Common Postnatal Problems Flashcards
What is meant by plethora?
Babies skin colour looks reddish
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).
What can cause cyanosis of a neonate?
Sepsis
Respiratory disease
Cardiovascular disease
Should you be worried about peripheral cyanosis in the newborn period?
Non, part of normal transition
->central cyanosis needs investigating with oxygen saturations
Which type of bilirubin is there in physiological jaundice?
Unconjugated
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
What is the most common type of prolonged jaundice?
Breast milk jaundice
Most important cause of prolonged jaundice that needs to be ruled out?
Cholestasis e.g. biliary atresia
What type of bilirubin is seen in biliary atresia?
Conjugated bilirubin
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
What is the most serious condition when too much unconjugated bilirubin passes through the blood brain barrier?
Kernicterus
What is erythema toxicum?
Maculo-papular rash occurring in 30-70% of infants
Rash fades by 1st week, no need for treatment
What are Mongolian blue spots?
Blue-grey pigmentations, accumulation of melanocytes
->can be mistaken for bruising
Where on the body are Mongolian blue spots usually seen?
Lower back and buttocks
Treatment of Mongolian blue spots?
Nothing, reassurance, they are simple birthmarks
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
Treatment of the capillary vascular malformations?
Nothing, they gradually fade within 1-2yrs
What is the one type of capillary vascular malformation which does not fade with time?
Port wine stain- naevus flammeus
Which conditions are associated with port wine stain, naevus flammeus?
Sturge Weber syndrome
Klippel-Trenaunay syndrome
->can cause associated seizures
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
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.
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
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
