Neonatal infections — MCQs

A 4390-g (9-lb 11-oz) male newborn is delivered at term to a 28-year-old primigravid woman. Pregnancy was complicated by gestational diabetes mellitus. Labor was prolonged by the impaction of the fetal shoulder and required hyperabduction of the left upper extremity. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Vital signs are within normal limits. Active movement of the left upper extremity is reduced. Further evaluation of this newborn is most likely to show which of the following?

Two hours after a 2280-g male newborn is born at 38 weeks' gestation to a 22-year-old primigravid woman, he has 2 episodes of vomiting and jitteriness. The mother has noticed that the baby is not feeding adequately. She received adequate prenatal care and admits to smoking one pack of cigarettes daily while pregnant. His temperature is 36.3°C (97.3°F), pulse is 171/min and respirations are 60/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows pale extremities. There is facial plethora. Capillary refill time is 3 seconds. Laboratory studies show: Hematocrit 70% Leukocyte count 7800/mm3 Platelet count 220,000/mm3 Serum Glucose 38 mg/dL Calcium 8.3 mg/dL Which of the following is the most likely cause of these findings?

A 10-day-old male infant is brought to the emergency room for abdominal distension for the past day. His mother reports that he has been refusing feeds for about 1 day and appears more lethargic than usual. While changing his diaper today, she noticed that the baby felt warm. He has about 1-2 wet diapers a day and has 1-2 seedy stools a day. The mother reports an uncomplicated vaginal delivery. His past medical history is significant for moderate respiratory distress following birth that has since resolved. His temperature is 101°F (38.3°C), blood pressure is 98/69 mmHg, pulse is 174/min, respirations are 47/min, and oxygen saturation is 99% on room air. A physical examination demonstrates a baby in moderate distress with abdominal distension. What is the best initial step in the management of this patient?

Two days after delivery, a newborn develops a red, irritated eye with yellow discharge. She was born at 39 weeks' gestation to a 28-year-old woman, gravida 1, para 1. Pregnancy and delivery were uncomplicated. The mother had not seen her gynecologist since her first prenatal visit. The newborn's temperature is 37.2°C (99.0°F), pulse is 140/min, respirations are 42/min, and blood pressure is 73/53 mm Hg. Ophthalmic examination shows eyelid edema, conjunctival injection, and copious yellow mucopurulent discharge from the right eye. There is no corneal ulceration or evidence of keratitis. Funduscopic examination is normal. The diagnosis is confirmed and appropriate treatment is administered. Which of the following is most likely to have prevented this patient's condition?

A baby is born after the 32nd gestational week by cesarean delivery. The mother suffered from gestational diabetes; however, she had no other pregnancy-related diseases and was otherwise healthy. The baby has a blood pressure of 100/58 mm Hg, heart rate of 104/min, and oxygen saturation of 88%. The child has tachypnea, subcostal and intercostal retractions, nasal flaring, and cyanosis. The cyanosis is responding well to initial administration of oxygen. The nasogastric tube was positioned without problems. Which of the following is the most likely diagnosis?

A 2-week-old female newborn is brought to the physician because of increasing yellow discoloration of her eyes and skin for 2 days. She was born at 39 weeks' gestation and weighed 3066 g (6 lb 12 oz); she now weighs 3200 g (7 lb 1 oz). She is exclusively breastfed. Her older brother died 3 months after liver surgery. Her temperature is 37.1°C (98.8°F), pulse is 145/min, and respirations are 40/min. Examination shows yellow discoloration extending to the palms and soles. The liver is palpated 1 cm below the right costal margin. Laboratory studies show: Hematocrit 51% Serum Bilirubin Total 16.1 mg/dL Direct 0.7 mg/dL Alkaline phosphatase 22 U/L AST 12 U/L ALT 12 U/L Which of the following is the most likely diagnosis?

Three days after delivery, a 1100-g (2-lb 7-oz) newborn has a tonic seizure that lasts for 25 seconds. She has become increasingly lethargic over the past 18 hours. She was born at 31 weeks' gestation. Antenatal period was complicated by chorioamnionitis. Apgar scores were 3 and 6 at 1 and 5 minutes, respectively. She appears ill. Her pulse is 123/min, respirations are 50/min and irregular, and blood pressure is 60/30 mm Hg. Examination shows a tense anterior fontanelle. The pupils are equal and react sluggishly to light. Examination shows slow, conjugate back and forth movements of the eyes. Muscle tone is decreased in all extremities. The lungs are clear to auscultation. Which of the following is the most likely diagnosis?

A 5-day-old male newborn is brought to the physician by his mother because of yellowish discoloration of the skin for 1 day. The discoloration first appeared on his face and then spread to his trunk. There have been no changes in his bowel habits or urination. He was born at 38 weeks' gestation via uncomplicated vaginal delivery. He is exclusively breastfed every 2–3 hours. Examination shows scleral icterus and jaundice of the face, chest, and abdomen. Laboratory studies show: Hemoglobin 17.6 g/dL Reticulocytes 0.3% Maternal blood group A, Rh-negative Fetal blood group 0, Rh-positive Serum Bilirubin, total 7 mg/dL Direct 0.6 mg/dL Free T4 12 μg/dL Which of the following is the most likely diagnosis?

An otherwise healthy, exclusively breastfed 4-day-old neonate is brought to the physician because of yellowing of his skin and eyes. His urine has been clear and stools have been normal. He was born at term by vacuum-assisted delivery and weighed 4000 g (8 lb 8 oz). Pregnancy was complicated by gestational diabetes mellitus. His older sibling had jaundice in the neonatal period. Vital signs are within normal limits. He appears alert and comfortable. Physical examination shows jaundice of the skin and sclerae. The liver is palpated 1 cm below the right costal margin. Laboratory studies show: Hemoglobin 17 g/dl Reticulocyte count 0.5 % Total bilirubin 21.2 mg/dl Direct bilirubin 2 mg/dl Indirect bilirubin 19.1 mg/dl Coombs test Negative Which of the following is the most appropriate next step in management?

A neonate born at 33 weeks is transferred to the NICU after a complicated pregnancy and C-section. A week after being admitted, he developed a fever and became lethargic and minimally responsive to stimuli. A lumbar puncture is performed that reveals the following: Appearance Cloudy Protein 64 mg/dL Glucose 22 mg/dL Pressure 330 mm H20 Cells 295 cells/mm³ (> 90% PMN) A specimen is sent to microbiology and reveals gram-negative rods. Which of the following is the next appropriate step in management?