Common post natal problems Flashcards
what is plethora caused by and how do we test for it?
polycythenia - high red cell conc in the blood
- full blood count - haematocrit, IV fluids
central cyanosis needs investigation with
oxygen sats
why do pre terms get jaundice
= what does this cause
- increased red cell turn over
- immaturity of the hepatic enzymes that process bilirubin
unconjugated hyperbilirubiemia
jaundice - 1st 24 Hours causes?
pathological -
Haemolytic ( Rh incompatibility, other antibodies, hereditary anaemias e.g. G6PD deficiency, spherocytosis )
Sepsis
jaundice - 2nd day - 2/3rd week causes?
Physiological Dehydration/poor feeding Breast milk Sepsis Polycythaemia Bruiding e.g. cephalohaematoma Haemolytic Crigler-Najjar Syndrome
prolonged jaundice >2 weeks term and > 3 weeks pre term
Breast milk Sepsis Haemolytic Hypothyroidism Cholestasis e.g. biliary atresia - conjugated
jaundice treatment aims
- bring down unconjgated bilirubin
- hydrate
- phototherapy
- exchange transfusion
- immunoglobulin
extremely common rash that occur in neonates?
Erythema toxicum
- maculo-papular rash, white pustules
- fades within 1 week
why do babies get Mongolian blue spots?
accumulation of melanocytes
- darker pigmented skin
Capillary vascular malformations - Stork marks
capillary dilatation
naevus simplex
Port Wine Stain
dilated mature capillaries in the superficial dermis - will be there for life
syndromes associated with port wine stain?
Sturge Weber - trigeminal nerve
- Klippel-Trenaunay
strawberry naevus are?
cluster of dilated capillaries
cold stress increases what?
metabolic acidosis - hypoglycaemia
what babies are at risk of hypoglycaemia
premature perinatal stress infants of diabetes sepsis hypothermia
Hypoglycaemia - in first 48 hours is defined as?
blood sugar <2 mol/l
symptoms of hyperglycaemia in a neonate
- Jitteriness
- Temperature instability
- Lethargy
- Hypotonia
- Apnoea, irregular respirations
- Poor suck / feeding
- Vomiting
- High pitched or weak cry
- Seizures
- Asymptomatic
tongue ties affect?
Restriction of tongue protrusion beyond the alveolar margins AND feeding is affected - frenotomy
signs of increased respiratory effort?
Grunting
Retractions
Nasal flaring
Areas to Assess for Retractions? (4)
Substernal
Subcostal
Intercostal
Suprasternal
absent or weak femoral pluses can indicated
duct dependent congenital cortication of the aorta
- blood pressure in all 4 limbs
- ECHO
how does a cleft palate from?
maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation
most common cleft palate/lip
left sided unilateral
associated anomalies with clot lip/palate
hearing screening
ECHO
tris 13= patau’s
tris 18 = EDWARDS
Ophthalmology examination in babies?
red reflex
Ophthalmology screening in babies - cataract features
- lens opacification
- If undetected early could lead to blindness
- May require no treatment
- May require lens removal and artificial lens
how can Retinoblastoma
be picked up on examination
leukocoria - white-red reflex
laser therapy, chemo, removal of eye
urates in the nappy (brick dust) can be caused by?
poor feeding
spinal dimples - features of NORMAL
small , close to anus in the midline, no associated skin features
Spinal dimples can be a sign of?
- clinical signs of this
spina bifida occulta
- large m off middle, cutaneous marker (hair). - spinal imagine
common finding with new born heads?
Cephalohaematomas - soft and non - translucent
- limits of cranial sutures, parietal bone
Cephalohaematomas - where is the haemorrhage?
- the increase in haemolysis mast cause
beneath the pericardium
- resolution in the 3-4 weeks
pronged neonatal jaundice
Talipes/club foot can be?
most common?
Medial (varus) or lateral (valgus)
- positional , flexible not rigid
Developmental Dysplasia of the Hip - what tests do we do?
Barlow test - adducting the hip, pressure to see if dislocates
Ortolani test - abducting outward, testing if it slips back into joint
- click or a clunk
- hip can become dislocated
risk factor for DDH
- breach
- breach in last month of pregnancy
- family history
- fixed foot deformity
Treatment of DDH
Relocate head of femur to acetabulum so hip develops normally
PAVIK harness
- surgical reduction
Tris 21 is screened for in?
1st trimester
- screening test
Features of Tris 21
- how may a child present ? (5)
dysmorphic features (7)
- hypotonia - marked head lag
- cardiac defects -ECHO
- learning difficulties
- Haematological problems
- Thyroid problems
- Low set ears, upward slanting palpebral fissures, epicanthic folds, single palmar creases, wide sandal gap
