BLOOD DISORDERS

HEMOLYTIC DISEASE OF THE NEWBORN

ABO incompatibility most common hemolytic disease of the newborn Mother- usually Type O Infant- may be type A or B Occurs in 20-25% of pregnancies 10% develops hemolytic disease Generally type A1

Clinical manifestations
Most cases are mild Jaundice being the only clinical manifestation Infant not affected at birth pallor is not present Liver and spleen not enlarge Jaundice usually appears during the 1st 24 hr

Diagnosis
Presumptive diagnosis- presence of ABO incompatibility Positive direct Coombs test Hyperbilirubinemia-often the only other laboratory abnormality Hemoglobin level- usually normal 10-20% of affected infants-unconj serum bilirubin may reach 20 mg/dl

Treatment
Phototherapy Exchange transfusion w/ type O blood of same Rh type as the infant

HEMORRHAGE IN THE NEWBORN INFANT

Hemorrhagic disease of the newborn Decrease in factors II, VII,IX, X-occurs in NB by 48-72 hr after birth Gradual return to birth levels by 7-10 days Probably due to: lack of free vitamin K from mother Absence of bacterial intestinal flora responsible for synthesis

Clinical manifestations
Bleeding from: Gastrointestinal Nasal Subgaleal Intracranial postcircumcision

Diagnosis
PT, PTT,coagulation time- prolonged Factors II, VII,IX,X significantly decreased

Treatment
Prevention- 1 mg Vitamin K IM at birth
Treatment- Vitamin K 1-5 mg slow IV infusion Fresh frozen plasma or whole blood transfusion in serious bleeding

Early onset age Site of hemorrhag

0-24 hr
cephalhematoma subgaleal Intracranial GI umbilicus

Classic disease
2-7 days
ENT Intracranial Circumcision Cutaneous GI Injection sites

Late onset
1-6 mo
Intracranial GI Cutaneous ENT Injection sites thoracic

Etiology
prevention

Maternal drugs Vitamin K that interfere w/ deficiency vit K braestfeeding

Vitamin K at birth Very rare Parenteral vitamin K at birth

Cholestasis Abetalipoprotei n def

Vitamin K during period of cholestasis

incidence

2% if not given Dependent on Vit K primary disease

INFECTIONS OF THE NEONATE

Definition of terms
BACTEREMIA
Recovery of bacteria in a blood culture May be a transient phenomenon not associated with disease or the serious extension of an invasive bacterial infection originating in the GIT, GUT, skin and respiratory tracts.

Definition of terms
SEPSIS
Severe form of bacteremia associated w/ active disease Referred to as the systemic response to infection w/ a constellation of signs and symptoms due to micro organisms of their toxic products in the circulation

Definition of terms
SEPSIS SYNDROME
Clinical presentation of sepsis w/ evidence of inadequate organ perfusion manifested by altered mental status, hypoxemia acidosis or oliguria Present in the absence of documented bacteremia

Definition of terms
MULTIPLE ORGAN DYSFUNCTION SYNDROME Organ function in an acutely ill patient so that homeostasis cannot be maintained w/out intervention

Definition of terms
SEPTIC SHOCK
Sepsis syndrome accompanied by hypotension or hypoperfusion ( poor capillary refill, cyanosis w/ hypoxemia, oliguria, acidosis) or altered mental status despite adequate fluid resuscitation

Definition of terms
NOSOCOMIAL INFECTIONS
Infection with a bacterial pathogen more than 3 days after birth (signs of generalized infection, positive culture, antibiotic tx for 5 days )

ORGANISMS THAT CAUSE NEONATAL SEPSIS

PRENATAL Rubella (german measles) cytomegalovirus
Varicella zoster virus Listeris monocytogenes

DURING DELIVERY Group B streptococcus

E. coli Herpes simplex virus

FOCAL NEONATAL INFECTIONS

Neonatal Pneumonia
Acquired transplacentally, perinatally,postnatally Risk factors include prematurity, PROM, chorioamnionitis, and fetal distress Clinical course/ chest radiograph is indistinguishable from severe HMD in GBS pneumonia

EARLY ONSET SEPSIS

Onset Incidence Obstetric risk Transmission Clinical sx Treatment Mortality Birth < 7 days, usually <3 days 5-25% Colonization, amnionitis,prematurity vertical Respiratory distress Meningitis 30% Ampi/genta or cefotaxime 10-30%

LATE ONSET SEPSIS

onset
incidence Obstetric risk transmission
8-28 days,occ 60 days

5-25% unusual Vertical/postnatal envt

Pyelonephritis,osteomyelitis,septis arthritis,cellulitis, meningitis 75%

Clinical sx
treatment

mortality

Ampi/genta or cefotaxime 10-20%

LATE-LATE ONSET SEPSIS

Onset Incidence Transmission Clinical sx >3 months Obstetric risk varies Post natal envt Associated with prolonged instrumentation Amphotherin/vancomyci low

Treatment Case fatality