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
