochete
Treponema palladium is transmitted from a pregnant woman to her fetus. Infection can result in stillbirth, prematurity, or a wide spectrum of clinical

manifestations; only severe cases are clinically apparent at birth.


-WHO

RISK FACTORS
A baby has an increased risk of developing congenital syphilis if the mother: Lack of or inadequate prenatal care. Maternal substance abuse. Failure to repeat a serological test for syphilis in the third

trimester.
Treatment failure. Inadequate access to Sexually Transmitted Diseases (STD)

clinics and STD outreach activities.

MODES OF TRANSMISSION:
Sexual contact.

Trans-placental passage from infected


mother.

Contact with lesion at the time of delivery.


The risk of developing syphilis after

exposure is about 40%.

TYPES:
ACQUIRED SYPILIS CONGENITAL SYPHILIS

CLASSIFICATION:

EARLY: It occurs in children between 0 and 2 years old.

LATE: Late congenital syphilis is a subset of


cases of congenital syphilis

PATHOPHYSIOLOGY
Initial invasion through mucous membranes or skin The organism rapidly multiplies and widely disseminates Organism spreads through the perivascular lymphatics Primary clinical manifestations

Hutchinson's trait

Scarring skin around the mouth & nasal discharge

Secondary lesions on feet

Lesions on face

Hutchinson's teeth (Abnormal notched and peg-shaped, blunted upper incisor teeth)

Saddle nose (collapse of the bony part of nose)

Clutton's joints (swelling of joints)

Sabre shins

Osteochondritis of distal radius and ulna

Osteochondritis of femur and tibia metaphysis

Papulosquamous Plaques

CSF abnormalities may occur in congenital syphilis Even in absence of neurologic involvement. * Leukocytosis * Elevated protein in CSF * positive VDRL (no false positives)

TREATMENT
Proven or highly probable:

Aqueous crystalline Penicillin G 100,000-150,000U/kg/day (given q8-q12hrs) IV for 10 days OR Procaine Penicillin G 50,000 U/kg/day IM for 10days
If >1 day of therapy missed, entire course should be restarted!

Asymptomatic, Normal CSF exam, CBC, platelets, and Radiologic exam: 1. No maternal tx aqueous PCN G IV for 10-14 days 2. Tx w/ Erythromycin clinical, serologic follow-up, and Benzathine Pcn G IM x 1 3. Tx < 1month before Delivery, or <4 fold Decrease in titers clinical, serologic follow-up and Benzathine Pcn G IM x 1

Treat all newborns w/ positive VDRL as if they have


congenital syphilis, even if mother thought to not have an active infection.

1.

Difficult to document that mother received adequate tx,


and has falling VDRL titer.

2. Low titer VDRL test may be compatible with latent maternal syphilis. 3. Newborn may not have clinical manifestations at birth. 4. Compliance with follow-up visits may be problem.

Follow-up
Should have careful follow-up examination at
1, 2, 4, 6, and 12 months of age. Serologic non-treponemal tests: 3, 6, 12 months, and end of tx (or until non-reactive) Non-treponemal Ab titers decline by 3 months of age, and Should be Non-reactive by 6 months, if infant was not infected. (transplacentally aquired antibodies.)

If persistent, stable titers, consider retreatment.


Congenital neurosyphilis- CSF exam at 6 month intervals until normal