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    Perinatal Nursing: Day 2 online discussion

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    arch_ang
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    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 10:23 pm

    * Hepatitis B is one of the major diseases that can be prevented with vaccination. Two types of recombinant hepatitis B vaccines are licensed for use in the United States; both are effective and safe.
    * Universal vaccination refers to the administration of HBV vaccine to all infants as a part of the routine childhood immunization schedule and to all children younger than 11 or 12 years who have not previously received a vaccine. Rapid (0-, 1-, and 2-mo) and standard (0-, 1-, 6-mo) schedules have identical efficacy.
    * Passive immunization refers to the administration of preformed human or animal antibody, in the form of hepatitis B immunoglobulin (HBIG), to patients after or just before exposure.
    o The current recommendation for neonates of mothers who are HB s Ag positive is to administer HBIG 0.5 mL intramuscularly with the first dose of recombinant HBV vaccine within 12 hours of birth.
    o After immunization, serology should be tested for HB s Ag and anti-HB s at age 9-18 months.
    o In infants of infected mothers, combined treatment with the vaccine and HBIG has 79-98% efficacy in preventing chronic HBV infection.
    * Patients on dialysis and those who are immunocompromised need to be evaluated annually for hepatitis B; if the anti HB s Ab level is less than 10 mIU/mL, a booster dose is recommended.
    * Testing of hepatitis serology for immune response is recommended for high-risk groups such as homosexuals and bisexuals, patients on dialysis, sexual and household contacts of hepatitis B carriers and patients with human immunodeficiency virus (HIV) infection.
    * After 3 primary doses of the vaccine, if no serologic response with anti-HB s of 10 mIU/ml is noted, reimmunization with a 3-dose series is recommended. If the response if still negative, they are unlikely to mount antibody with additional doses.
    * Twinrix is a combination of hepatitis B (Engerix-B, 20 mcg) and hepatitis A (Havrix, 720 ELU) vaccine approved for people aged 18 years or older in a 3-dose schedule administered at 0 months, 1 month, and 6 or more months later.
    * For preterm infants who weigh less than 2000 g and are born to mothers with unknown HB s Ag status, 0.5 ml HBIG should be given within 12 hours. The birth dose should not be counted, and 3 additional doses are given according to recommendations.

    Hepatitis B

    Author: Poonam Sharma, MD, Assistant Professor, Department of Pathology, Creighton University Medical Center and Veterans Affairs Medical Center; Director of Pathology Course, School of Pharmacy and Health Professions, Creighton University Medical Center
    Coauthor(s): Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University School of Medicine; Alexander T Kessler, MD, Consulting Staff, Northside Medical Specialties, LLC; Athena P Kourtis, MD, PhD, Assistant Professor, Department of Pediatrics, Divisions of Infectious Diseases and Epidemiology, Emory University School of Medicine


    Updated: May 1, 2008

    Angel Ve
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Angel Ve on Tue 11 Aug 2009, 10:20 pm

    yes.. all of you are correct... when handling vaccination like Hepa B we should try to consider cold chain, because Hep B vaccine is least heat sensitive.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    intrapartal considerations...

    Post  ara_portillo on Tue 11 Aug 2009, 10:20 pm

    >> i think it will be adherence to the contact precaution...

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    hepa B vaccines..

    Post  ara_portillo on Tue 11 Aug 2009, 10:19 pm

    considerations in giving it to the infant:
    1) follow the schedule of immunization. give 3 doses, 1st dose at birth, 2nd dose after 6 weeks, 3rd dose after 8 weeks. It is given IM in the upper outer portion of the infant's thigh.
    2)contraindication in giving it is severe sensitivity to the drug/its component.

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 10:18 pm

    Antepartum
    Pregnant Hepatitis B carriers should be advised to
    Obtain vaccination against hepatitis viruses A as indicated.
    Abstain form alcohol use
    Avoid hepatotoxic drugs such as acetaminophen (Tylenol) that may worsen liver damage.
    Not donate blood, body organs, other tissue, or semen.
    Not share any personal items that may have blood on them (e.g., toothbrushes and razors).
    Inform the infants pediatrician, OB/GYN, and labor staff that they are a hepatitis B carrier.
    Make sure their baby receives hepatitis B vaccine at birth, one month, and six months of age as well as H-BIG at birth.
    Be seen at least annualy by their regular medical doctor.
    Discuss the risk for transmission with their partner and discuss the need for counseling and testing
    b. Liver function testing is recommended for women who test positive for HBsAg [1]

    The following recommendations from The Society of Obstetricians and Gynecologists of Canada may be helpful in counseling women considering amniocentesis.

    SOGC Recommendations [14]

    The risk of fetal hepatitis B infection through amniocentesis is low. However, knowledge of the maternal hepatitis B e antigen status is valuable in the counselling of risks associated with amniocentesis.
    For women infected with hepatitis B, hepatitis C, or HIV, the addition of noninvasive methods of prenatal risk screening, such as nuchal translucency, triple screening, and anatomic ultrasound, may help in reducing the age-related risk to a level below the threshold for genetic amniocentesis.
    For those women infected with hepatitis B, hepatitis C, or HIV who insist on amniocentesis, every effort should be made to avoid inserting the needle through the placenta.


    Although cesarean delivery has been proposed as a means of reducing mother to child transmission (MCT) of HBV. The mode of delivery does not appear to have a significant effect on the interruption of HBV maternal-baby transmission by immunoprophylaxis. Delivery by cesarean section for the purpose of reducing MCT of HBV is note presently recommended by either the CDC or the ACOG.

    Breast feeding.
    With appropriate hepatitis B immunoprophylaxis, breast-feeding poses no additional risk for transmission from infected hepatitis B virus carriers

    Reference:

    Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines --- 2002 .MMWR May 10, 2002 / 51(RR06);1-80
    2. ACOG educational bulletin. Viral hepatitis in pregnancy. Number 248, July 1998 . American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1998 ;63:195-202. MEDLINE

    http://www.perinatology.com/exposures/Infection/HepatitisB.htm

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 10:17 pm

    Ara and tina were correct. It's just like what they do in the barangay health centers during EPI.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:15 pm

    the hepatitis vaccine should maintain the cold chain. meaning the vaccine should be maintained at +2C.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    perinatal nursing: day 2 online discussion

    Post  ara_portillo on Tue 11 Aug 2009, 10:15 pm

    considerations in handling Hepa B vaccines:
    1) in keeping/storing the vaccines, cold chain management should be applied. Meaning proper temperature management should be followed. HEPA B VACCINE is LEAST SENSITIVE to Heat and it should be stored in +2 C to 8 C (in the body of the refrigerator).
    2) temperature will be checked twice a day. one in the morning and one in the afternoon.

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 10:13 pm

    If the mother is positive for both HBsAg and HBeAg and her baby does not receive immunoprophylaxis, the risk of the baby developing chronic HBV infection by age 6 months is 70% to 90%.810. Of those exposed in early childhood, 28.8% are HBsAg positive by age 4 years.5 These data underscore the need for early vaccination. (Tran. T)

    Source: http://www.ccjm.org/content/76/Suppl_3/S25.full

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:12 pm

    hepatitis B considerations

    RISKS AND SIDE EFFECTS

    Most infants who receive the hepatitis B vaccine have no side effects. Others may have minor problems, such as soreness and redness at the injection site or a mild fever. Serious problems are rare and are mainly due to allergic reactions to a component of the vaccine.

    CONSIDERATIONS

    If the child is ill with something more serious than a cold, the hepatitis B vaccine may be delayed.

    If the child has a severe allergic reaction to baker's yeast, they should not receive this vaccine.

    If severe allergic reaction occurs after receiving the vaccine, no further hepatitis B vaccines should be given to the child.

    (Medline, 2008)

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 10:09 pm

    owkhai, miss arroyo

    Angel Ve
    Guest

    reply to Jenny

    Post  Angel Ve on Tue 11 Aug 2009, 10:08 pm

    Yes Jenny.. We are now discussing the answer for Question 3 in Case 4 about Hepatitis B.

    Angel Ve
    Guest

    yogi's post

    Post  Angel Ve on Tue 11 Aug 2009, 10:07 pm

    I agree with Yogi..Interferon does not appear to adversely affect the embryo or fetus. However, the data is limited, and the potential benefits of interferon use during pregnancy should clearly outweigh possible hazards . Initial data do not suggest that Lamivudine is teratogenic. Lamivudine has been used in the latter half of pregnancy in attempt to prevent perinatal transmission of hepatitis B virus infection with mixed success.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:05 pm

    yes ms. tan.

    jenny c.
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  jenny c. on Tue 11 Aug 2009, 10:05 pm

    good evening everyone!

    sorry for being late again...
    would you kindly help me be in the track of the discussion..thanks!

    Angel Ve
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Angel Ve on Tue 11 Aug 2009, 10:04 pm

    Your answers to medical managements include:

    Supportive treatment
    Proper referral to health professional with experience in treatment of Hepatitis B
    Treatment with alpha-interferon or lamivudine which shows no adverse effect to the fetus

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:03 pm

    so, conclude the answer for no.3, we say that vaccination and antiviral therapy is indicated for the pregnant mother?

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    To add up..

    Post  ara_portillo on Tue 11 Aug 2009, 10:03 pm

    Antepartum Care: Pregnant Hepatitis B carriers should be advised to
    Obtain vaccination against hepatitis viruses A as indicated.
    Abstain form alcohol use
    Avoid hepatotoxic drugs such as acetaminophen (Tylenol) that may worsen liver
    damage.
    Not donate blood, body organs, other tissue, or semen.
    Not share any personal items that may have blood on them (e.g., toothbrushes
    and razors).
    Inform the infants pediatrician, OB/GYN, and labor staff that they are a
    hepatitis B carrier.
    Make sure their baby receives hepatitis B vaccine at birth, one month, and six
    months of age as well as H-BIG at birth.
    Be seen at least annualy by their regular medical doctor.
    Discuss the risk for transmission with their partner and discuss the need for
    counseling and testing
    b. Liver function testing is recommended for women who test positive for HBsAg
    [1]
    The following recommendations from The Society of Obstetricians and
    Gynecologists of Canada may be helpful in counseling women considering
    amniocentesis.
    SOGC Recommendations
    The risk of fetal hepatitis B infection through amniocentesis is low.
    However, knowledge of the maternal hepatitis B e antigen status is valuable in
    the counselling of risks associated with amniocentesis.
    For women infected with hepatitis B, hepatitis C, or HIV, the addition of
    noninvasive methods of prenatal risk screening, such as nuchal translucency,
    triple screening, and anatomic ultrasound, may help in reducing the age-related
    risk to a level below the threshold for genetic amniocentesis.
    For those women infected with hepatitis B, hepatitis C, or HIV who insist on
    amniocentesis, every effort should be made to avoid inserting the needle through
    the placenta.

    Reference: http://www.perinatology.com/exposures/Infection/HepatitisB.htm

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 10:03 pm

    Miss arroyo...

    In one cohort of 38 HBV-infected women who became pregnant while taking lamivudine and elected to continue the treatment throughout the pregnancy, there were no pregnancy complications, no instances of fetal injury and no cases of perinatal HBV transmission.

    Hepatitis B and Pregnancy: An Underestimated Issue: Vaccination Against Hepatitis B Virus During Pregnancy and Treatment for Hepatitis B Virus During Pregnancy
    Maureen M. Jonas
    Published: 04/24/2009

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 10:02 pm

    treatment includes oral HBV antiviral agent in the third trimester which may be considered after discussion with the mother regarding the risks and benefits of therapy. One strategy for therapy is the use of lamivudine, tenofovir, or telbivudine starting at 32 weeks of pregnancy; the HBV DNA level that warrants treatment depends on the presence or absence of a history of perinatal transmission. (Tran, T.)

    Source: http://www.ccjm.org/content/76/Suppl_3/S25.full

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:01 pm

    Initial data do not suggest that Lamivudine is teratogenic. Lamivudine has been used in the latter half of pregnancy in attempt to prevent perinatal transmission of hepatitis B virus infection with mixed success.

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 10:01 pm

    For these reasons, in most instances, it is reasonable to defer therapy until after delivery, to avoid fetal exposure to the therapeutic agents. After delivery, standard therapy indications, as expressed in the several available HBV guidelines, will apply. However, if maternal liver disease requires treatment, or if a pregnancy occurs in a woman already receiving a medication for HBV, decisions must be made about treatment course.

    there are no standards regarding managing HBV in women who become pregnant while receiving antiviral therapy. One option is discontinuation of treatment as soon as the pregnancy is recognized. This is an option only for those with mild hepatitis, with a low risk of serious flare or disease progression. Other possibilities include continued careful monitoring or change of therapy to lamivudine, either temporarily or permanently, acknowledging the risk of development of resistance.

    Hepatitis B and Pregnancy: An Underestimated Issue: Vaccination Against Hepatitis B Virus During Pregnancy and Treatment for Hepatitis B Virus During Pregnancy
    Maureen M. Jonas
    Published: 04/24/2009

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:01 pm

    In one study: In highly viraemic HBsAg-positive mothers, reduction of viraemia by lamivudine therapy in the last month of pregnancy may be an effective and safe measure to reduce the risk of child vaccination breakthrough.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    risks to the fetus..

    Post  ara_portillo on Tue 11 Aug 2009, 10:00 pm

    treatment of mothers during pregnancy with vaccination shows to harm to the fetus. however, literature will tell us that there is no enough evidence to support this claim..

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 10:00 pm

    Refer for or provide HBsAg-positive women counseling and medical management. Give the following information:

    * Modes of hepatitis transmission.

    * Perinatal concerns (i.e. HBsAg-positive mothers may breastfeed, treatment of newborns for exposure to hepatitis B).
    * Prevention of HBV to contacts, include vaccine prophylaxis for infant(s) and testing and/or hepatitis B vaccination for household, sexual, and needle-sharing contacts.
    * Substance abuse treatment and/or mental healthcare if appropriate.
    * Medical evaluation and possible treatment of chronic hepatitis B.
    (Minnesota Department of Health, 2008)

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