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NEONATAL ASSESSMENT
Deborah A Kroeker, MD
March 1, 2017
OUTLINE
Assessment of Gestational Age
Assessment for Hypoglycemia
Assessment for Jaundice
Assessment for Sepsis/Chorio
Assessment for NAS
Assessment for Discharge
UpToDate
Committee on Fetus and Newborn Pediatrics 2011;127:575-579
©2011 by American Academy of Pediatrics
OUTLINE
Assessment of Gestational Age
Assessment for Hypoglycemia
Assessment for Jaundice
Assessment for Sepsis/Chorio
Assessment for NAS
Assessment for Discharge
Risk factor sheet targeting prediction of nonhemolytic hyperbilirubinemia in term newborn infants.
Mikael Norman et al. Pediatrics 2015;136:1087-1094
©2015 by American Academy of Pediatrics
OUTLINE
Assessment of Gestational Age
Assessment for Hypoglycemia
Assessment for Jaundice
Assessment for Sepsis/Chorio
Assessment for NAS
Assessment for Discharge
GBS DISEASE
Age: Neonates, pregnant or postpartum women, older adults
Colonization: GI, GU, pharynx
Early-Onset Disease
Late-Onset Disease
Late, Late-Onset Disease
Date of download: 2/22/2017Copyright © 2017 American Academy of Pediatrics.
All rights reserved.
Group B Streptococcal Infections
Courtesy of Centers for Disease Control and Prevention
Incidence of Early and Late-onset invasive GBS disease
Date of download: 2/22/2017Copyright © 2017 American Academy of Pediatrics.
All rights reserved.
Group B Streptococcal Infections
Red Book® 2015, 2015
Courtesy of Centers for Disease Control and Prevention
Incidence of early-onset invasive GBS disease 2000-2007
Date of download: 2/22/2017Copyright © 2017 American Academy of Pediatrics.
All rights reserved.
Group B Streptococcal Infections (CDC)
RISK FACTORS FOR GBS DISEASE IN NEONATES
<37WGA
ROM >/18 hours
High GBS inoculum
Temperature >100.4 intrapartum temperature in mother
Chorioamnionitis
GBS bacteriuria
Previous infant with invasive GBS disease
Intrauterine fetal monitoring
Maternal age <20 years
Black race
Secondary prevention of GBS disease.1,2 Algorithm for the prevention of early-onset GBS infection in the newborn.
Michael T. Brady, and Richard A. Polin Pediatrics 2013;132:166-168
©2013 by American Academy of Pediatrics
Date of download: 2/22/2017Copyright © 2017 American Academy of Pediatrics.
All rights reserved.
Group B Streptococcal Infections
Courtesy of Centers for Disease Control and Prevention
Predictor Scenario
Incidence of
Early-Onset
Sepsis
Gestational
age
weeks
days
Highest
maternal
antepartum
temperature
ROM (Hours)
Maternal GBS
status
Negative
Positive
Unknown
Type of intrapartum
antibiotics
Broad spectrum antibiotics
> 4 hrs prior to birth
Broad spectrum antibiotics
2-3.9 hrs prior to birth
GBS specific antibiotics > 2
hrs prior to birth
No antibiotics or any
antibiotics < 2 hrs prior to
birth
Fahrenheit
https://neonatalsepsiscalculator.kaiserpermanente.org/
Risk per 1000/births
EOS Risk @ Birth
Please enter details below.
Classification of Infant's Clinical PresentationClinical Illness
Equivocal
Well Appearing
EOS Risk after Clinical
Exam
Risk per
1000/births
Clinical
Recommen
dation
Vitals
Well Appearing
Equivocal
Clinical Illness
Fahrenheit
Rate of sepsis according to gestational age.
Karen M. Puopolo et al. Pediatrics 2011;128:e1155-e1163
©2011 by American Academy of Pediatrics
Rate of sepsis according to highest maternal intrapartum temperature.
Karen M. Puopolo et al. Pediatrics 2011;128:e1155-e1163
©2011 by American Academy of Pediatrics
Rate of sepsis according to duration of ROM. ROM was measured to the nearest 0.1 hour and took on values from 0
to 226.4 (inclusive); ROM times of >50 hours were rare, and times between 30 and 50 hours were sparse.
Karen M. Puopolo et al. Pediatrics 2011;128:e1155-e1163
©2011 by American Academy of Pediatrics
IMPLICATIONS OF CHORIOAMNIONITIS
Preterm delivery
1-3% develop neonatal sepsis
IVH (2.8 OR) and PVL (3.4 OR)
FIR (4.1 OR of grades II-IV IVH)
No increase when inflammation is limited to the maternal placental tissues
Intra-amniotic IL-6 better predicts neonatal morbidity and preterm birth
Neurodevelopmental outcomes
Inconclusive
OUTLINE
Assessment of Gestational Age
Assessment for Hypoglycemia
Assessment for Jaundice
Assessment for Sepsis/Chorio
Assessment for NAS
Assessment for Discharge
NAS CAUSED BY VARIOUS SUBSTANCES
Drug Onset, h Frequency, % Duration, d
Opioids
Heroin 24‒48 40‒8027 8‒10
Methadone 48‒72 13‒9437 Up to 30 or more
Buprenorphine 36‒60 22‒6746,48 Up to 28 or more
Prescription opioid medications 36‒72 5‒2056,60 10‒30
Nonopioids
SSRIs 24‒48 20‒3064 2‒6
TCAs 24‒48 20‒5064 2‒6
Methamphetamines 24 2‒49101 7‒10
Inhalants 24‒48 4870 2‒7
CRITERIA FOR DISCHARGE OF FT NEONATE
Examination
Vital signs normal for 12 hours
Stool and void
2 consecutive feedings
Circumcision
Maternal labs
Hearing/neoscreen, CCHD
Social situation
Primary care physician
Discharge mother and infant together if possible
Jaundice
REFERENCES
Benitz, W.E. Committee on Fetus and Newborn. (2015). Hospital Stay for Healthy Term Newborn Infants Pediatrics. 135 (5)948-953; DOI: 10.1542/peds.2015-0699.
Kocherlakota, P. (2014). Neonatal Abstinence Syndrome. Pediatrics 134(2) e547-e561; DOI: 10.1542/peds.2013-3524.
Norman, M., Åberg, K., Holmsten, K., Weibel, V., Ekéus C. (2015). Predicting Nonhemolytic Neonatal Hyperbilirubinemia. Pediatrics, 136(6)1087-1094. DOI: 10.1542/peds.2015-2001.
Patrick, S., Dudley, J., Martin, P., Harrell, F., Warren, M., Hartmann, K., et al. (2015). Prescription Opioid Epidemic and Infant Outcomes. Pediatrics. 135(5) DOI: 10.1542/peds.2014-3299.
Schrag, S., Phil, D., Zywicki, S., Farley, M., Reingold, A., Harrison, L., et al. (2000). Group B Streptococcal Disease in the Era of Intrapartum Antibiotic Prophylaxis. The New England Journal of Medicine. 342:15-20. DOI: 10.1056/NEJM200001063420103.
