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Systems: Paediatrics AB > Common Post-Natal Problems > Flashcards

Common Post-Natal Problems Flashcards

1
Q

What types of problems are common post-nataly?

A
  • Skin
  • Jaundice
  • Hypoglycaemia
  • Hypothermia
  • Feeding
  • GI
  • Respiratory
  • Cardiovascular
  • ENT
  • Ophthalmology
  • Genito-urinary
  • Neurology
  • Orthopaedic
  • Genetics
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2
Q

What are the 3 components of the energy triangle?

A
  • Pink (hypoxia)
  • Warm (hypothermia)
  • Sweet (hypoglycaemia)
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3
Q

What 3 things can affect a neonate’s skin?

A
  • Colour
  • Rashes
  • Birthmarks
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4
Q

Give examples of why a baby’s skin may change colour.

A
  • Jaundice
  • Pallor
  • Plethora
  • Cyanosis
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5
Q

Give examples of types of rashes that occur in neonates.

A
  • Benign
  • Milia
  • Milaria
  • Eryhtema toxicum neonatorim
  • Infections
  • Sebaceous naevus
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6
Q

Give examples of birthmarks that can present in neonates.

A
  • Capillary haemangiomas
  • Mongolian blue spots
  • Port wine stains
  • Stork marks
  • Giant melanocytic naevi
  • Café au lait spots
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7
Q

Who does physiological jaundice occur in?

A

Most new-borns especially pre-terms

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8
Q

Why does physiological jaundice occur?

A

A combination of increased red cell breakdown and immaturity of the hepatic enzymes causes unconjugated hyperbilirubinaemia.

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9
Q

What can exacerbate physiological jaundice?

A

It is exacerbated by dehydration, which can occur if establishment of feeding is delayed.

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10
Q

What does jaundice within 24 hours of life suggest?

A

Always pathological

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11
Q

Why is it important to recognise and treat neonatal unconjugated hyperbilirubinaemia?

A

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).

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12
Q

Why is it important to evaluate conjugated hyperbilirubinaemia early?

A

Early evaluation of conjugated hyperbilirubinaemia (>20 mmol/L) is important to allow early (<6weeks) diagnosis and treatment of biliary atresia.

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13
Q

Why can jaundice occur in the first 24 hours of life?

A
  • Haemolytic (G6PD or spherocytosis)

- TORCH (congenital infection)

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14
Q

Why may jaundice occur between the 2nd day and 3rd week of life?

A
  • Physiological (goes after 1st week)
  • Breast milk
  • Sepsis
  • Polycythaemia
  • Cephalohematoma
  • Crigler-Najjar syndrome
  • Haemolytic disorders
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15
Q

Why may jaundice occur after the 3rd week of life?

A
  • Breast milk
  • Hypothyroidism
  • Pyloric stenosis
  • Cholestasis
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16
Q

How is jaundice treated?

A

-Treat the underlying cause
-Hydrate
-Phototherapy (NICE guideline charts)
-Exchange transfusion
Immunoglobulin

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17
Q

What babies are at risk of hypoglycaemi?

A

Limited glucose supply

  • Premature babies
  • Perinatal stress

Hyperinsulinism
-Infants of diabetic mothers

Increased glucose utilisation

  • Small and large for gestational age
  • Hypothermia
  • Sepsis
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18
Q

What are the symptoms of neonatal hypoglycaemia?

A
  • Jitteriness
  • Hypothermia
  • Temperature instability
  • Lethargy
  • Hypotonia
  • Apnoea, irregular respirations
  • Poor suck/feeding
  • Vomiting
  • High pitched or weak cry
  • Seizures
  • Asymptomatic
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19
Q

What is hypoglycaemia defined as?

A

Blood sugars <2.6mmol/l

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20
Q

How do we test neonates blood sugars?

A
  • Bedside testing (can be inaccurate if high, low, poor perfusion, polycythaemia)
  • Lab sample for testing
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21
Q

How can babies lose heat?

A
  • Evaporation
  • Conduction
  • Convection
  • Radiation
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22
Q

What is radiation heat loss?

A

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)

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23
Q

What is convection heat loss?

A

Loss of heat from body surface to cooler air

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24
Q

What is conduction heat loss?

A

Loss of heat from the body surface to cooler surface in direct contact

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25
Q

What is evaporation heat loss?

A

Loss of heat when liquid is converted to vapour

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26
Q

How are babies resuscitated in response to cold stress?

A
  • Dry quickly
  • Use warm towels/blankets
  • Provide radiant warmer heat
  • Use heated/humidified oxygen
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27
Q

What are tongue ties?

A
  • 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
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28
Q

How are tongue ties managed?

A
  • Usually no treatment necessary

- If it impacts feeding then a frenotomy must be performed

29
Q

What type of feeding should be promoted?

A

Breast feeding

30
Q

What GI problems may occur in the post-natal period?

A
  • Vomiting
  • Posseting
  • Mucous vomits
  • GOR
  • Cows milk protein allergy
  • Bilious vomiting
  • Failure to pass meconium
  • Bloody stools
  • Blood in vomit
31
Q

What is the commonest reason for admission to NNU?

A

Respirator distress

32
Q

How are neonate assessed for respiratory distress?

A

Increased effort

  • Grunting
  • Retractions
  • Nasal flaring
  • RR
  • Colour
  • Oxygen sats
33
Q

What areas should be assessed for retractions?

A
  • Substernal
  • Subcostal
  • Intercostal
  • Suprasternal
34
Q

How can cleft lips vary?

A
  • 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)
35
Q

Why do cleft palates occur?

A

Maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation

36
Q

What issues may cleft lip and palate lead to?

A

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
37
Q

What should always be checked in an ophthalmological check of neonates?

A

Red light reflexes

38
Q

How does cataracts present?

A

Lens opacification

39
Q

What may cataracts lead to?

A

If left untreated then blindness

40
Q

How is cataracts managed?

A
  • May require no treatment

- May require lens removal and artificial lens

41
Q

What is retinoblastoma?

A

Rare eye cancer which can be successfully treated if picked up early

42
Q

How is retinoblastoma treated?

A
  • Laser therapy
  • Chemotherapy
  • Surgical removal of the eye
43
Q

What genito-urinary issues can occur in neonates?

A

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

44
Q

What can spinal dimples suggest?

A
  • 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
45
Q

When should spinal dimples be investigated with ultrasounds and MRIs?

A

If the dimple is:

  • Red
  • Swollen
  • Off midline
  • Higher than sacral area
  • Pigmented
  • Tender
  • Accompanied by fluid
46
Q

What is cephalohaematolmas?

A
  • Localised swelling over one or both sides of the head

- Softly, non translucent swelling

47
Q

What are the limits of cephalohaematomas?

A

Cranial bones usually parietal bone

48
Q

Where is the haemorrhage in cephalohaematomas?

A

Beneath the pericranium

49
Q

When do cephalhaemotomas become maximal in size?

A

By the 3rd to 4th day of life

50
Q

What is the treatment for cephalohaematomas?

A

No treatment required, resolution usually occurs within 3-4 weeks

51
Q

Why can cephalohaematomas lead to prolonged jaundice?

A

Occasionally, if the haematoma is very large, the increased haemolysis results in increased or prolonged neonatal jaundice

52
Q

What is caput succedaneum?

A
  • Serosanguinous, subcutaneous fluid collection with poorly defined margins
  • Scalp swelling that extends across the midline and over suture lines and associated with head moulding
53
Q

What causes caput succedaneum?

A

Pressure of presenting part of the scalp against the dilating cervix during delivery

54
Q

What is the management for caput succedaneum?

A

Does not usually cause complications and resolve over the first few days

55
Q

What is talipes?

A

-Medial (varus) or lateral (valgus) deviation of the foot is often positional and requires no treatment other than physiotherapy

56
Q

How is fixed talipes managed?

A
  • More vigorous manipulation
  • Strapping
  • Casting
  • Possible surgery
57
Q

What may babies with significant talipes also have?

A

Developmental dysplasia of the hips

58
Q

What are the deformities associated with talipes?

A
  • Cavus
  • Adduction
  • Varus
  • Equinus
59
Q

What is the goal of DDH treatment?

A

Relocate the head of the femu to acetabulum so hip develops normally

60
Q

How is DDH treated?

A
  • Pavlik harness

- Surgical reduction

61
Q

What dysmorphic features are associated with trisomy 21?

A
  • Low set ears
  • Downwards slanting palpebral fissures
  • Epicanthic folds
  • Single palmar creases
  • Wide sandal gap
62
Q

What conditions is trisomy 21 associated with?

A
  • Hypotonia
  • Cardiac defects
  • Learning problems
  • Haematological problems
  • Thyroid problems
63
Q

What is plethora?

A

Red skin usually caused by polycythaemia which makes the blood viscous

64
Q

What is cyanosis?

A

Blue tinge to the skin associated with poor oxygenation/peerfusion

65
Q

What is erythema toxicum?

A

-Maculo-papular rash which occurs in 30-70% of term babies but very rare in pre-term babies

66
Q

What is the treatment for erythema toxicum?

A
  • Fades by end of 1st week and no treatment required

- Cause is unknown

67
Q

What are Mongolian blue spots?

A
  • 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
68
Q

What are stork marks?

A

-Naevus simplex are light colour capillary dilatations commonly found on the back of the neck but may be in the midline of the face

69
Q

What is the outcome of stork marks?

A

Gradually fade usually within 1-2 years

Systems: Paediatrics AB (31 decks)

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