Common newborn problems

Question 1

What is erythema toxicum?

Answer 1

• neonatal urticaria
• appears at days 2-3 of life
• white pinpoint papules at centre of erythematous base
• fluid contains eosinophils
• concentrated on trunk
• come and go at different sites
• resolve spontaneously

Question 2

What is Mongolian blue spot?

Answer 2

• blue/ black maculae discolouration
• base of spine
• buttocks
• occassionally legs and other parts of body
• Afro-Carribean/ Asian children
• May be misdiagnosed as bruising

Question 3

What are capillary haemangiomas?

Answer 3

• strawberry naevus
• often not presetn at birth
• appear first few months of life
• multiple
• more common preterm
• increases in size up to 3-15m then gradually regresses
• no treatment indicated unless
  
  • vision or airway inteference
• ulceration/ haemorrhage may occur

Question 4

Classify physiological jaundice

Answer 4

• marked physiological release of haemoglobin from the breakdown of RBCs because of high Hb at birth
• red cell lifespan = 70 days in neonate vs. 120 days in adults
• hepatic bilirubin metabolism less efficient in the first few days of life

Question 5

Describe different types of birth trauma injuries

Answer 5

• Caput succendaneum: bruising and oedema of the presenting part of the skull extending beyond the margins of of the skull bones. Resolves in a few days
• Cephalhaematoma: haematoma from bleeding below the periosteum. Confined within the margins of skull sutures. Usually involves parietal bone. Centre of haematoma feels soft- resolves in a few weeks.
• Chignon: brusing and oedema from Ventouse delivery
• Subaponeurotic haemorrhage: very uncommon, diffuse boggy swelling of scalp, bloos loss may be severe –> hypovolaemic shock and coagulopathy
• Brachial plexus injury: traction of brachial plexus nerve roots. More likely to occur in breech delivery/ shoulder dystocia.
  
  • C5/ C6 = Erb’s plasy
    
    • associated with phrenic nerve palsy (elevated diaphragm)
  • most nerve palsies resolve completely, some need orthopedic/ plastic input if still present at 2-3 months
  • Facial nerve palsy can occur

Question 6

What is the ‘sticky eye’?

Answer 6

• conjunctivitis
• common in neonatal period (3rd/ 4th day of life)
• Tx: cleaning with saline and water
• ? staphylococcal/ streptococcal infection: neomycin
• purulent discharge with conjunctival infection and swelling of eyelids= in first 48h of life = gonococcal infection
  
  • gram stain
  • culture
  • treatment immediately
• chlamydia trachomatis purulent discharge and sweeling of eyelids
  
  • 1-2 weeks of life
  • organism can be identified with immunofluorescent staining
  • oral erythromycin for 2 weeks
• Mother and father treatment where necessary