A healthy neonate was born to a GBS + mother that was given Amp only 3 hours prior to delivery. Since you know that was not effective treatment, you decide to do a CBC with diff just to be on the safe side. The WBC, Hct, and diff were all PERFECT, but the platelets were only 55,000. You wisely decide to examine the maternal labs and find that the mother also has thrombocytopenia. When you ask the mom about her thrombocytopenia she responds, “Oh, that’s because I have …”
Neonatal autoimmune thrombocytopenia is due to maternal antiplatelet antibodies crossing the placenta. The infant is at increased risk for intracranial (1%) or visceral hemorrhage with platelet counts less than 50,000. Steroids and/or IVIG are used only when there is active bleeding or a very low platelet count. Platelet transfusions are not helpful! The neonatal thrombocytopenia will resolve once there are no more maternal antibodies in the fetal circulation. Immune Thrombocytopenic Purpura
A neonate born to a mother with uncontrolled hypertension (chronic or pregnancy induced) is at risk for …
Intrauterine Growth Restriction (IUGR) – Damage to the placenta’s blood vessels causes a decrease in placental O2 and nutrient exchange Oligohydramnios – Hypotension in the fetus causes decreased kidney blood flow and therefore decreased urine output Maternal Hypertension
It’s Quiz Time! Drug and Effects
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Respiratory depression
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Ebstein’s anomaly
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Phocomelia
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Anuria Hypoplasia of the skull Hypotension
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Microcephaly Microphthalmia Hypoplastic ears Truncus arteriosis Absent thymus Developmental delay
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Neural Tube Defects
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Placental abruption IUGR
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Depressed nasal bridge Hypoplastic distal phylanges Stippled epiphyses Hemorrhage
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
Flat philtrum Thin upper lip Midface hypolasia Short palpebral fissures Growth delay Developmental delay
Lithium Alcohol Thalidomide Valproic Acid Magnesium Sulfate Cocaine Warfarin ACE Inhibitors Isotretinoin Tobacco
What screening test do you do if you suspect withdrawal in a newborn due to hyperactivity and irritability? Urine Toxicology within 24 hours Meconium Toxicology Withdrawals
Neonatal Abstinence Syndromes are the postnatal withdrawal effects in an infant after in utero chronic drug exposure Different drugs have different (but very similar) withdrawal symptoms! Withdrawals
Hyperactivity, irritability, and hypoglycemia Alcohol withdrawal Withdrawals
Hyperactivity, irritability, hyperphagia, and poor suck/swallow coordination Barbiturate Withdrawal Withdrawals
Irritability, tremors, jitteriness, hypertonia, loose stools, and emesis (with or without seizures) Opioid Withrawal What treatment would you use if indicated? Swaddling, pacifier, minimal stimulation, etc. Methadone, Morphine, “Tincture of Opium”, or Phenobarbitol Do NOT use Narcan with chronic maternal narcotic use or you will induce rapid withdrawal/seizures Withdrawals
What about cocaine? No known abstinence syndrome exists Do not treat cocaine “withdrawal”. Do consider maternal use of multiple drugs if the newborn shows signs of withdrawal in a cocaine + mom. Withdrawals