2025 – PAGE 173 – NEONATOLOGY

2025 – Core Study Guide 07 –Neonatology 2025 – PAGE 173 – NEONATOLOGY

MISCELLANEOUS

FULL TERM

For the boards, assume 37–41 + 6/7 weeks gestation is full-term.

NEONATE

The term “neonate” applies from birth to 1 month of age.

INFANT

The term “infant” applies from 1 month to 12 months of age.

APNEA

Apnea is defined as > 20 seconds between breaths. If the interval is less than 20 seconds, it’s called PERIODIC BREATHING. The differential diagnosis is wide, including cardiac issues, infections, metabolic disorders, neurologic problems, and prematurity. Treat with THEOPHYLLINE or CAFFEINE.

TERMINOLOGY:

  • PRIMARY APNEA: Reversible with stimulation
  • SECONDARY APNEA: Not reversible with stimulation, so intubate.

PEARLS: Start your workup with NONINVASIVE testing, such as an echocardiogram. Apnea of Prematurity is NOT associated with an increased risk of Sudden Infant Death Syndrome (SIDS). Low birth weight IS associated with an increased risk of SIDS.

(DOUBLE TAKE) GBS SCREENING AND PROPHYLAXIS MADE EASY!

Here are some key points and PEARLS about GBS screening and prophylaxis.

  • RECTOVAGINAL GROUP B BETA HEMOLYTIC STREPTOCOCCUS (GBS)SCREENING CULTURES: These are obtained at 36 to 37 6/7 weeks gestation.
  • INTRAPARTUM ANTIBIOTIC PROPHYLAXIS (IAP): Intrapartum Antibiotic Prophylaxis (IAP) refers to antibiotics given to mom when she presents for delivery. If indicated, give IV penicillin, ampicillin or cefazolin at least 4 hours prior to delivery. The latest guidelines from the CDC may be viewed for some “light reading” by visiting www.pbrlinks.com/gbsprophylaxis.
  • TO GIVE OR NOT TO GIVE INTRAPARTUM ANTIBIOTIC PROPHYLAXIS? IAP is indicated for any of the following scenarios:
    • Invasive GBS disease was present in a previous infant
    • Positive GBS was noted in the URINE at ANYTIME during THIS pregnancy (regardless of treatment and subsequent cultures)
    • Positive rectovaginal GBS screening culture noted 36 to 37 6/7 weeks in THIS pregnancy
    • Unknown GBS status PLUS any of these:
      • < 37 weeks gestation
      • ROM > 18 hours
      • Intrapartum fever of >4 F
      • Positive intrapartum NAAT testing
  • IAP is considered “adequate” when penicillin, ampicillin or cefazolin is administered > 4 hours prior to delivery.
  • IAP is NOT indicated for GBS positivity in previous pregnancies or for c-sections done with intact membranes.
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