1. Birth injury + birth marks Flashcards
What can cause hypoxic ischaemic encephalopathy?
-Reduced umbilical blood flow (eg cord prolapse)
-Reduced placental gas exchange (eg placental abruption)
-Reduced maternal placental perfusion (abruption, accreta)
-Maternal hypoxia
-Inadequate postnatal CPC
How does HIE present?
Depends on severity - important predictor of outcome:
MILD
-Irritability
-Hyperalert
-Poor sucking
-Hypotonia
MODERATE
-Lethargy
-Seizures
-Marked abnormalities of tone
-NG feeding
SEVERE
-Coma
-Prolonged seizures
-Severe hypotonia
-Breathing support
What investigations would you order for HIE?
-Assess for evidence of intrapartum problem eg CTG abnormality, cord prolapse, abruption
-Respiratory depression at birth
-APGAR score at 5min <5
-Moderate to severe acidosis
How would you manage a baby with HIE?
-Resuscitate at birth
-Insert IV / arterial lines
-Avoid hyperthermia
–Head cooling to 33-34 degrees for 72h
-Assess eligibility for therapeutic hypothermia
-Cerebral function analysis monitoring
-Assess for features of birth trauma / dysmorphism
-Exclude other causes of encephalopathy eg meningitis, maternal drugs, haemorrhage, metabolic disturbances
-Manage multi-organ failure
-Maintain homeostasis, support BP, fluid restriction initially
-Omit milk for 1-2days, then slowly feed
-Room air
What prognosis does HIE have?
-Without cooling, risk of later disability or death is greater
-Likely complications:
–Spastic quadriplegia
–Dyskinetic cerebral palsy
–Severely reduced IQ
–Cortical blindness, hearing loss
–Epilepsy
What are the two types of birth mark?
-Vascular (red but if deep can appear blue)
-Pigmented (usually brown)
What are the features of a salmon patch / stork mark birthmark?
-The most common type of vascular birthmark (50% of babies)
-Flat red/pink patches on the eyelids, nape of neck or forehead at birth
-Most fade completely within a few months (up to 4y if on forehead/neck)
-Often more noticeable when baby cries (fills with blood)
What are the features of an infantile haemangioma / strawberry mark?
-Occurs in 5% of babies, more common in girls
-Raised mark, red superficially, may have blue deeper component
-Can appear anywhere on the body
-Reassure parents - increase in size for the first 6 months and eventually shrink / fade by 7y
-If they get bigger rapidly or interfere with vision / feeding then may require topical propranolol / laser/ surgical removal
What are the features of a capillary malformation / port wine stain?
-Flat red / purple marks affecting very few children
-Often on one side of the body
-Sensitive to hormones - may become more noticeable around puberty, pregnancy, menopause
-Most are permanent and may deepen in colour over time
-Involvement of eyelid can be associated with glaucoma
-Treatment = laser
-Associated with Sturge-Webere syndrome (learning disabilities)
What are the features of cafe-au-lait spots?
-Coffee-coloured skin patches
-Many children have 1-2, but if 6+ develop by 5y, could be a sign of neurofibromatosis type 1
What are the features of congenital dermal melanocytosis?
-Blue-grey / bruised looking birthmarks present from birth aka Mongolian blue spots
-Usually occur over lower back / buttocks
-More common in darker-skinned children
-Can last for months-years - usually gone by 4y
-Harmless, may be mistaken for a bruise - must document clearly
What are the features of congenital melanocytic naevi?
-Large black / brown moles present from birth
-Fairly common, may change over time
-Low risk of developing into skin cancer, but increased size = increased risk
What is a cephaloheamatoma?
-Fluctuant swelling on newborn’s head due to sub-periostal bleed
-Typically develops several hours after delivery
-Most often occur over parietal bones - do not cross suture lines so swelling is limited
-Resolves over weeks, up to 3months
-Jaundice can be a complication
What risk factors are there for developing cephalohaematoma?
-Large for gestational age (LGA)
-Cephalic-pelvic disproportion
-Malpresentation
-Precipitate / instrumental delivery
-Shoulder dystocia
-Prematurity
How is prematurity defined?
-Birth before 37 weeks gestation
-8% of all births
-Most problems seen in infants born <32 weeks (2%)
