Common Post-Natal Problems Flashcards
What types of problems are common post-nataly?
- Skin
- Jaundice
- Hypoglycaemia
- Hypothermia
- Feeding
- GI
- Respiratory
- Cardiovascular
- ENT
- Ophthalmology
- Genito-urinary
- Neurology
- Orthopaedic
- Genetics
What are the 3 components of the energy triangle?
- Pink (hypoxia)
- Warm (hypothermia)
- Sweet (hypoglycaemia)
What 3 things can affect a neonate’s skin?
- Colour
- Rashes
- Birthmarks
Give examples of why a baby’s skin may change colour.
- Jaundice
- Pallor
- Plethora
- Cyanosis
Give examples of types of rashes that occur in neonates.
- Benign
- Milia
- Milaria
- Eryhtema toxicum neonatorim
- Infections
- Sebaceous naevus
Give examples of birthmarks that can present in neonates.
- Capillary haemangiomas
- Mongolian blue spots
- Port wine stains
- Stork marks
- Giant melanocytic naevi
- Café au lait spots
Who does physiological jaundice occur in?
Most new-borns especially pre-terms
Why does physiological jaundice occur?
A combination of increased red cell breakdown and immaturity of the hepatic enzymes causes unconjugated hyperbilirubinaemia.
What can exacerbate physiological jaundice?
It is exacerbated by dehydration, which can occur if establishment of feeding is delayed.
What does jaundice within 24 hours of life suggest?
Always pathological
Why is it important to recognise and treat neonatal unconjugated hyperbilirubinaemia?
Recognition and treatment of severe neonatal unconjugated hyperbilirubinaemia is important to avoid bilirubin encephalopathy or kernicterus (brain damage due to deposition of bilirubin in the basal ganglia).
Why is it important to evaluate conjugated hyperbilirubinaemia early?
Early evaluation of conjugated hyperbilirubinaemia (>20 mmol/L) is important to allow early (<6weeks) diagnosis and treatment of biliary atresia.
Why can jaundice occur in the first 24 hours of life?
- Haemolytic (G6PD or spherocytosis)
- TORCH (congenital infection)
Why may jaundice occur between the 2nd day and 3rd week of life?
- Physiological (goes after 1st week)
- Breast milk
- Sepsis
- Polycythaemia
- Cephalohematoma
- Crigler-Najjar syndrome
- Haemolytic disorders
Why may jaundice occur after the 3rd week of life?
- Breast milk
- Hypothyroidism
- Pyloric stenosis
- Cholestasis
How is jaundice treated?
-Treat the underlying cause
-Hydrate
-Phototherapy (NICE guideline charts)
-Exchange transfusion
Immunoglobulin
What babies are at risk of hypoglycaemi?
Limited glucose supply
- Premature babies
- Perinatal stress
Hyperinsulinism
-Infants of diabetic mothers
Increased glucose utilisation
- Small and large for gestational age
- Hypothermia
- Sepsis
What are the symptoms of neonatal hypoglycaemia?
- Jitteriness
- Hypothermia
- Temperature instability
- Lethargy
- Hypotonia
- Apnoea, irregular respirations
- Poor suck/feeding
- Vomiting
- High pitched or weak cry
- Seizures
- Asymptomatic
What is hypoglycaemia defined as?
Blood sugars <2.6mmol/l
How do we test neonates blood sugars?
- Bedside testing (can be inaccurate if high, low, poor perfusion, polycythaemia)
- Lab sample for testing
How can babies lose heat?
- Evaporation
- Conduction
- Convection
- Radiation
What is radiation heat loss?
Loss of heat from the body surface to a cooled surface that is not in direct contact, but in close proximity to the body (cold objects near to baby)
What is convection heat loss?
Loss of heat from body surface to cooler air
What is conduction heat loss?
Loss of heat from the body surface to cooler surface in direct contact
What is evaporation heat loss?
Loss of heat when liquid is converted to vapour
How are babies resuscitated in response to cold stress?
- Dry quickly
- Use warm towels/blankets
- Provide radiant warmer heat
- Use heated/humidified oxygen
What are tongue ties?
- Short thickened frenulum’s that are attached anteriorly to the base of the tongue
- They restrict tongue protrusion beyond the alveolar margins or heavy grooving of tip of tongue and/or feeding is affected
How are tongue ties managed?
- Usually no treatment necessary
- If it impacts feeding then a frenotomy must be performed
What type of feeding should be promoted?
Breast feeding
What GI problems may occur in the post-natal period?
- Vomiting
- Posseting
- Mucous vomits
- GOR
- Cows milk protein allergy
- Bilious vomiting
- Failure to pass meconium
- Bloody stools
- Blood in vomit
What is the commonest reason for admission to NNU?
Respirator distress
How are neonate assessed for respiratory distress?
Increased effort
- Grunting
- Retractions
- Nasal flaring
- RR
- Colour
- Oxygen sats
What areas should be assessed for retractions?
- Substernal
- Subcostal
- Intercostal
- Suprasternal
How can cleft lips vary?
- Can be incomplete (small gap in lip) or complete (continue into the nose)
- Can be unilateral (left sided unilateral is most common) or bilateral (85% have palatal involvement)
Why do cleft palates occur?
Maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation
What issues may cleft lip and palate lead to?
Feeding issues
- Special bottles and teats
- Can still attempt breast feeding
Airway problems
-70% experience respiratory distress
Associated anomalies
- Need hearing screen
- Need cardiac echo
- Remember trisomies
What should always be checked in an ophthalmological check of neonates?
Red light reflexes
How does cataracts present?
Lens opacification
What may cataracts lead to?
If left untreated then blindness
How is cataracts managed?
- May require no treatment
- May require lens removal and artificial lens
What is retinoblastoma?
Rare eye cancer which can be successfully treated if picked up early
How is retinoblastoma treated?
- Laser therapy
- Chemotherapy
- Surgical removal of the eye
What genito-urinary issues can occur in neonates?
Pseudomenstruation
- Bloody mucous in nappy
- Occurs in girls due to hormones from mum which are still circulating in baby
Urate brick powdery deposits
-Essentially uric acid crystals can occur in the urine
What can spinal dimples suggest?
- Can reveal a more serious abnormality involving the spine and/or spinal cord, such as spina bifida occulta which is the least serious form of spina bifida
- Dimples may also be indicative of a possible kidney problem
When should spinal dimples be investigated with ultrasounds and MRIs?
If the dimple is:
- Red
- Swollen
- Off midline
- Higher than sacral area
- Pigmented
- Tender
- Accompanied by fluid
What is cephalohaematolmas?
- Localised swelling over one or both sides of the head
- Softly, non translucent swelling
What are the limits of cephalohaematomas?
Cranial bones usually parietal bone
Where is the haemorrhage in cephalohaematomas?
Beneath the pericranium
When do cephalhaemotomas become maximal in size?
By the 3rd to 4th day of life
What is the treatment for cephalohaematomas?
No treatment required, resolution usually occurs within 3-4 weeks
Why can cephalohaematomas lead to prolonged jaundice?
Occasionally, if the haematoma is very large, the increased haemolysis results in increased or prolonged neonatal jaundice
What is caput succedaneum?
- Serosanguinous, subcutaneous fluid collection with poorly defined margins
- Scalp swelling that extends across the midline and over suture lines and associated with head moulding
What causes caput succedaneum?
Pressure of presenting part of the scalp against the dilating cervix during delivery
What is the management for caput succedaneum?
Does not usually cause complications and resolve over the first few days
What is talipes?
-Medial (varus) or lateral (valgus) deviation of the foot is often positional and requires no treatment other than physiotherapy
How is fixed talipes managed?
- More vigorous manipulation
- Strapping
- Casting
- Possible surgery
What may babies with significant talipes also have?
Developmental dysplasia of the hips
What are the deformities associated with talipes?
- Cavus
- Adduction
- Varus
- Equinus
What is the goal of DDH treatment?
Relocate the head of the femu to acetabulum so hip develops normally
How is DDH treated?
- Pavlik harness
- Surgical reduction
What dysmorphic features are associated with trisomy 21?
- Low set ears
- Downwards slanting palpebral fissures
- Epicanthic folds
- Single palmar creases
- Wide sandal gap
What conditions is trisomy 21 associated with?
- Hypotonia
- Cardiac defects
- Learning problems
- Haematological problems
- Thyroid problems
What is plethora?
Red skin usually caused by polycythaemia which makes the blood viscous
What is cyanosis?
Blue tinge to the skin associated with poor oxygenation/peerfusion
What is erythema toxicum?
-Maculo-papular rash which occurs in 30-70% of term babies but very rare in pre-term babies
What is the treatment for erythema toxicum?
- Fades by end of 1st week and no treatment required
- Cause is unknown
What are Mongolian blue spots?
- Blue grey pigmentations often located on the lower back and buttocks
- They ae an accumulation of melanocytes and are therefore very common in races with pigmented skin
What are stork marks?
-Naevus simplex are light colour capillary dilatations commonly found on the back of the neck but may be in the midline of the face
What is the outcome of stork marks?
Gradually fade usually within 1-2 years
