THE NEWBORN AT RISK BECAUSE OF
Typically, a newborn at risk,
MATERNAL INFECTION OR ILLNESS
Maternal Infection
Newborns are susceptible to infection at
birth because their
ability to produce antibodies is immature.
A number of in-fections in newborns, such
as toxoplasmosis, rubella, syphilis,
and cytomegalovirus infections, are
spread to the fetus across
the placenta in utero. The effect on the
woman of these dis-orders is discussed in
Chapter 12. Other infections are con-
tracted from exposure to vaginal
secretions at birth. Those
infections are described next.
-Hemolytic, Group B Streptococcal
Infection
The major cause of infection in newborns
is the -hemolytic,
group B streptococcal organism (GBS).
This gram-positive
bacterium is a natural inhabitant of the
female genital tract.
Between 50 and 300 infants in every 1000
live births display
a positive culture for the organism (Heath
& Schuchat,
2007). It may be spread from baby to
baby if good hand-washing technique is
not used in handling newborns. If a
woman is found to be positive for GBS
during late pregnancy
(see Chapter 21), ampicillin administered
intravenously at
28 weeks and again during labor helps to
reduce the possi-bility of newborn
exposure.
Assessment.
such as one born
after prolonged rupture of membranes or
if the woman’s
vaginal culture is positive for GBS, will be
screened for in-fection with a blood
culture.
Colonization by GBS can result in an early-
onset or a late-onset illness. With the
early-onset form, signs of pneumonia
become apparent within the first day of
life, as well as tachyp-nea, apnea, and
signs of shock such as decreased urine
out-put, extreme paleness, or hypotonia.
A chest radiograph is al-most
indistinguishable from that of RDS (a
ground-glass
appearance). Pneumonia may develop so
rapidly that as
many as 20% of infants who contract the
infection die
within 24 hours of birth.
A late-onset type occurs at 2 to 4 weeks of
age. With
this, instead of pneumonia being the
infection focus,
meningitis tends to occur. Typical signs
include lethargy,
fever, loss of appetite, and bulging
fontanelles from in-creased intracranial
pressure as meningitis develops.
Mortality from the late-onset type is not
as high as that
from the early-onset form (15% versus
20%), but neuro-logic consequences can
occur in up to 50% of infants who
survive.
Therapeutic Management.If a newborn
displays signs or a
blood screening test is positive, antibiotics
are administered.
Gentamicin, ampicillin, and penicillin are
all effective against
GBS infections.
Parents may have difficulty understanding
how their in-fant could suddenly become
this ill and may need a great
deal of support in caring for their infant.
This is even more
important if the newborn survives the
infection but is left
neurologically challenged. In the future,
immunization of
all women of childbearing age against
streptococcal B or-ganisms could decrease
the incidence of newborns infected
at birth.
Ophthalmia Neonatorum
Ophthalmia neonatorumis an eye
infection that occurs at
birth or during the first month
(MacDonald, Mailman, &
Desai, 2008). The most common causative
organisms are
Neisseria gonorrhoeaeand Chlamydia
trachomatis.An infant
contracts the organism during birth, from
vaginal secretions.
N. gonorrhoeaeinfection is an extremely
serious form of con-junctivitis because, if
left untreated, the infection progresses
to corneal ulceration and destruction,
resulting in opacity of
the cornea and severe vision impairment.
Assessment.Ophthalmia neonatorum is
generally bilat-eral. The conjunctivae
become fiery red, with thick pus.
The eyelids are edematous. Although this
usually occurs on
day 1 to day 4 of life, it should be
considered as a possibil-ity when
conjunctivitis occurs in any infant younger
than
30 days.
Prevention.The prophylactic instillation of
erythromycin
ointment into the eyes of newborns
prevents both gonococ-cal and chlamydial
conjunctivitis. In the past, eye prophy-
laxis was given immediately after birth so
it was never for-gotten. Now it is
customary to delay administration of the
ointment until after the first reactivity
period so the newborn
can clearly see the parents during this
important attachment
period. This makes it easy for
administration to be forgotten,
so use some type of a checklist as a
reminder of this impor-tant prophylaxis.
Infants born outside the hospital also
need
prophylaxis to prevent ophthalmia
neonatorum, the same as
infants born in a birthing room.
Therapeutic Management.Therapy is
individualized de-pending on the
organism cultured from the exudate. If
gono-cocci are identified, intravenous
ceftriaxone (Rocephin) and
penicillin are effective drugs. If chlamydia
is identified, an
ophthalmic solution of erythromycin is
used.