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Perinatal Illness

Perinatal Illness. Mary P. Martinasek, BS, RRT Director of Clinical Education Hillsborough Community College. Etiology of Perinatal Illness. Bacterial Viral AIDS CMV (cytomegalovirus) Rubella Herpes Type I and Type II Protozoa Toxoplasmosis Pneumocystis carinii.

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Perinatal Illness

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  1. Perinatal Illness Mary P. Martinasek, BS, RRT Director of Clinical Education Hillsborough Community College

  2. Etiology of Perinatal Illness • Bacterial • Viral • AIDS • CMV (cytomegalovirus) • Rubella • Herpes Type I and Type II • Protozoa • Toxoplasmosis • Pneumocystis carinii

  3. Diagnosis and Treatment • Viral • Proper prevention • Proper treatment • Bacterial • Broad spectrum antibiotics • 48 - 72 hours if premature rupture of membranes

  4. Prevention of Infection • Proper aseptic technique • Proper hand washing • Wearing of gloves • Use of masks • Proper disposal of infected material

  5. Fetal Immunities • IgA • Not transported placentally • IgD • in presence of allergic reactions to milk, penicillin , insulin, toxins • IgE • Allergic reactions from mast cell • IgG • Only antibody transported through placenta • Protects fetus from infections that mother has immunity towards • IgM • 30 weeks • Main fetally produced antibody in baby

  6. Congenital Anomalies • Tracheoesophageal anomalies • 75-80% atresia of upper esophagus with fistual between the lower esophageal tube and trachea • Diagnosis and Treatment • Accumulation of secretions in mouth • Respiratory distress • Repeated regurgitation of feedings

  7. Pulmonary anomalies • Choanal atresia • Blockage of nares • Diaphragmatic hernia • Incomplete formation of diaphragm • Degree of distress = severity of herniation • Pierre Robin Syndrome (micronathia) • Hypoplasia of the mandible ( small jaw) • Maintain airway until jaw grows ( 6 mos)

  8. Cardiac System • PDA (Patent ductus arteriosus) • ASD (Atrial septal defect) • VSD (Ventral septal defect) • TOF (Tetralogy of Fallot) • Subaortic stenosis • Coarctation of the Aorta • Tricuspid Atresia • TAPVR (Total anomalous venous return) • Truncus Arteriosus

  9. Patent Ductus Arteriosus • Ductus Arteriosus connects pulmonary artery to aorta • Closes hours to days post delivery • L to R shunt = low pulmonary pressures • R to L shunt = high pulmonary pressures • Desirable with some heart lesions (TPGV) • PGE1 = prostaglandin E1 indicated for left heart obstruction of decreased pulmonary perfusion

  10. Atrial Septal Defect • Incompetent foramen ovale • Majority are without symptoms • Possible atrial arrhythmias as patient matures

  11. Ventricular Septal Defect • May be isolated or occur with other anomalies of the heart • Classified as to location • Small VSD’s asymptomatic • No treatment unless patient is failure to thrive or in congestive heart failure

  12. Tetralogy of Fallot • VSD • Overriding aorta • Hypertrophy of right ventricle • Obstruction to flow through the pulmonary artery • Usually cyanotic due to decrease in pulmonary blood and venous blood in the aorta • Boot shaped heart on chest x ray • Treatment = closure of VSD and pulmonary outflow obstruction relief

  13. Transposition of the Great Vessels • Aorta arises from the right ventricle • Pulmonary artery arises from the left ventricle • Egg on a string • Major cause of death in the newborn who does not undergo surgery • Need PGE to open ductus until surgery

  14. Subaortic Stenosis • Stenosis of aortic valve • Causes obstruction to outflow from the left ventricle • Cardinal finding = reduced cardiac output • Pale skin and diminished peripheral pulses • Surgical intervention for treatment

  15. Coarctation of the Aorta • Constriction of the aorta that severely restricts blood flow • Decreased femoral pulses compared to upper extremities • CXR shows cardiomegaly and increased vascular markings • Treatment = surgical

  16. Tricuspid Atresia • Complete agenesis of tricuspid valve • Cyanosis present • Balloon septostomy • Fontan procedure = surgical creation of a connection between the right atria and pulmonary artery or right ventricle

  17. Total anomalous venous return • Pulmonary venous blood returns to the right atrium instead of the left atrium • ASD must be present for infant to survive • Cyanosis present • Balloon septostomy to increase intraatrial mixing • Surgical correction needed to reimplant the pulmonary veins into the left atria

  18. Truncus Arteriosus • One large vessel arises from both the right and left ventricles over a large VSD • Cyanosis is usually present • Diagnosed by echocardiogram • Presence of one valve helps to differentiate from Transposition of the great vessels (TGV) • Surgical treatment involves separating the pulmonary artery from the large vessel • Prognosis poor = 40-50% mortality

  19. Hypoplastic Left-Heart syndrome • Coarctation of the aorta • Hypoplastic left ventricle • Aortic and mitral valve stenosis or atresia • Patient appears ashen and gray • Surgical treatment • High mortality

  20. Abdominal Wall Defects • Omphalocele • Condition in which the protruding intestines are contained within a sac and it originates from the umbilical cord • Gastroschisis • Condition in which the protruding intestines are lateral to the umbilical cord and not contained.

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