Common Postnatal Problems Flashcards
what are the different types of problems that may occur in newborns?
what changes to the skin may you notice and what ca they signify?
Skin colour - Plethora
what is it?
One twin get more blood form placenta than other
Red colour
Take a FBC to look at haematocrit
If blood flow can cause end organ damage
Skin colour - what cyanosis should you be worried about?
Blue peripheries is common in new borns
Central cyanosis needs investigation with oxygen saturations
skin colour - is jaundice common?
Very common
physiological jaundice occurs in almost all new borns especially pre terms
Increased red cell turnover and also immaturity of hepatic enzymes that process bilirubin
This causes unconjugated hyperbilirubinaemia
what causes jaundice in 1st 24hrs?
- Haemolytic ( Rh incompatibility, other antibodies, hereditary anaemias e.g. G6PD deficiency, spherocytosis )
- Sepsis
In first 24 hours is always pathological and always needs investigation
what causes jaundice in 2nd day – 2nd/3rd wk ?
- Physiological
- Dehydration/poor feeding
- Breast milk
- Sepsis
- Polycythaemia
- Bruiding e.g. cephalohaematoma
- Haemolytic
- Crigler-Najjar Syndrome
what causes jaundice in Prolonged jaundice (>2 weeks term, >3 weeks preterm)?
- Breast milk
- Sepsis
- Haemolytic
- Hypothyroidism
•Cholestasis e.g. biliary atresia
Prolonged jaundice needs investigation, most of these babies will have breast milk jaundice, but do need to exclude other causes
how do you treat jaundice?
Treat underlying cause
Hydrate
Phototherapy – NICE guideline charts (convers the unconjugated bilirubin to water soluble isomers that can be excreted through the normal pathways)
Exchange transfusion
Immunoglobulin
(Exchange transfusion and immunoglobulin are more extreme treatments)
what is Erythema toxicum? how common is it? how is it treated?
- maculo-papular rash
- 30 – 70% of normal term neonates
- very rare in the pre-term
- rash fades by end of 1st wk
- no Rx is required
what are Mongolian blue spots?
- blue-grey pigmentations (Can be mistaken with bruising)
- often : lower back + buttocks
- accumulation of melanocytes
- very common : races with pigmented skin
- less obvious as skin darkens
Simple birth marks and nothing needs to be done about them apart form reassurance
what are Capillary vascular malformations - Stork marks?
•Naevus simplex
- light colour capillary dilatation
- commonly at back of neck
- Maybe along midline of face
- Gradually fade
- within the 1st 2 yrs
what are Capillary vascular malformations - Port Wine Stain?
- Naevus flammeus
- Present at birth, flat or slightly raised.
- Caused by dilated, mature capillaries in the superficial dermis
- These do not regress
Associations: Sturge Weber, Klippel-Trenaunay
what are Capillary haemangioma - Strawberry naevus?
- a cluster of dilated capillaries which appears within the first month after birth.
- Raised and bright red, with discrete edges, occurring in any part of the body.
- Usually regresses after one year of age
how are babies vulnerable to hypothermia?
The large body surface area in relation to weight and the relative lack of subcutaneous fat make preterm infants at risk for hypothermia (body temperature below 36.5°C), especially in the first few hours after birth
Resuscitation and Cold Stress - how should it be done?
Dry quickly
Remove wet linens
Use warm towels/blankets
Provide radiant warmer heat
Use heated/humidified oxygen
Key message – always keep newborns warm
Hypoglycaemia = blood sugar <2.0 mmol/l
what babies are at risk?
Limited glucose supply - Premature babies, Perinatal stress
Hyperinsulinism - Infants of diabetic mothers
Increased glucose use - Hypothermia, Sepsis
how can we test for hypoglycaemia?
Bedside testing can be inaccurate:
- At low or high levels
- When there is poor perfusion
- When there is polycythaemia (high Hct)
Check a lab sample if there are concerns - Glucose on a blood gas machine is also just as accurate as the lab sample and will give you an immediate result so I recommend to use this
what are the symptoms of hypoglycaemia?
Jitteriness
Temperature instability
Lethargy
Hypotonia
Apnoea, irregular respirations
Poor suck / feeding
Vomiting
High pitched or weak cry
Seizures
Asymptomatic - Can be asymptomatic so important in babies with identified risk factors for low sugars that we do some routine monitoring of the bed side blood sugars to detect any hypoglycaemia
Promote breast feeding
what are tongue ties? and how are they managed?
◦Short +/- thickened frenulum
◦Attached anteriorly = base of the tongue
◦Mostly: no treatment necessary (If no impact on feeding then they don’t need treatment)
◦Restriction of tongue protrusion beyond the alveolar margins AND feeding is affected = frenotomy
what are some common gastrointestinal problems?
Bilious vomiting is important not to miss as it is bowel obstruction until proven otherwise
Yellow vomiting is not bilious vomiting as can just be partially digested milk
Respiratory distress is one of the commonest reasons for admission to NNU
what things should you evaluate?
Respiratory rate
Increased effort - Grunting, Retractions, Nasal flaring
Colour
Oxygen saturations
Absent/weak femoral pulses - what may they indicate?
Very important that the femoral pulses are palpated during the newborn examination
Absent/weak femoral pulses can indicate coarctation of the aorta
Cyanotic and congenital heart disease
what is Cleft lip?
70% of cases also have cleft palate
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)
Maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation
Guidance about cleft palate detection had become important as delay in detection can adversely affect growth and development and the timely medical and surgical management of these cases
Cleft lip/palate issues - what issues may it cause?
Feeding issues - Special bottles and teats, Can still attempt breast feeding
Airway problems
Associated anomalies - Need hearing screen, Need cardiac echo, Remember trisomies
Ophthalmology - whats important to watch out for?
Always check red reflexes
Cataracts
- lens opacification
- If undetected early could lead to blindness
- May require no treatment
- May require lens removal and artificial lens
Important to pick up cataracts as vision development is incomplete at birth and is dependant on light coming in and stimulating the retina
Retinoblastoma:
- Rare eye cancer which can be successfully treated if picked up early
- Laser therapy, chemo, surgical removal of eye
White red reflex
what are spinal dimples?
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 +/- tethered cord
If the dimple is large, off midline, high or with other cutaneous maker (e.g. hairy tuft) = spinal imaging
what are Cephalohaematomas?
Localised swelling over one or both sides of the head
becomes maximal in size by the 3rd to 4th day of life
Soft, non translucent swelling
limits are those of one of the cranial bones – usually parietal bone
haemorrhage is beneath the pericranium
Limited by the sutures so wont spread out with that region
Bleeding associated with traumatic process of birth
how are Cephalohaematomas managed?
no treatment is required and resolution occurs in 3-4 weeks
occasionally, if the haematoma is very large, the increased haemolysis results in increased or prolonged neonatal jaundice
no association with intracranial bleeding
Talipes (Club foot) - what is it and how is it managed?
Medial (varus) or lateral (valgus) deviation of the foot is often positional and requires no treatment other than physiotherapy
Fixed talipes requires more vigorous manipulation, strapping, casting or possibly surgery
Babies with significant talipes may also have developmental dysplasia of the hips
Positional – when an otherwise normal foot is help in a incorrect position in the womb and on examination the foot is flexible instead of rigid and will correct itself with time but sometimes physio therapy may be needed
what is Developmental Dysplasia of the Hip (DDH)?
Developmental dysplasia of the hip (DDH) is a condition where the “ball and socket” joint of the hip does not properly form in babies and young children
socket is shallow and not develop properly so the hip slips out and becomes dislocated
Check movements
what tests can be done for DDH?
what is DDH treatment?
Goal - Relocate head of femur to acetabulum so hip develops normally
Pavlik harmess
Surgical reduction
what are the effects of trisomy 21?
Dysmorphism - Low set ears, upward slanting palpebral fissures, epicanthic folds, single palmar creases, wide sandal gap
Hypotonia
Cardiac defects
Learning problems
Haematological problems
Thyroid problems
Take home messages:
A good newborn examination is crucial
Know the range of normal and reassure
Signs of acute illness may be subtle
Some findings require investigation
This can prevent permanent disability e.g. DDH, cataracts, hypoglycaemia
