NEONATAL INFECTION AND BIRTH INJURIES.pptx

Birth injuries:subconjuntival haemorrhage, ecchymosis,abrasion
Scalp injuries: subgeal bleed,caput succedaneum,cephalhematoma

1. NEONATAL INFECTIONS BY: BOAKYE, EMMANUEL PEPRAH MBCHB

2. DEFINITION I nfection refers to the invasion and proliferation of microorganisms in the body of an organism. A neonate is a newborn less than 28 days of life. Various organisms can cause infection in the newborn due to immaturity of their immune system.

3. aetiology N eonatal infection may be caused by a single group of microorganism or a combination of organisms. I t may include bacteria, viral , fungal or parasites. The presentation may vary according to the organism and site affected

4. S igns and symptoms of neonatal infection Fever( temperature >37.5) Hypothermia Hypoglycemia Poor feeding Vomiting Splenomegaly Hepatomegaly Seizures Tachypnea tachycardia

5. N eonatal sepsis T his is a clinical syndrome in a neonate ( up to 28 days of life) manifested by systemic signs of infection and isolation of a pathogen in the bloodstream I t may be classified based on duration of onset as early onset ( within 72 hours of life) or late onset (after 72 hours of life).

6. Early onset neonatal sepsis Infection can be acquired through the birth tract especially when there is Premature Rupture of Membranes , through the placenta as a result of maternal infection. Signs of infections are usually broad & vague in the newborn.

7. E arly onset neonatal sepsis risk factors Antenatal Infections Labour & delivery PROM Spontaneous Preterm labour Prolonged labour Multiple vaginal examinations Poor IPC practices Aspiration of meconium Resuscitation at birth Maternal infections like UTI, chorioamnionitis etc Fever > 38C Home delivery

8. Late onset neonatal sepsis Confirmed infection in the neonate after 72 hours of life Usually, causative organisms are picked from the postnatal environment

9. R isk factors for late onset sepsis Prolonged Hospital stay Delay in initiation or lack of breastmilk Overcrowding Excessive procedures & investigations / Handling by staff (Cluster nursing) Poor or lack of infection prevention & control measures Prolonged antibiotic use Prematurity “Some traditional / cultural practices”

10. Management High index of suspicion and low threshold for prescribing antibiotics (one of the few groups of patients in whom this is acceptable) Investigations should include at least a FBC and a sample for culture and sensitivity: Blood CS is the Gold standard for the investigation of Sepsis in neonates Start empirical antibiotics Antibiotics may be changed depending on how baby is doing clinically and or on the results of the C & S

11. CORD SEPSIS Infection of the cord stump and surrounding area…signs of inflammation Commonly caused by the application of shea butter, dung and use of unclean water for bathing It delays falling off of the cord ,which should normally fall off by 7-10 days Other causes of delayed falling off of the cord include jaundice Manage with empirical antibiotics. Cord care

12. CORD SEPSIS

13. IMPETIGO This is staphylococcal infection of the newborn skin Could also be non-staphylococcal- Streptococcus pyogenes Manifests as pustules with red bases Could be nonbullous (70% of cases) or bullous Predispositions include unclean water and colonization of the newborn skin with relevant bacterial strains Treatment is oral antibiotics or topical ( mupurocin ) cream in babies who look well Parenteral antibiotics can be used in babies who look toxic

14. IMPETIGO

15. OPTHALMIA NEONATORIUM Infection of the neonate’s eyes secondary to colonization of the maternal birth canal with bacteria (N gonorrheae , C trachomatis) Chemical irritation and HSV infections are also considered sometimes Mild forms should be treated with tetracycline or chloramphenicol or erythromycin ointments after adequate irrigation of the affected eye(s). Severer forms require admission, topicals and systemic cephalosporin eg ceftriaxone I.M Adequate irrigation of the eyes before applying topicals

16. MENINGITIS Inflammation of the meninges due to infection Mostly caused by bacteria Onset Acute ( symptoms evolving rapidly over 1-24hrs) Sub acutely ( 1-7days ) Chronically (> 1 wk ). Clinical emergency Potentially fatal ( mortality 35-40%

17. Meningitis In the newborn, it is commonly caused by; Group B  Streptococcus, Escherichia coli , Listeria monocytogenes, staph aureas .

18. MENINGITIS Manifests with seizures, dystonia and bulging fontanelles Other nonspecific signs and symptoms like poor feeding, irritability and abnormal crying Treat with crystalline penicillin+genta or ampicillin+ cefotaxime Seizures should be managed with phenobarbitone Perform lumbar puncture in a suspected case of meningitis unless contraindicated eg skin infection overlying the spine, thrombocytopenia, ongoing seizure, signs of raised intracranial pressure etc

19. BIRTH INJURIES These are injuries sustained by the newborn during the delivery process I nadequate obstetric skills may increase the incidence of birth injuries but may occur regardless of the skills and experience of the individual conducting the delivery .

20. Risk factors Cephalopelvic disproportion Malpresentation eg shoulder, breech presentations Repeated vaginal examinations Instrumentation Prolonged labour

21. S oft tissue injuries These include ecchymosis, abrasions and subconjunctival hemorrhages They usually resolve on their own So managed with watchful waiting

22. Ecchymosis and facial edema

23. S ubconjunctival hemorrhage

24. S calp injuries These are commonly caused by prolonged labour They include caput succedaneum, cephalhematoma and subgaleal bleed in order of increasing morbidity

25. Layers of the scalp

26. CAPUT SUCCEDANEUM A diffuse, edematous swelling of the soft tissues of the scalp involving the presenting part in an SVD. It is nontender May extend across the midline and sutures Edema usually disappears within the 1 st few days of life No specific treatment is needed

27. CELPHALHEMATOMA Hemorrhage restricted to between the skull bone and overlying periosteum Hence bleeding always limited to surface of one cranial bone No obvious discoloration of overlying scalp An underlying linear skull fracture may be seen Resolution usually within 2weeks - 3months depending on size A massive one could lead to anemia and hyperbilirubinemia

28. CEPHALHEMATOMA

29. TREATMENT Usually, no treatment is required Phototherapy may be required in very massive bleeds Monitoring of the PCV / Hb may be necessary to rule out anemia I & D IS CONTRAINDICATED

30. SUBGALEAL/SUBAPONEUROTIC BLEED Collection of blood under the aponeurosis and superficial to the periosteum, hence it crosses suture lines Risk factors include prolonged labour and instrumentation Can be prone to shock, anemia and hyperbilirubinemia

31. SUBGALEAL /SUBAPONEUROTIC BLEED

32. MANAGEMENT Monitoring/evaluation of swelling, vital signs, HB/PCV • Haemotransfusion when needed • Be on the look out for hypovolemic shock • Monitor for jaundice and manage accordingly

33. NERVE INJURIES Usually results in paralysis of the upper part of the arm with or without paralysis of the forearm or hand or, more commonly, paralysis of the entire arm Risk factors: macrosomic infants, shoulder dystocia- , poor handling in the neonatal period, infections of bone and joint

34. ERB DUCHENNE PALSY

35. ERB DUCHENNE PALSY

36. ERB DUCHENNE PALSY Injury to the 5th and 6th cervical nerves (C7 in 50%). Adduction and internal rotation of the arm with pronation of the forearm; flexion of wrist and fingers-- "Waiter's tip" position Power of extension of forearm is intact but biceps reflex is lost; Moro reflex is absent on the affected side. Presence of hand grasp is a good prognostic sign. Treatment: Physiotherapy after 10-14 days after birth— B/4, gentle immobilization of arm against abdomen to prevent further injury-swelling/bleeding

37. KLUMPKE’S PALSY Rarer form of brachial palsy Commonly, injury to C7, C8 and T1 nerves Paralysis of hand with clawing; when the sympathetic fibres of T1 are involved, it results in ipsilateral ptosis & miosis (Horner syndrome) Mild cases may not be detected immediately at birth

38. KLUMPKE’S PALSY 1. Return of function if edema or hemorrhage resolves- may take months to resolve 2. laceration:- causes permanent damage Partial immobilization and appropriate positioning; Gentle massage and range of motion exercises to be started when 7-10 days of age.

39. CLAVICULAR FRACTURE CLAVICLE: The most fractured bone during delivery; mostly during delivery of the shoulder in vertex and of the extended arms in breech Signs:-no free arm movement on affected side -crepitus and bony irregularity -Moro reflex may be absent Excellent prognosis Treatment (if any)-immobilization of arm and shoulder A remarkable degree of callus forms within a week and may be the first sign of the fracture.

40. CLAVICULAR FRACTURE

41. HEMURAL FRACTURE Risk factors include big baby, CPD, shoulder dystocia & precipitous deliveries Management - immobilization of involved arm for 2 weeks Flex the elbow at 90 and strap the forearm across the lower chest wall with a bandage

42. HEMURAL FRACTURE

43. MANAGEMENT

44. FEMURAL FRACTURE Risk factors are big baby, breech presentation Thigh looks deformed, swollen and may be reddened Main mode of Management involves splinting the limb from the waist to below the knee and applying the bandage from underneath the level of the umbilicus and around the thigh to below the knee.

45. FE MURAL FRACTURE

46. FEMURAL FRACTURE

47. MANAGEMENT

48. ANY QUESTIONS ? THANK YOU!!!