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%)
What risk factors are there for premature birth?
-40% are idiopathic
-Maternal previous preterm birth
-Multiple pregnancies
-Maternal illness (chorioamnionitis, pre-eclampsia, unstable DM)
-PROM (premature rupture of membranes)
-Uterine malformation
-Cervical incompetence
-Placental disease (dysfunction, placenta praevia, antepartum haemorrhage)
-Poor mental health, poor SE status
-Foetal compromise
-Haemolytic disease
What respiratory problems might occur from preterm birth?
-RDS (immature T2 pneumocystis causing surfactant deficiency –> ground glass CXR changes)
-Apnoea of prematurity
-Chronic lung disease
What CNS complications might occur from a preterm birth?
-Intraventricular haemorrhage (–>hydrocephalus, learning difficulties, cerebral palsy, PVL)
-Neurodevelopmental issues
-Retinopathy of prematurity (abnormal blood vessel growth at back of eye, treat with laser therapy)
What GI complications can occur from a preterm birth?
-Necrotising enterocolitis
–Inflammation and bacterial invasion of bowel wall, occurs after 1st week of life
–Presents with abdo distension, desaturated, pale, vomiting, erythema, apnoea, bradycardia, PR bleeding
–Metabolic acidosis, thrombocytopenia, hyponatraemia
–Treat with broad spec abx, stop feed, IV fluids
-Inability to suck
-Poor milk tolerance - immature gut
-Hypoglycaemia
What other broad complications can occur in prematurity?
-Hypothermia
-Immunocompromise resulting in increasing risk and severity of infection
-Patent ductus arteriosus
-Anaemia
-Jaundice
-Birth trauma
-Perinatal hypoxia
What late complications can occur from prematurity?
-Behavioural / neurodevelopment problems
-Sudden infant death syndrome (SIDS)
-Non-accidental injury due to impaired bonding, stress
How should you manage prematurity antenatally?
-Delivery in appropriate centre
-IM corticosteroids if <34 weeks (beta/dexamethasone)
How should you manage prematurity postnatally?
-Most require stabilisation and resus
-Delay cord clamping, keep warm
-Provide respiratory support if necessary
-Maintain BG, monitor weight and temp
-Encourage expressing of breast milk
-Abx if ?infection
-Minimal handling of infant
What is acrocyanosis?
-Blue appearance to peripheries - very common in neonates due to polycythaemia
-Normal –> reassure
