Common Postnatal Problems Flashcards by Lucy Jefford

What is meant by plethora?

Babies skin colour looks reddish

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What can cause plethora?

Twins- often one will have plethora and one will be pale

Can happen in single babies too, due to polycythemia (large concentration of RBCs).

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What can cause cyanosis of a neonate?

Sepsis
Respiratory disease
Cardiovascular disease

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Should you be worried about peripheral cyanosis in the newborn period?

Non, part of normal transition

->central cyanosis needs investigating with oxygen saturations

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Which type of bilirubin is there in physiological jaundice?

Unconjugated

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Physiological jaundice is normal and occurs after second day of life.
What if there is jaundice on first day of life?

If within 24hrs, always pathological and requires investigations

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What is the most common type of prolonged jaundice?

Breast milk jaundice

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Most important cause of prolonged jaundice that needs to be ruled out?

Cholestasis e.g. biliary atresia

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What type of bilirubin is seen in biliary atresia?

Conjugated bilirubin

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Options of treatment for jaundice?

Treat underlying cause, even if physiological as if unconjugated bilirubin levels become too high, can be neurotoxic

Hydrate

Phototherapy

Exchange transufion

Immunoglobulin

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What is the most serious condition when too much unconjugated bilirubin passes through the blood brain barrier?

Kernicterus

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What is erythema toxicum?

Maculo-papular rash occurring in 30-70% of infants

Rash fades by 1st week, no need for treatment

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What are Mongolian blue spots?

*now called congenital dermal melanoccytosis

Blue-grey pigmentations, accumulation of melanocytes

->can be mistaken for bruising

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Where on the body are Mongolian blue spots usually seen?

*congenital dermal melanoccytosis

Lower back and buttocks

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Treatment of Mongolian blue spots?

*congenital dermal melanoccytosis

Nothing, reassurance, they are simple birthmarks

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Capillary vascular malformations are another type of skin change which can be seen in neonates.

Where on the body are they seen?

Commonly back of neck- called stork marks as is where the stork has picked up the baby

May be along midline of face

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Treatment of the capillary vascular malformations?

Nothing, they gradually fade within 1-2yrs

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What is the one type of capillary vascular malformation which does not fade with time?

Port wine stain- naevus flammeus

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Which conditions are associated with port wine stain, naevus flammeus?

Sturge Weber syndrome
Klippel-Trenaunay syndrome

->can cause associated seizures

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What is a capillary haemangioma?

A cluster of dilated capillaries which appears in the first month after birth

Known as strawberry naevus

Can occur in any part of the body

Often looks stuck on

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Treatment of capillary haemangioma aka strawberry naevus?

Usually nothing, regresses after 1 yr

Depends on site, might need medical treatment if on eyelid and obstructing eyesight or is in a place that is quite irritant.

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Respiratory distress is one of the most common reasons for admission to the neonatal unit.

What are some of the things that suggest increased breathing effort?

Grunting
Nasal flaring
Chest retractions

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What is increased RR in neonates?

> 60 per minute

In respiratory distress in neonates, where would you want to assess for chest retractions?

Substernal
Suprasternal
Subcostal
Intercostal

It's important to palpate femoral pulses during the newborn examination. What can weak/absent femoral pulses indicate?

Coarctation of the aorta

If a newborn has cleft lip, what other congenital anomaly do most have?

Cleft palate ->cleft lip is obvious, cleft palate is not, so it's recommended to do a careful examination of the palate in newborn examination

What are some of the problems that can be caused in cleft lip/cleft palate?

Feeding issues Airway problems ->note that can still attempt breastfeeding

If a baby has cleft lip or palate, what investigations need to be done?

Hearing screen Cardiac echo Consider different trisomies

In which syndromes may there be cleft lip/palate?

Trisomy 13- Patau syndrome Trisomy 18- Edward's syndrome

If there is no red light reflex in one eye, and is more white, what is this indicative of?

Retinoblastoma

What other condition, other than retinoblastoma, can cause there to be an absent red light reflex?

Cataracts >if undetected, could lead to blindness. May not require treatment, but may require lens removal and insertion of an artificial lens

What is a normal cause of bleeding in nappies in newborn baby girls?

Pseudo/false menstruation ->seen between day 2-10 of life, due to sudden drop off of mother's oestrogen.

What else is a normal cause of a small amount of bleeding in nappies within the first few days of life?

Urates- crystals of urate, brick dust appearance Normal but can suggest baby is behind on fluids do worth checking feeding is going okay for the infant

Small spinal dimples in the midline with no associated skin features are normal and don't require treatment. When would a spinal dimple require further investigation?

Large dimple Off midline Has other cutaneous markers e.g. hairy tuft

Which further investigations can be done for spinal dimples?

Spinal ultrasound

What is cephalohematoma?

Localised swelling over one or both sides of a baby's head -> if both sides, looks heart shaped

Management of cephalohaematomas?

Reassurance ->looks dramatic and is associated with bleeding due to birth but resolves the same way any of bruise would.

What is Talipes better known as?

Club foot ->varus or valgus deviation of the foot

Management of tallipes/club foot?

Physiotherapy Fixed talipes require more vigorous manipulation, strapping, casting or possibly surgery

Babies with significant talipes/club foot may have what other problem?

DDH- developmental dysplasia of the foot

Which tests are done in the newborn examination to assess for DDH?

Barlow test Ortolani test

Treatment of DDH?

Relocate head of femur into the acetabulum so the hip develops normally This is done by Pavlik harness or surgical reduction

What are some of the dysmorphic features associated with Trisomy 21?

Low sets ears Single palmar creases Wide sandral gap

What are some of the associated problems with Trisomy 21?

Hypotonia- floppy baby, feels like they slip through your hands when you hold them Cardiac defects Learning problems Thyroid problems Haematological problems

What is the most common cardiac defect seen in Trisomy 21?

Atrioventricular septal defect

What four processes make newborns more vulnerable to hypothermia?

Evaporation- loss of heat by wet skin, wet nappy Conduction- loss of heat of warm body or cooler surface Convection- loss of heat to cooler air Radiation- loss of heat from body surface to object in close proximity, but not in direct contact

What is done in newborns if they have cold stress to reduce risks of hypothermia?

Dry quickly Remove wet linens Use warm blankets/towels Provide radiant warmer heat Use heated/humidified oxygen

What are some of the risk factors for newborns to experience hypoglycaemia?

Premature babies Perinatal stress Diabetic mothers Hypothermia Sepsis

What measurement is indicative of hypoglycaemia in a newborn?

Blood sugar < 2.0mmol/L

What sign on examination can be indicative of hypoglycaemia in neonates?

Baby who is very jittery These movements can be mistaken for seizures ->good video shown in lecture to demonstrate what this looks like

Summarise the symptoms of hypoglycaemia in neonates.

Jitteriness Temperature instability Lethargy Hypotonia Apnoea, irregular respirations Poor suck/feeding Vomiting High pitched or weak cry Seziures

What is tongue tie?

Shortened and thickened frenulum which can cause issues with breastfeeding

What is meconium?

First stool that baby's pass Looks very dark and tar-like