common postnatal problems Flashcards
Describe the different colors you could see a neonate?
- Yellow (Jaundice - see separate deck)
- Pale
- Red (Plethora - Polycythaemia)
- Cyanosed
cause of jaundice in the first 24hours
Haemolytic ( e.g. G6PD deficiency, spherocytosis )
Sepsis
2nd day – 2nd/3rd wk cause of jaundice
Physiological Dehydration/poor feeding Breast milk (second 2) Sepsis Polycythaemia Bruiding e.g. cephalohaematoma Haemolytic Crigler-Najjar Syndrome
Prolonged jaundice (>2 weeks term, >3 weeks preterm): causes
Breast milk Cholestasis e.g. biliary atresia!! Sepsis (each one) Haemolytic Hypothyroidism
treatment of jaundice in baby?
Treat underlying cause Hydrate Phototherapy – NICE guideline charts Exchange transfusion Immunoglobulin
It’s very common (50-70%) for babies to develop a red maculopapular rash after birth.(v rare in preterm tho neonates) What do we call this and how is it managed?
Erythema Toxicum
Reassure, it clears by it’s self within 1-2wks
Babies of races with pigmented skin are often born with blue-grey patches on lower back/buttocks, What is this?
Mongolian blue spots
Due to accumulation of melanocytes
Leave it an it will fade
Sometimes babies are born with light pink marks on the back of the neck or midline of face, what do we call this and what do we do?
Stork Marks (or Naevus Simplex)
It’s just dilated capillaries, leave it and it will disappear within 2 yrs
port wine stain- Present at birth, flat or slightly raised.
what is it called?
pathophysiology?
associated with what conditions?
Naevus flammeus- doesn’t regress!1
Caused by dilated, mature capillaries in the superficial dermis.
Sturge Weber
Klippel-Trenaunay
Raised and bright red, with discrete edges, occurring in any part of the body. (Fahriya had this)
- what is it called?
Capillary haemangioma / Strawberry naevus
a cluster of dilated capillaries which appears within the first month after birth.
Usually regresses after one year of age.
Babies often present hypothermic following birth, how do we prevent this?
During resuscitation:
- Dry quickly
- Remove wet linens
- Use warmed towels
- Provide a radiant warmer
- Use heated/humidified O2
what RF for babies to have hypoglycaemia?
- Premature
- Diabetic mum –> Hyperinsulinaemia
- Hypothermia
- Sepsis
- Small/Large for Gestational Age
how to diagnose a baby as hypoglycaemiac?
Bedside skin prick glucose
blood sugar <2.0 mmol/l we send for a lab sample to confirm
What might a hypoglycaemic baby look like?
Jittery or lethargic Hypothermic Hypotonic! Apnoea or irregular breathing Poor feed and vomiting High pitched weak cry
If bad –> Seizures
What is a “tongue Tie”
A short or thick frenulum, it may be attached too anteriorly to the base of tongue
What’s the problem of a tongue tie and how do we treat it?
They can make feeding difficult
In which case we would do a frenotomy
3 DDxs for neonatal resp distress
- Transient tachypnoea of Newborn (TTN)
- Sepsis
- Meconium Ileus
What is ttn?
a delay in clearing foetal lung fluids
Looks like grunting, tachypnoea, O2 requirement but normal gasses
How can you test for and treat TTN?
CXR can spot the fluids & hyperinflation
O2, airway support, fluid and maybe Abx
areas to assess for retraction in RDS?
Substernal
Subcostal
Intercostal
Suprasternal
wha can indicate coarctication of the aorta?
Absent/weak femoral pulses
Very important that the femoral pulses are palpated during the newborn examination
What are the types of Cleft lip/palate?
Incomplete
complete
Unilateral
Bilateral
what causes cleft lip?
Maxillary & Medial Nasal processes fail to fuse around wk 5
What do we do with a cleft lip baby?
Use special bottle/teat
Check for airway problems
Check for ass anomalies with hearing screen, cardio exam, echo & exam for signs of trisomies
What is the most common problem picked up on ophthalmology exam in babies?
what cancer can cause it?
Lack of red reflex, usually meaning cataracts
We can do lens removal and give an artificial lens
can also be?
Retinoblastoma
Rare eye cancer which can be successfully treated if picked up early
Laser therapy, chemo, surgical removal of eye
Mum finds some bloody mucousy discharge in her baby girls nappy?
Probably pseudomenstruation
Very common and due to hormones from mum. It’ll clear up itself
Spinal Dimples can be a sign of nothing or a sign of something more serious, when and how would we investigate?
US & MRI if:
- Large
- hairy tuft
- Red or swollen
- Off midline
- Above sacral area
- Pigmented
- Tender
- Fluid
can be:
spina bifida occulta which is the least serious form of spina bifida +/- tethered cord.
What are the 2 common benign causes of a newborn with a swollen head?
Cephalohaematoma (Haemorrhoage under pericranium)
Caput Seccedaneum (Serosanguinous fluid collecting subcu)
What characterises a Cephalohaematoma?
Localised, soft, non-translucent
Peaks at DoL 3/4
Limited by cranial bones (usually parietal bone)
haemorrhage is beneath the pericranium
How long does a cephalohaematoma take to disappear and does it have any complciations?
no treatment is required and resolution occurs in 3-4 weeks
Can lead to jaundice via haemolysis of the haemorrhage
NOT associated with intracranial bleeds
What characterises a Caput Succedaneum?
Serosanguinous fluid
Subcu
Poor margins
Over midline & suture lines
Ass with head moulding
What are the types of Talipes?
Physiological - I.e. you can straigten the foot - only needs physio
Fixed - Needs Ortho i.e. strapping, casting or surgery
How do we confirm and treat a DDH?
US to confirm dislocation
Pavlik harness & Surgical reduction
All to relocate head of femur into acetabulum
Name 5 causes of failure to pass stool in a newborn?
Constipation Large bowel atresia Imperforate anus Hirshsprung's disease Meconium Ileus (from CF)
how does trisomy 21/ downs present
Low set ears, upward slanting palpebral fissures, epicanthic folds, single palmar creases, wide sandal gap
Hypotonia Cardiac defects Learning problems Haematological problems Thyroid problems
