Page 1096 - TNFlipTest

P62 Pediatrics
Neonatology
Toronto Notes 2019
NEONATAL ALLOIMMUNE THROMBOCYTOPENIA Epidemiology
• 1per4,000-5,000livebirths
Pathophysiology
• plateletequivalentofRhdiseaseofthenewborn
• occurswhenmotherisnegativeforHPAandfetusispositive
• developmentofmaternalIgGantibodiesagainstHPAantigensonfetalplatelets
Clinical Presentation
• petechiae,purpura,thrombocytopeniainotherwisehealthyneonate • severediseasecanleadtointracranialbleeding
Diagnosis
• maternalandpaternalplatelettypingandidentificationofplateletalloantibodies
Treatment
• IVIg to mother prenatally starts in second trimester ± steroids ± fetal platelet transfusions • if transfusion required, use washed maternal platelets or donor HPA negative platelets
• treatneonatewithIVIg(lesseffectivethanplatelettransfusions)
AUTOIMMUNE THROMBOCYTOPENIA
Pathophysiology
• causedbyantiplateletantibodiesfrommaternalITPorSLE • passivetransferofantibodiesacrossplacenta
Clinical Presentation
• similarpresentationtoneonatalalloimmunethrombocytopenia,butthrombocytopeniausuallyless severe
Treatment
• steroidstomotherfor10-14dpriortodeliveryorIVIgtomotherbeforedelivery
• treatneonatewithIVIg(usuallyifplatelets<60,000)
• transfusionofinfantwithmaternal/donorplateletsonlyinseverecases,asantibodieswilldestroy
transfused platelets
HEMORRHAGIC DISEASE OF THE NEWBORN
Pathophysiology
• causedbyvitaminKdeficiency
• factorsII,VII,IX,XarevitaminK-dependent,thereforebothPTandPTTareabnormal
Etiology and Clinical Presentation
• neonatesatincreasedriskofvitaminKdeficiencydueto:
■ poor transfer of vitamin K across the placenta
■ insufficient bacterial colonization of colon at birth to synthesize vitamin K ■ breastfeeding (inadequate vitamin K intake)
■ additional risk if maternal use of antiepileptics
• neonatemaypresentwithhematomas,ICH(causingapneaorseizures),internalbleeding,hematuria, bruising, prolonged bleeding (often from mucous membranes, umbilicus, circumcision, and venipunctures)
Prevention
• vitaminKIMadministrationatbirthtoallnewborns
Bronchopulmonary Dysplasia
Definition
• alsoknownaschroniclungdisease
• clinicallydefinedasO2requirementfor>28dpluspersistentneedforoxygenand/orventilatory
support at 36 wk corrected GA
• damagetodevelopinglungswithprolongedintubation/ventilation,highlevelsO2,infections
Investigations
• CXRfindingsmaydemonstratedecreasedlungvolumes,areasofatelectasis,signsofinflammation,and hyperinflation