Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection within the first month of life. It is a leading cause of neonatal mortality, responsible for about 52% of neonatal deaths. The presentation and risk factors differ based on whether the onset of sepsis is early (within 72 hours of life) or late (after 72 hours of life). Management involves screening protocols to determine the need for antibiotics and treatment, which typically involves empiric broad-spectrum antibiotics that may need to be adjusted based on culture and sensitivity results. Close monitoring is important as the condition can deteriorate rapidly.
The document discusses the approach to evaluating and diagnosing bleeding in neonates. It notes that while the neonatal coagulation system is immature compared to adults, healthy term infants do not typically have bleeding issues. A bleeding neonate should first be assessed for general health and vitamin K administration history. Screening tests include a complete blood count, coagulation tests, and peripheral smear. Abnormal results can indicate disorders like disseminated intravascular coagulation, infection, liver disease, immune thrombocytopenia, or inherited coagulation factor deficiencies. The causes, patterns, and management of various bleeding disorders seen in neonates are described.
This document discusses neonatal thrombocytopenia. It defines thrombocytopenia in neonates as a platelet count below 150,000/mcL. The incidence is 0.7-0.9% overall but higher in NICUs at 22-35%. Causes include fetal alloimmune conditions, infections, genetic disorders, placental insufficiency, and perinatal complications. Evaluation and management depends on timing of onset (early vs late) and severity (mild, moderate, severe). Testing may include antigen screening for conditions like NAIT. Treatment involves treating any underlying conditions, IVIG, and platelet transfusions following guidelines based on platelet count and clinical status.
H.D. is a preterm newborn with risk factors for sepsis including prematurity, low birth weight, and maternal risk factors. Clinical signs observed in H.D. that indicate sepsis include tachycardia, hypothermia, leukopenia, neutropenia, and an elevated C-reactive protein level. Empiric intravenous antibiotic treatment with ampicillin and an aminoglycoside such as gentamicin should be started immediately to treat potential bacterial infections like group B streptococcus while culture results are pending. Management of neonatal sepsis aims to identify the pathogen, treat with appropriate antibiotics to prevent mortality and complications like meningitis, and consider switching or adding antibiotics based on suspected organism and patient condition.
This document discusses neonatal hypocalcemia, including its types, causes, and management. There are two types - early onset within 72 hours requiring calcium supplementation, and late onset after 7 days requiring longer treatment. Hypocalcemia is defined as low serum calcium levels. Causes of early onset include prematurity, maternal conditions, and iatrogenic factors. Management of early onset involves calcium supplementation. Late onset in the first week is usually symptomatic and caused by high phosphate intake. Causes also include hypomagnesemia, vitamin D deficiency, and genetic or metabolic syndromes.
Neonatal sepsis is a clinical syndrome of bacteremia and infection in infants under 4 weeks of age. Common causes are E. coli, Group B Streptococcus, and Listeria. It can be early-onset from transmission during birth or late-onset from hospital-acquired infections. Symptoms are non-specific but include respiratory distress, feeding issues, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment is antibiotics like ampicillin and gentamicin for 10-14 days along with supportive care. Prevention includes good antenatal care, treating maternal infections, early breastfeeding and infection control policies in the NICU.
Neonatal sepsis is defined as a clinical syndrome of infection occurring in the first month of life, characterized by non-specific signs and symptoms. It can involve septicemia, pneumonia, or meningitis. Common causative organisms include E. coli, Staphylococcus aureus, Group B Streptococcus, and Klebsiella species. Risk factors include prematurity, prolonged rupture of membranes, and maternal fever. Diagnosis involves a sepsis screen of a complete blood count, blood culture, and C-reactive protein level. Treatment involves broad-spectrum antibiotics like ampicillin and gentamicin or cefotaxim and amikacin with supportive care. Outcomes depend on gestational age,
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
The document discusses the approach to evaluating and diagnosing bleeding in neonates. It notes that while the neonatal coagulation system is immature compared to adults, healthy term infants do not typically have bleeding issues. A bleeding neonate should first be assessed for general health and vitamin K administration history. Screening tests include a complete blood count, coagulation tests, and peripheral smear. Abnormal results can indicate disorders like disseminated intravascular coagulation, infection, liver disease, immune thrombocytopenia, or inherited coagulation factor deficiencies. The causes, patterns, and management of various bleeding disorders seen in neonates are described.
This document discusses neonatal thrombocytopenia. It defines thrombocytopenia in neonates as a platelet count below 150,000/mcL. The incidence is 0.7-0.9% overall but higher in NICUs at 22-35%. Causes include fetal alloimmune conditions, infections, genetic disorders, placental insufficiency, and perinatal complications. Evaluation and management depends on timing of onset (early vs late) and severity (mild, moderate, severe). Testing may include antigen screening for conditions like NAIT. Treatment involves treating any underlying conditions, IVIG, and platelet transfusions following guidelines based on platelet count and clinical status.
H.D. is a preterm newborn with risk factors for sepsis including prematurity, low birth weight, and maternal risk factors. Clinical signs observed in H.D. that indicate sepsis include tachycardia, hypothermia, leukopenia, neutropenia, and an elevated C-reactive protein level. Empiric intravenous antibiotic treatment with ampicillin and an aminoglycoside such as gentamicin should be started immediately to treat potential bacterial infections like group B streptococcus while culture results are pending. Management of neonatal sepsis aims to identify the pathogen, treat with appropriate antibiotics to prevent mortality and complications like meningitis, and consider switching or adding antibiotics based on suspected organism and patient condition.
This document discusses neonatal hypocalcemia, including its types, causes, and management. There are two types - early onset within 72 hours requiring calcium supplementation, and late onset after 7 days requiring longer treatment. Hypocalcemia is defined as low serum calcium levels. Causes of early onset include prematurity, maternal conditions, and iatrogenic factors. Management of early onset involves calcium supplementation. Late onset in the first week is usually symptomatic and caused by high phosphate intake. Causes also include hypomagnesemia, vitamin D deficiency, and genetic or metabolic syndromes.
Neonatal sepsis is a clinical syndrome of bacteremia and infection in infants under 4 weeks of age. Common causes are E. coli, Group B Streptococcus, and Listeria. It can be early-onset from transmission during birth or late-onset from hospital-acquired infections. Symptoms are non-specific but include respiratory distress, feeding issues, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment is antibiotics like ampicillin and gentamicin for 10-14 days along with supportive care. Prevention includes good antenatal care, treating maternal infections, early breastfeeding and infection control policies in the NICU.
Neonatal sepsis is defined as a clinical syndrome of infection occurring in the first month of life, characterized by non-specific signs and symptoms. It can involve septicemia, pneumonia, or meningitis. Common causative organisms include E. coli, Staphylococcus aureus, Group B Streptococcus, and Klebsiella species. Risk factors include prematurity, prolonged rupture of membranes, and maternal fever. Diagnosis involves a sepsis screen of a complete blood count, blood culture, and C-reactive protein level. Treatment involves broad-spectrum antibiotics like ampicillin and gentamicin or cefotaxim and amikacin with supportive care. Outcomes depend on gestational age,
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
This document provides information on acute pediatric gastroenteritis. It defines gastroenteritis and discusses its main causes such as rotavirus, norovirus, and various bacteria. Signs and symptoms include diarrhea, vomiting, fever and dehydration. Management involves oral rehydration with WHO oral rehydration solution. For severe dehydration, intravenous fluids are used. Antibiotics generally are not needed unless for specific infections. Probiotics and zinc supplementation may shorten the duration of diarrhea.
This document discusses neonatal hematological disorders, including physiological anemia of the newborn, pathological anemia, and hemorrhagic disease of the newborn. Physiological anemia occurs as hemoglobin levels normally decrease after birth. Pathological anemias can result from blood loss, hemolysis, or diminished red blood cell production. Hemorrhagic disease of the newborn is caused by vitamin K deficiency and can cause bleeding at injection sites, in the GI tract, or intracranially. Treatment involves vitamin K supplementation to prevent hemorrhagic disease, and blood transfusions to treat blood loss or low hemoglobin levels.
This document discusses neonatal jaundice (hyperbilirubinemia) in infants. It covers the definition, causes, types (physiological vs pathological), investigations, management including phototherapy and exchange transfusion, and prevention of kernicterus. Key points include:
- Jaundice is caused by high bilirubin levels which cause yellowing of the skin and eyes. Bilirubin is produced from the breakdown of red blood cells.
- Physiological jaundice appears after 24-72 hours and is common, while pathological jaundice appears within 24 hours and requires treatment.
- Management involves phototherapy to reduce bilirubin levels or exchange transfusion for severe
This neonatal case presentation involves a 16 day old infant admitted to the NICU with jaundice since birth and vomiting for 1 day. Investigations revealed severe anemia, indirect hyperbilirubinemia, increased reticulocyte count, and elevated LDH. The infant received a PRBC transfusion and was discharged with improved Hb. The clinical picture is suggestive of hemolytic anemia, possibly due to fetomaternal hemorrhage given the maternal history of blood transfusions in the second trimester.
1. This case presents a 1.5 month old boy with pancytopenia, fever, and respiratory symptoms.
2. Initial workup showed normocytic anemia, leukopenia, thrombocytopenia, and low corrected reticulocyte count. Bone marrow aspiration found erythroid dysplasia and megaloblastic changes.
3. Further testing found B cell immune deficiency. The patient was eventually diagnosed with MYSM1 mutation, a rare cause of congenital sideroblastic anemia and immunodeficiency. He requires supportive care including transfusions and immunoglobulin therapy.
This document discusses prematurity and the management of preterm infants. It defines prematurity as birth before 37 weeks gestation. It describes the problems that can occur in preterm infants relating to immaturity of organ systems, including respiratory issues, temperature regulation difficulties, neurological impairments, and metabolic concerns like hypoglycemia. The document outlines assessment and management approaches for various initial problems in the preterm newborn as well as long term issues involving development, medical complications, and social factors. Mortality and morbidity rates are provided based on gestational age and birth weight.
This document summarizes the approach to hypertension in children. It defines hypertension and prehypertension based on blood pressure percentiles for age, gender and height. Secondary causes of hypertension in children include renal, cardiovascular, endocrine and neurological conditions. Evaluation involves assessing for target organ damage and investigating for underlying causes based on clinical features. Treatment involves lifestyle modifications and medications like ACE inhibitors, calcium channel blockers and diuretics based on the patient's age, gender and other health conditions. Hypertensive crisis requires prompt parenteral treatment to lower blood pressure over minutes to hours to prevent complications.
Definition
A group of malignant diseases in which genetic abnormalities in a hematopoietic cell give rise to an unregulated clonal proliferation of cells
The progeny of these cells have a growth advantage over normal cellular elements, with an increased rate of proliferation & a decreased rate of spontaneous apoptosis
Disruption of normal marrow function, leading to marrow failure
This document provides an overview on approaching and managing a child with jaundice. It begins by defining jaundice as a visible manifestation of increased bilirubin levels. It then discusses the burden of jaundice in newborns, describing how most will experience some jaundice in the first week due to immature bilirubin metabolism. The document outlines how to classify jaundice as physiological or pathological based on clinical signs and bilirubin levels. For pathological jaundice, the main treatment approaches of phototherapy and exchange transfusion are described. The document provides guidance on evaluating the potential causes of jaundice and managing cases based on whether the hyperbilirubinemia is conjugated or
Neonatal jaundice refers to yellowing of the skin and eyes in newborns due to high bilirubin levels. Severe hyperbilirubinemia can cause bilirubin-induced neurological dysfunction (BIND) if bilirubin crosses the blood-brain barrier and causes brain cell death. BIND may present as acute bilirubin encephalopathy with symptoms like lethargy, poor feeding, and seizures, or progress to chronic bilirubin encephalopathy called kernicterus with neurological deficits. Treatment involves phototherapy or exchange transfusion to reduce bilirubin levels and prevent permanent brain damage.
This document provides guidance on managing neonatal jaundice. It discusses how to suspect, measure, diagnose, approach, manage, and educate parents about physiological and pathological jaundice. Key points include that 60-80% of newborns develop jaundice, jaundice persisting beyond 14 days requires further investigation, and physiological jaundice is generally harmless and does not require treatment beyond observation.
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
Pediatric Acute Liver Failure (PALF) is defined as evidence of liver dysfunction within 8 weeks of symptoms onset in children, with uncorrectable coagulopathy and no evidence of chronic liver disease. Common etiologies include viral hepatitis, drugs, and other metabolic causes. Diagnostic workup involves general and etiology-specific tests. Key parameters to monitor include encephalopathy grade, coagulopathy, electrolytes, and complications. Treatment focuses on supportive care, complication management, and liver transplantation if indicated based on severity scores. Prognosis depends on etiology and degree of encephalopathy.
Pediatric urinary tract infections (UTIs) are common in children, especially girls under the age of 1. Left untreated, UTIs can cause renal scarring and long-term kidney damage. Diagnosis involves urine tests to check for white blood cells and bacteria. Treatment depends on symptoms and severity but often involves antibiotics and hydration. Follow up is important to monitor for recurrent UTIs and issues like vesicoureteral reflux, as both increase risk of permanent kidney damage if not addressed.
This document provides an overview of hemolytic anemia in children. It defines hemolytic anemia as anemia resulting from increased red blood cell destruction. The document describes the different types of hemolytic anemia including hereditary, immune, and non-immune causes. It outlines the pathophysiology, clinical features, diagnostic approach and management of common forms of hemolytic anemia in children such as hereditary spherocytosis, thalassemia, sickle cell anemia, and G6PD deficiency. Investigations for diagnosis include blood counts, peripheral smear, reticulocyte count, hemoglobin electrophoresis and enzyme or genetic testing depending on etiology.
This document provides guidance on managing birth asphyxia through proper newborn resuscitation. Key points discussed include:
1. Preparation for delivery is critical as each birth is an emergency, ensuring proper equipment and staff readiness.
2. Initial resuscitation steps are providing warmth, clearing the airway, drying and stimulating the newborn. Positive pressure ventilation may be needed if breathing does not improve.
3. If the heart rate remains low despite adequate ventilation, chest compressions and medications like epinephrine may be administered to support circulation. Intubation should only be considered in specific situations.
4. Post resuscitation care focuses on monitoring vital signs and providing support until stabilization is achieved.
- Human milk is ideal for infants but lacks sufficient protein and minerals for preterm infants, especially very low birth weight infants. Human milk fortifiers were developed to supplement breast milk and meet the nutritional needs of preterm infants to support growth.
- Commercial fortifiers provide additional protein, minerals, calories, vitamins and electrolytes. Liquid fortifiers dilute breast milk while powder fortifiers may not fully dissolve. Fortifiers have been shown to improve growth, bone mineralization and outcomes in preterm infants. Monitoring is needed due to risks of electrolyte imbalances. Lactoengineering breast milk by feeding hindmilk is proposed as an alternative.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
The document summarizes neonatal sepsis, including its definition, epidemiology, causes, symptoms, diagnosis, and treatment. It discusses the pathophysiology of neonatal immune deficiency that predisposes infants to sepsis. Early and late onset sepsis are described, along with common pathogens for each. Risk factors like prematurity, maternal infections, and invasive procedures are outlined. The clinical presentation of sepsis is generally non-specific. Evaluation includes blood tests and cultures. Treatment involves initial broad-spectrum antibiotics tailored based on results and infant risk factors. Prevention strategies like vaccines and hand washing are mentioned.
1) Bacterial sepsis in neonates is a clinical syndrome of infection with bacteremia in the first month of life, which can lead to pneumonia or meningitis. It is a major cause of neonatal mortality.
2) Early onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract bacteria. Late onset sepsis occurs after 72 hours and is often due to environmental bacteria or prolonged hospitalization.
3) Diagnosis is based on risk factors, clinical features and confirmation via sepsis screening tests, blood and cerebrospinal fluid cultures. Treatment involves supportive care and antibiotics.
This document provides information on acute pediatric gastroenteritis. It defines gastroenteritis and discusses its main causes such as rotavirus, norovirus, and various bacteria. Signs and symptoms include diarrhea, vomiting, fever and dehydration. Management involves oral rehydration with WHO oral rehydration solution. For severe dehydration, intravenous fluids are used. Antibiotics generally are not needed unless for specific infections. Probiotics and zinc supplementation may shorten the duration of diarrhea.
This document discusses neonatal hematological disorders, including physiological anemia of the newborn, pathological anemia, and hemorrhagic disease of the newborn. Physiological anemia occurs as hemoglobin levels normally decrease after birth. Pathological anemias can result from blood loss, hemolysis, or diminished red blood cell production. Hemorrhagic disease of the newborn is caused by vitamin K deficiency and can cause bleeding at injection sites, in the GI tract, or intracranially. Treatment involves vitamin K supplementation to prevent hemorrhagic disease, and blood transfusions to treat blood loss or low hemoglobin levels.
This document discusses neonatal jaundice (hyperbilirubinemia) in infants. It covers the definition, causes, types (physiological vs pathological), investigations, management including phototherapy and exchange transfusion, and prevention of kernicterus. Key points include:
- Jaundice is caused by high bilirubin levels which cause yellowing of the skin and eyes. Bilirubin is produced from the breakdown of red blood cells.
- Physiological jaundice appears after 24-72 hours and is common, while pathological jaundice appears within 24 hours and requires treatment.
- Management involves phototherapy to reduce bilirubin levels or exchange transfusion for severe
This neonatal case presentation involves a 16 day old infant admitted to the NICU with jaundice since birth and vomiting for 1 day. Investigations revealed severe anemia, indirect hyperbilirubinemia, increased reticulocyte count, and elevated LDH. The infant received a PRBC transfusion and was discharged with improved Hb. The clinical picture is suggestive of hemolytic anemia, possibly due to fetomaternal hemorrhage given the maternal history of blood transfusions in the second trimester.
1. This case presents a 1.5 month old boy with pancytopenia, fever, and respiratory symptoms.
2. Initial workup showed normocytic anemia, leukopenia, thrombocytopenia, and low corrected reticulocyte count. Bone marrow aspiration found erythroid dysplasia and megaloblastic changes.
3. Further testing found B cell immune deficiency. The patient was eventually diagnosed with MYSM1 mutation, a rare cause of congenital sideroblastic anemia and immunodeficiency. He requires supportive care including transfusions and immunoglobulin therapy.
This document discusses prematurity and the management of preterm infants. It defines prematurity as birth before 37 weeks gestation. It describes the problems that can occur in preterm infants relating to immaturity of organ systems, including respiratory issues, temperature regulation difficulties, neurological impairments, and metabolic concerns like hypoglycemia. The document outlines assessment and management approaches for various initial problems in the preterm newborn as well as long term issues involving development, medical complications, and social factors. Mortality and morbidity rates are provided based on gestational age and birth weight.
This document summarizes the approach to hypertension in children. It defines hypertension and prehypertension based on blood pressure percentiles for age, gender and height. Secondary causes of hypertension in children include renal, cardiovascular, endocrine and neurological conditions. Evaluation involves assessing for target organ damage and investigating for underlying causes based on clinical features. Treatment involves lifestyle modifications and medications like ACE inhibitors, calcium channel blockers and diuretics based on the patient's age, gender and other health conditions. Hypertensive crisis requires prompt parenteral treatment to lower blood pressure over minutes to hours to prevent complications.
Definition
A group of malignant diseases in which genetic abnormalities in a hematopoietic cell give rise to an unregulated clonal proliferation of cells
The progeny of these cells have a growth advantage over normal cellular elements, with an increased rate of proliferation & a decreased rate of spontaneous apoptosis
Disruption of normal marrow function, leading to marrow failure
This document provides an overview on approaching and managing a child with jaundice. It begins by defining jaundice as a visible manifestation of increased bilirubin levels. It then discusses the burden of jaundice in newborns, describing how most will experience some jaundice in the first week due to immature bilirubin metabolism. The document outlines how to classify jaundice as physiological or pathological based on clinical signs and bilirubin levels. For pathological jaundice, the main treatment approaches of phototherapy and exchange transfusion are described. The document provides guidance on evaluating the potential causes of jaundice and managing cases based on whether the hyperbilirubinemia is conjugated or
Neonatal jaundice refers to yellowing of the skin and eyes in newborns due to high bilirubin levels. Severe hyperbilirubinemia can cause bilirubin-induced neurological dysfunction (BIND) if bilirubin crosses the blood-brain barrier and causes brain cell death. BIND may present as acute bilirubin encephalopathy with symptoms like lethargy, poor feeding, and seizures, or progress to chronic bilirubin encephalopathy called kernicterus with neurological deficits. Treatment involves phototherapy or exchange transfusion to reduce bilirubin levels and prevent permanent brain damage.
This document provides guidance on managing neonatal jaundice. It discusses how to suspect, measure, diagnose, approach, manage, and educate parents about physiological and pathological jaundice. Key points include that 60-80% of newborns develop jaundice, jaundice persisting beyond 14 days requires further investigation, and physiological jaundice is generally harmless and does not require treatment beyond observation.
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
Pediatric Acute Liver Failure (PALF) is defined as evidence of liver dysfunction within 8 weeks of symptoms onset in children, with uncorrectable coagulopathy and no evidence of chronic liver disease. Common etiologies include viral hepatitis, drugs, and other metabolic causes. Diagnostic workup involves general and etiology-specific tests. Key parameters to monitor include encephalopathy grade, coagulopathy, electrolytes, and complications. Treatment focuses on supportive care, complication management, and liver transplantation if indicated based on severity scores. Prognosis depends on etiology and degree of encephalopathy.
Pediatric urinary tract infections (UTIs) are common in children, especially girls under the age of 1. Left untreated, UTIs can cause renal scarring and long-term kidney damage. Diagnosis involves urine tests to check for white blood cells and bacteria. Treatment depends on symptoms and severity but often involves antibiotics and hydration. Follow up is important to monitor for recurrent UTIs and issues like vesicoureteral reflux, as both increase risk of permanent kidney damage if not addressed.
This document provides an overview of hemolytic anemia in children. It defines hemolytic anemia as anemia resulting from increased red blood cell destruction. The document describes the different types of hemolytic anemia including hereditary, immune, and non-immune causes. It outlines the pathophysiology, clinical features, diagnostic approach and management of common forms of hemolytic anemia in children such as hereditary spherocytosis, thalassemia, sickle cell anemia, and G6PD deficiency. Investigations for diagnosis include blood counts, peripheral smear, reticulocyte count, hemoglobin electrophoresis and enzyme or genetic testing depending on etiology.
This document provides guidance on managing birth asphyxia through proper newborn resuscitation. Key points discussed include:
1. Preparation for delivery is critical as each birth is an emergency, ensuring proper equipment and staff readiness.
2. Initial resuscitation steps are providing warmth, clearing the airway, drying and stimulating the newborn. Positive pressure ventilation may be needed if breathing does not improve.
3. If the heart rate remains low despite adequate ventilation, chest compressions and medications like epinephrine may be administered to support circulation. Intubation should only be considered in specific situations.
4. Post resuscitation care focuses on monitoring vital signs and providing support until stabilization is achieved.
- Human milk is ideal for infants but lacks sufficient protein and minerals for preterm infants, especially very low birth weight infants. Human milk fortifiers were developed to supplement breast milk and meet the nutritional needs of preterm infants to support growth.
- Commercial fortifiers provide additional protein, minerals, calories, vitamins and electrolytes. Liquid fortifiers dilute breast milk while powder fortifiers may not fully dissolve. Fortifiers have been shown to improve growth, bone mineralization and outcomes in preterm infants. Monitoring is needed due to risks of electrolyte imbalances. Lactoengineering breast milk by feeding hindmilk is proposed as an alternative.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
The document summarizes neonatal sepsis, including its definition, epidemiology, causes, symptoms, diagnosis, and treatment. It discusses the pathophysiology of neonatal immune deficiency that predisposes infants to sepsis. Early and late onset sepsis are described, along with common pathogens for each. Risk factors like prematurity, maternal infections, and invasive procedures are outlined. The clinical presentation of sepsis is generally non-specific. Evaluation includes blood tests and cultures. Treatment involves initial broad-spectrum antibiotics tailored based on results and infant risk factors. Prevention strategies like vaccines and hand washing are mentioned.
1) Bacterial sepsis in neonates is a clinical syndrome of infection with bacteremia in the first month of life, which can lead to pneumonia or meningitis. It is a major cause of neonatal mortality.
2) Early onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract bacteria. Late onset sepsis occurs after 72 hours and is often due to environmental bacteria or prolonged hospitalization.
3) Diagnosis is based on risk factors, clinical features and confirmation via sepsis screening tests, blood and cerebrospinal fluid cultures. Treatment involves supportive care and antibiotics.
This document discusses recent advances in neonatal septicemia. It begins by defining neonatal septicemia and describing the types, including early onset sepsis within 72 hours of birth and late onset sepsis from 3-90 days of life. It then discusses the epidemiology, risk factors, clinical presentation and diagnostic evaluation. Key diagnostic tests discussed include blood cultures, sepsis screens, lumbar puncture and novel biomarkers. Management of neonatal septicemia includes supportive care and administration of empiric and targeted antibiotic therapy guided by culture results.
1) The study analyzed changes in organisms causing neonatal sepsis and outcomes over two time periods (1995-1998 and 2001-2006) at a tertiary care center in Northern India.
2) The incidence of bacterial sepsis increased over time, while the incidence in low birth weight infants decreased significantly. Mortality from sepsis also decreased.
3) The organisms causing sepsis changed between the periods - Klebsiella pneumoniae and Enterobacter decreased while Staphylococcus aureus increased. Non-fermenting Gram-negative bacilli emerged as new pathogens.
Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteria in the blood occurring in the first month of life. It can be early-onset within the first week of life, usually acquired during birth from the mother, or late-onset between 1 week to 1 month of life, often from hospital-acquired infections. Symptoms are non-specific but can include temperature irregularities, poor feeding, or respiratory distress. Treatment involves blood cultures, antibiotics like ampicillin and gentamicin, and supportive care for complications involving various organ systems. Ongoing research focuses on immunotherapies and blocking inflammatory responses.
Neonatal septicemia is a systemic bacterial infection occurring in newborns. It is a major cause of mortality, especially in developing countries and low birth weight/preterm infants. Sepsis can be classified as early onset (within 72 hours of birth) or late onset. Common clinical features include poor feeding, respiratory distress, hypothermia, and lethargy. Definitive diagnosis requires a positive culture from blood, CSF, or other sterile sites. However, cultures are often negative so diagnostic tests including complete blood count, c-reactive protein, and blood culture are also used. Early diagnosis and treatment with antibiotics is important to prevent mortality from neonatal septicemia.
El documento describe la sepsis neonatal. Se define como la presencia de una infección junto con manifestaciones sistémicas de infección en el primer mes de vida, especialmente en la primera semana debido a gérmenes que pasan de la madre al niño durante el parto. Las causas pueden ser prenatales como infecciones urinarias o vaginosis materna, o posnatales como infecciones locales o dispositivos vasculares. Los signos clínicos incluyen alteraciones en la termorregulación, respiratorias, abdominales, cardiovasculares y de la p
Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection in the first month of life. It can involve sepsis, meningitis, pneumonia and other infections. The document discusses the definition, classification, risk factors, clinical features, investigations and management of neonatal sepsis. Key points include that sepsis is a leading cause of neonatal mortality, the importance of sepsis screening and blood cultures, and that initial empirical antibiotic therapy typically involves ampicillin and an aminoglycoside.
This document provides an overview of neonatal immunology and the epidemiology, clinical presentation, diagnosis, and treatment of common neonatal infections. It discusses how the neonatal immune system is immature and ineffective, putting neonates at high risk for infection. The most common bacterial infections are sepsis, meningitis, and pneumonia, often caused by Group B Streptococcus, E. coli, and other organisms. Signs of early onset sepsis can be nonspecific but include respiratory distress, hypothermia/fever, and poor feeding. Diagnosis involves blood, urine and CSF cultures along with blood tests. Empiric antibiotics such as ampicillin and gentamicin are typically started. Late onset infections from healthcare-associated sources are also
Fever Without a Focus in the Neonate.pptxWalaa Manaa
1. Fever without a focus in neonates and young infants aged 0-3 months refers to a temperature over 38°C without other symptoms.
2. It can be challenging to distinguish between serious infections like bacteria or viruses versus self-limited viral illnesses based on isolated fever alone.
3. Common causes of serious bacterial infection include UTI, bacteremia, and meningitis, with E. coli and GBS being the most frequent pathogens. Viral illnesses are generally more common than bacterial.
Neonatal sepsis is a blood infection in infants under 90 days old that is a major cause of neonatal mortality. It can be caused by various bacteria, viruses, fungi or parasites. The presentation may include non-specific symptoms like temperature instability or feeding difficulties. Treatment involves supportive care and antibiotics, with a focus on early detection and treatment to prevent severe complications or death, which occurs in 13-25% of cases without timely intervention. Risk factors include prematurity, maternal infections, and improper sanitation or medical techniques.
This document discusses neonatal sepsis, including definitions, risk factors, evaluation, treatment and prevention. It provides guidelines for:
- Empiric antibiotic treatment of common organisms like GBS and E. coli based on susceptibility patterns. For GBS, penicillin is recommended. For ampicillin-sensitive E. coli, ampicillin or cefotaxime can be used.
- Duration of treatment based on culture results and clinical response. Treatment is typically 10-14 days for positive cultures and 48 hours for negative cultures if the infant is improving.
- Changing or extending treatment if meningitis is suspected or the infant is not improving on current regimens. Serial monitoring of markers like CRP is advised to
The document discusses fever in infants and children. It notes that fever is common in young children and can be caused by minor or life-threatening infections. While most pediatric infections are viral, some may be bacterial. The medical history, physical exam, and complementary tests usually allow for prompt diagnosis and reassurance or treatment as needed. For febrile infants under 3 months, further testing such as blood and urine cultures as well as lumbar puncture may be required depending on factors like age, appearance, and symptoms to check for potential serious bacterial infections. Management depends on risk level, with higher risk infants often needing admission and parenteral antibiotics.
The document discusses neonatal sepsis, including causes, risk factors, clinical manifestations, evaluation, diagnosis, and treatment. It provides definitions for early-onset and late-onset sepsis. Evaluation includes blood, CSF and other cultures, as well as CBC, CRP, and PCT. Empiric antibiotic therapy for early-onset sepsis is ampicillin and gentamicin, while late-onset depends on risk of multidrug-resistant pathogens. The goals of evaluation are to identify and treat infected infants while minimizing unnecessary treatment.
Neonatal Sepsis by dr Hesham Tawakol, Consultant Neonatologist at Corniche Ho...mohamed osama hussein
This document discusses neonatal sepsis and the prevention of healthcare-associated infections. It begins with an overview of neonatal sepsis, including definitions, epidemiology, risk factors, clinical presentation, diagnosis, and treatment. Drug resistance is a growing problem. To prevent healthcare-associated infections, transmission must be reduced through proper hand hygiene and infection control practices like cleaning equipment. Compliance with hand hygiene is challenging but critical for patient safety.
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
This document discusses the management of fever without a source in infants. It reviews the risk factors and prevalence of serious bacterial infections (SBI) and urinary tract infections (UTI) in different age groups. For neonates, a full septic workup is recommended. For infants 1-3 months, predictors like white blood cell count can identify high vs low risk for SBI. The pneumococcal vaccine has significantly reduced SBI risk in infants 3-36 months. Rapid viral testing may help identify low-risk infants, particularly those already at low risk based on other factors. Urine collection methods like bag vs catheter are discussed, noting limitations of bag specimens.
This document discusses the evaluation and management of fever without a source in children. It defines fever of unknown origin and provides background on the incidence and common causes. Guidelines are presented for evaluation and treatment based on a child's age, appearance, and vital signs. For children who appear well, testing and treatment depends on factors like temperature and white blood cell count. Toxic-appearing children should receive a full evaluation and empiric antibiotics in the hospital. The importance of careful evaluation and follow-up is discussed to avoid potential medical/legal issues.
A seminar on urinary tract infections (UTIs) was presented. UTIs are common in children and can lead to complications if not treated properly. The presentation covered the definition, causes, risk factors, clinical presentation, investigations, treatment, and follow-up management of UTIs in children of different ages. Proper diagnosis and treatment of UTIs as well as preventing recurrence are important to avoid long-term issues like renal scarring and kidney damage.
This document discusses acute bacterial infections in infants in the intensive care nursery. It describes the differences between early onset sepsis (occurring in the first 3 days of life) and late onset sepsis (occurring after 3 days of life). For both, it covers risk factors, common causative organisms, signs and symptoms, evaluation and treatment recommendations. It emphasizes that thorough diagnostic evaluation and prompt treatment with intravenous antibiotics such as ampicillin and gentamicin are essential for successful management of neonatal sepsis.
Neonatal sepsis refers to systemic bacterial infections in newborns. Early-onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract organisms. Late-onset sepsis occurs after 72 hours and is often caused by environmental organisms acquired in the hospital or home. Treatment involves supportive care and empiric antibiotics targeting common causes like E. coli, S. aureus, and Klebsiella spp. Prompt treatment is important but overuse of antibiotics risks emerging resistance, so diagnosis is confirmed using blood cultures and sepsis screening tests when possible. Outcomes depend on the infant's health and prompt, appropriate treatment.
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
This document discusses pediatric urinary tract infections. It covers the incidence, etiology, risk factors, clinical presentation, investigations including urinalysis, urine culture and radioimaging tests, management including choice of antimicrobials and prophylaxis, prognosis, and prevention of urinary tract infections in children. The management involves treating with antibiotics based on culture results and sensitivity, with outpatient or inpatient treatment depending on factors like age and severity of symptoms. Investigations help identify anatomical abnormalities and assess renal function and damage. Prognosis depends on factors like presence of reflux or scarring and timely treatment of infections.
This document discusses pediatric urinary tract infections. It covers the incidence, etiology, risk factors, clinical presentation, investigations including urinalysis, urine culture and radioimaging tests, management including choice of antimicrobials and prophylaxis, prognosis, and prevention of urinary tract infections in children. The management involves treating with antibiotics based on culture results and sensitivity, with inpatient versus outpatient treatment determined by factors like age and severity of symptoms. Prognosis depends on factors like presence of renal abnormalities, with recurrence increasing risk of long term issues like renal scarring and failure.
Neonatal sepsis is a clinical syndrome of infection in infants under 1 month of age, which can include systemic infections like septicemia, meningitis, and pneumonia. It is a major cause of neonatal mortality in Sri Lanka. Early onset sepsis within 3 days of life is usually caused by maternal infections, while late onset sepsis after 3 days is often hospital-acquired. Signs are non-specific but may include fever, lethargy, poor feeding, and respiratory distress. Blood cultures and a full sepsis screen are important for diagnosis. Early administration of antibiotics is crucial. Complications can include organ damage, shock, and long term disabilities like cerebral palsy. Prevention strategies include identifying at-risk infants and
A 2 week old infant presented with fever, poor feeding, lethargy, and a bulging fontanelle. Cerebrospinal fluid analysis showed 2,000 white blood cells per mm3. Group B streptococcus (GBBS) is the most likely causative organism given the clinical presentation and lab findings. GBBS is a common cause of infection in neonates and accounts for 50-70% of neonatal infections.
This document describes a case study of a neonatal baby presenting with signs of sepsis. The baby is pale, floppy and has cool peripheries. Initial management involves resuscitation and investigations including blood cultures, urine culture, full blood count and C-reactive protein. Antibiotics are started for suspected early onset sepsis. Blood cultures later grow Group B Streptococcus. The baby requires intubation for respiratory support. Treatment is continued with antibiotics targeting GBS. The parents are informed of the diagnosis and prognosis, and told the baby is currently responding well to targeted treatment.
Similar to Neonatal sepsis surenda godara 23-8-11 (20)
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. AIIMS protocol NICU 2010
PGI Chandigarh Protocol NICU 2010
Manual of neonatal care
John P Cloherty
Avery’s Disease of newborn
8th Edition
Foranoff & Martin
Neonatal & perinatal medicine, Volume II 8th Edition
3. Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of
infection with or without accompanying bacteremia in the first month of life. It
include:-
septicemia,
meningitis,
pneumonia,
arthritis,
osteomyelitis, and
urinary tract infections.
Superficial infections like conjunctivitis and oral thrush are not usually included
under neonatal sepsis.
8. 1. Low birth weight (<2500 grams) or prematurity
2. Febrile illness in the mother with evidence of bacterial infection within 2
weeks prior to delivery.
3. Foul smelling and/or meconium stained liquor.
4. Rupture of membranes >24 hours.
5. Single unclean or > 3 sterile vaginal examination(s) during labor
6. Prolonged labor (sum of 1st and 2nd stage of labor > 24 hrs)
7. Perinatal asphyxia (Apgar score <4 at 1 minute)
Presence of foul smelling liquor or three of the above mentioned risk factors
warrant initiation of antibiotic treatment. Infants with two risk factors should
be investigated and then treated accordingly.
9. Risk factor Score
IP per vaginal examinations >3 6
Clinical chorioamnionitis 6
BW <1.5kg 3
Male gender 3
Not received IP antibiotics 2
Gestation <30 wks 2
If - score 0-6 monitoring
7 or >7 antibiotics , blood culture
Extreme risk factor – prom>72hr
-prolonged labor>24hr
-unclean vaginal exam’
- Maternal septisemia
10. Neonates who become symptomatic after 72 h must be evaluated
for LOS..
Based on clinical assessment the neonate must be categorized into
low probability of sepsis or high probability of sepsis. “Low
probability” represents situations where the clinician would be
willing to withhold antibiotics if-the sepsis screen is negative.
Those with low probability of sepsis (e.g. single episode of
apnea, but otherwise well) should undergo a sepsis screen. The
purpose of the sepsis screen is to rule out sepsis rather than to rule
in sepsis. The sepsis screen consists of:TLC, CRP, ANC. ITR and
micro-erythrocyte sedimentation rate (m-ESR).
11. Components Abnormal values
Total leukocyte count <5000/mm3
Absolute neutrophil count <1750/mm3
Immature /total neutrophil >0.2
Micro-ESR >10 mm in 1st hour
C reactive protein (CRP) >1mg/dL
o CRP: It is done by quantitative ELISA or by a bedside semi-
quantitative latex agglutination kit. More than 1 mg/dL is
positive.
o ANC: It must be read off Manroe’s charts, Schelonka’s chart or
Mouzinho’s chart, depending on whether it is a term baby or a
preterm baby respectiveIy.
12. o ITR: It is considered to be positive if>20%. ITR is defined as
Immature PMN (band forms, metamyelo & myelocytes)
Mature + immature neutrophils
Mature neutrophil Band cell
12
13. o mESR, Value (in mm in first hour)> “3+age in days” in the 1
wk of life or >10 thereafter is considered positive.
Two systematic reviews on sepsis screens reached the same
conclusions- that there is no ideal test or combination of tests.
Among the various tests, quantitative CRP is the best, followed by
qualitative CRP and ITR.
If all the parameters of the sepsis screen are negative in a neonate
assessed to have low probability of LOS, antibiotics may not be
started and the neonate must be monitored clinically. The screen
must be repeated after 12-24h. Two consecutive completely
negative screens are suggestive of no sepsis.
14. Since CRP is the key parameter in the sepsis screen, a pragmatic
approach is that if the CRP alone is positive or any two
parameters of the sepsis screen are positive, a blood culture must
be drawn and empirical antibiotics must be started. A CSF
examination must be performed.
Neonates assessed to have a high clinical probability of sepsis
may not be subjected to a sepsis screen, because a negative screen
would not alter the decision to start antibiotics. A CSF
examination must be performed.
15. Sepsis screen
Blood culture
LP Revised guideline for empirical treatment of meningitis based on csf parameter
Among neonates with Among neonates with
suspected sepsis blood culture proven
sepsis
Preterm babies
•WBC >25 AND protein >170 •WBC >10
OR • OR
•WBC>100 •Glucose <25
Cut-off values to •OR OR
diagnose meningitis •Glucose <25 •Protein >170
Term babies
•WBC >21 •WBC >8 OR
• OR •Glucose <20 OR
•Glucose <20 •Protein >120
18. First line: Ciprofloxacin + Amikacin (covers - 75% isolates) .
If meningitis is suspected, replace Ciprofloxacin. by Cefotaxime-
sulbactam (see section D24)
Second line: Vancomycin + Piperacillin-Tazobactam (covers -
90% isolates)
Third line: Vancomycin + Meropenem (covers - 95-100%)
The antibiotic policy is reviewed periodically and may change after
the next review. Cephalosporins rapidly induce the production of
extended spectrum b-lactamases, cephalosporinases and fungal
colonization, and hence, are best avoided as empirical antibiotics.
19. Empirical upgradation must be done if the expected clinical
improvement with the ongoing line of antibiotics does not occur.
A minimum of 48-72 h of observation should be allowed before
declaring the particular line as having failed. The duration may
be longer for Vancomycin compared to the Penicillin group and
Aminoglycosides
In case the neonate is extremely sick or deteriorating very
rapidly and the treating team feels that the neonate may not able
to survive 48 h in the absence of appropriate antibiotics, a
decision may be taken to bypass the first line of antibiotics and
start with the second- line of antibiotics
20. If the growth is a non-contaminant, the antibiotic sensitivity must
be assessed to decide whether antibiotics need to be changed or
not. The following guidelines must be adhered to:
o If the organism is sensitive to an antibiotic with a narrower
spectrum or lower cost, therapy must be changed to such an
antibiotic, even if the neonate was improving with the
empirical antibiotics.
o If possible, a single sensitive antibiotic must be used, the
exception being Pseudomonas for which 2 sensitive
antibiotics must be used. Two sensitive antibiotics (a
Penicillin + an Aminoglycoside) may also be used for S
aureus and E. fecalis.
21. o If the empirical antibiotics are reported sensitive, but the neonate has
worsened on these antibiotics, it may be a case of in vitro resistance.
Antibiotics may be changed to an alternate sensitive antibiotic with the
narrowest spectrum and lowest cost.
o If the empirical antibiotics are reported resistant but the neonate has
improved clinically, it may or may not be a case of in-vivo sensitivity. In
such cases a careful assessment must be made before deciding on
continuing with the empirical antibiotics. One must not continue with
antibiotics with in vitro resistance in case of Pseudomonas, Kiebsiella and
MRSA; and in cases of CNS infections and deep-seated infections.
o If no antibiotic has been reported sensitive, but one or more has been
reported moderate1y sensitive’, therapy must be changed to such
antibiotics at the highest permissible dose. Use a combination, in such
cases.
22.
23. The survival of a sick septic newborn often depends upon
aggressive supportive care.
Oxygen saturation should be maintained in the normal range and
mechanical ventilation may be required in case of increased work
of breathing.
Anemia, thrombocytopenia, and DIC are treated with appropriate
transfusions. Packed red cells and FFP might have to be used.
Septic infants should be screened for hypoglycemia and treated
appropriately.
Management of Septic Shock
24. IVIG
The currently available evidence does not support the use
of IVIG. IVIG may be used in a difficult situation, after
discussion with the consultant.
Dose : pentaglobin 5 mL/kg/d for 2 d (IgM 6 mg, IgA 6
mg and IgG 38 mg/ml).
Among patients with clinically suspected infection, the
reduction of mortality with IVIG is of borderline
significance [typical RR 0.63 (95% CI; 0.40, 1.00)]. In
cases of subsequently proven infection the reduciton in
mortality is statistically but has very wide Cl [typical RR
0.55 (95% Cl; 0.31, 0.98)].
25. Exchange transfusion (ET): Sadana et al have evaluated the role
of double volume exchange transfusion in septic neonates with
sclerema and demonstrated a 50% reduction in sepsis related
mortality in the treated group. We perform double-volume
exchange transfusion with cross-matched fresh whole blood as
adjunctive therapy in septic neonates with sclerema.
.Granulocyte-Macrophage colony stimulating factor (GM-CSF):
This mode of treatment is still experimental.
26. Prevention of infections
Exclusive breastfeeding
Keep cord dry
Hand washing by care givers
Hygiene of baby
No unnecessary interventions
Teaching Aids: NNF NS- 26
27. Control of hospital infections
Hand washing by all staff
Isolation of infectious patient
Use plenty of disposable items
Avoid overcrowding
Aseptic work culture
Infection surveillance
Teaching Aids: NNF NS- 27
28. Work culture
Sterile gowns and linen for babies
Hand washing by all
Regular cleaning of unit
No sharing of baby belongings
Dispose waste-products in separate bins
Teaching Aids: NNF NS- 28
29.
30. Definition
Defined as total serum calcium concentration of <7 mg/dL or an
ionized calcium concentration of <4 mg/dL (i.e. 1 mEq/L).
umbilical calcium level is 10-11mg/dL
first 24-48h-7.5-8.5 mg/dL .
Classification: early onset (<3 d) and late onset (>3 d)
Causes:
Early onset: Prematurity, 1DM, perinatal asphyxia, maternal intake
of anticonvulsants, IUGR. If hypocalcemia does not resolve within
72 h of therapy investigate for causes of late onset hypocalcemia.
31. Treatment
Maintenance: 4-6 mL/kg/d of Ca gluconate IV (added in last 2 h of
6 hourly IVF)
Preparation: Ca-gluconate 10% (IV)- 9 mg/mL (preferred), Ca-
chloride (IV)-27 mg/mL
Therapeutic:
Asymptomatic: increase maintenance to 8-12 mL/kg/d of Ca-
gluconate
Symptomatic: 2 mL/kg of Ca-gluconate diluted in 1:1 dilution with
NS or 5% D IV over 10-15 mm under strict cardiac monitoring
(stop infusion if HR drops for >20 beats/mm than baseline or any
other arrhythmia appears on ECO). Start maintenance calcium after
bolus dose.
32. Hypocalcemia
Total serum Cal <7 mg/dl
Asymptomatic
80 mg/kg/day for 48 hrs
(8 mL/kg/day of 10% calcium gluconate )
Taper to 40 mg/kg/day for one day
Then stop
Symptomatic
Bolus of 2 mL/kg calcium gluconate 1:1 diluted with 5 % dextrose over 10 minutes under cardiac monitoring
Followed by continuous infusion 80 mg/kg/day for 48 hrs (8 mL/kg/day of 10% calcium gluconate )
Document normal calcium at 48 hrs
Then taper to 40 mg/kg/day for one day
Then stop
Prophylactic
Preterm< 32 wks, sick IDM, severe asphyxia 40 mg/kg/day for 3 days
(4ml/kg/day of 10% calcium gluconate ) IV or oral if can tolerate per oral
Treatment is for 72 hours
Continuous infusion is better than bolus
Symptomatic babies treatment is 48 hrs continuous infusion
33. Prolonged or resistant hypocalcemia
This condition should be considered in the following
situations:
Symptomatic hypocalcemia unresponsive to adequate
doses of calcium therapy
Infants needing calcium supplements beyond 72 hours
of age
Hypocalcemia presenting at the end of the first week.
These infants should be investigated for causes of LNH
34. Causes of late onset hypocalcemia
Increased phosphate load--Cow milk, renal insufficiency
Hypomagnesemia
Vitamin D deficiency
Maternal vitamin D deficiency
Malabsorption
Renal insufficiency
Hepatobiliary disease
PTH resistence--Transient neonatal pseudohypoparathyroidism
Hypoparathyroidism
Primary
Hypoplasia, aplasia of parathyroid glands - (Di George’s
syndrome), CATCH 22 syndrome (cardiac anomaly, abnormal
facies, thymic aplasia, cleft palate, hypocalcaemia with deletion
on chromosome 22)
Activating mutations of the calcium sensing receptor (CSR)
Secondary
Maternal hyperparathyroidism
35. Metabolic Syndromes
Kenny-caffey syndrome
Long-chain fatty acyl CoA dehydrogenase deficiency
Kearns-sayre syndrome
Iatrogenic
Citrated blood products
Lipid infusions
Bicrbonate therepy
Diueretics (loop diuretics)
Glucocorticosteriods
Phosphate therepy
Use of Aminoglycosides (mainly gentamicin) as single dose
Alkalosis
Phototherapy
36. Investigation required
First line Second line Others
Serum phosphate Serum magnesium CT brain for calcification
Serum alkaline Serum parathormone Echocardiography
phosphatase (SAP) levels (PTH) Vitamin D levels (1,25
Liver function tests Urine calcium creatinine D3)
Renal function tests ratio Hearing evaluation
X ray chest/ wrist Maternal calcium, Serum cortisol
Arterial pH phosphate, and alkaline Thyroid function tests
phosphatase
S.No. Disorder causing Findings
hypocalcemia
1 Hypoparathyroidism High : Phosphate
Low : SAP, PTH, 1,25 D3
2 Pseudo High : SAP, PTH, Phosphate
Hypoparathyroidim Low : 1,25 D3
3 Chronic renal failure High : phosphate, SAP, PTH, pH (acidotic), deranged RFT
Low : 1,25 D3
4 Hypomagnesemia High : PTH
Low : Phosphate, Mg,1,25 D3
5 VDDR1 High : SAP, PTH
Low : Phosphate, 1,25 D3
6 VDDR2 High : SAP, 1, 25 D3, PTH
Low : Phosphate
37. Treatment of LNH
The treatment of LNH is specific to etiology and may in certain
diseases be lifelong.
1. Hypomagnesemia: Symptomatic hypocalcemia unresponsive to
adequate doses of IV calcium therapy is usually due to
hypomagnesemia. It may present either as ENH or later as LNH.
The neonate should receive 2 doses of 0.2 mL/kg of 50% MgSO4
injection, 12 hours apart, deep IM followed by a maintenance dose
of 0.2 mL/kg/day of 50% MgSO4, PO for 3 days.
2. High phosphate load: These infants have hyperphosphatemia
with near normal calcium levels. Exclusive breast-feeding should
be encouraged and top feeding with cow’s milk should be
discontinued. Phosphate binding gels should be avoided.
38. Treatment of LNH
3. Hypoparathyroidism: These infants tend to be
hyperphosphatemic and hypocalcemic with normal renal function.
Elevated phosphate levels in the absence of exogenous phosphate
load (cow’s milk) and presence of normal renal functions indicates
parathormone inefficiency. It is important to realize that if the
phosphate level is very high, then adding calcium will lead to
calcium deposition and tissue damage. Thus attempts should be
made to reduce the phosphate (so as to keep the calcium and the
phosphate product less than 55). These neonates need
supplementation with calcium (50 mg/kg/day in 3 divided doses)
and 1,25(OH)2 Vitamin D3 (0.5-1 mg/day). Syrups with 125 mg
and 250 mg per 5ml of calcium are available.1,25(OH)2 vitamin
D3 (calcitriol) is available as 0.25 mg capsules. Therapy may be
stopped in hypocalcemia secondary to maternal
hyperparathyroidism after 6 weeks.
39. Treatment of LNH
4. Vitamin D deficiency states: These babies have hypocalcemia
associated with hypophosphatemia due to an intact parathormone
response on the kidneys. They benefit from Vitamin D3
supplementation in a dose of 30-60 ng/kg/day
Monitoring
The baby is monitored for the SCa, and phosphate, 24 hour urinary
calcium, and calcium creatinine ratio. Try to keep the calcium in
the lower range as defective distal tubular absorption leads to
hypercalciuria and nephrocalcinosis.
40. Treatment of LNH
Prognosis and outcome
Most cases of early neonatal hypocalcemia resolve within 48-72
hours without any clinically significant sequelae.
Late neonatal hypocalcemia secondary to exogenous phosphate
load and magnesium deficiency also responds well to phosphate
restriction and magnesium repletion. When caused by
hypoparathyroidism, hypocalcemia requires continued therapy with
vitamin D metabolites and calcium salts. The period of therapy
depends on the nature of the hypoparathyroidism which can be
transient, last several weeks to months, or be permanent.