immune thrombocytopenic purpura

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

AnuriaHypoplasia of the skullHypotension

• Lithium

• Alcohol

• Thalidomide

• Valproic Acid

• Magnesium Sulfate

• Cocaine

• Warfarin

• ACE Inhibitors

• Isotretinoin

• Tobacco

MicrocephalyMicrophthalmiaHypoplastic earsTruncus arteriosisAbsent thymusDevelopmental 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 abruptionIUGR

• Lithium

• Alcohol

• Thalidomide

• Valproic Acid

• Magnesium Sulfate

• Cocaine

• Warfarin

• ACE Inhibitors

• Isotretinoin

• Tobacco

Depressed nasal bridgeHypoplastic distal phylangesStippled epiphysesHemorrhage

• Lithium

• Alcohol

• Thalidomide

• Valproic Acid

• Magnesium Sulfate

• Cocaine

• Warfarin

• ACE Inhibitors

• Isotretinoin

• Tobacco

Flat philtrumThin upper lipMidface hypolasiaShort palpebral fissuresGrowth delayDevelopmental 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 WithrawalWhat treatment would you use if indicated?Swaddling, pacifier, minimal stimulation, etc.Methadone, Morphine, “Tincture of Opium”, or

PhenobarbitolDo 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