Common Presentations in Neonates Flashcards
What is there a close relationship in neonates
Hypothermia
Hypoglycaemia
Hypoxia
What can affect colour of skin
Jaundice - seen easiest in sclera, then periphery then palms
Pallor
Plethora
Cyanosis
What is plethora (deep rosy red) associated with
Polycythaemia
What is pallor associated with
Anaemia
- Bleeding
- Bone marrow failure
- Destruction
- DIC
- Blood sampling
When do you not worry about cyanosis
Peripheral
Common in first 24 hours due to vasomotor changes
What type of rash do you worry about
Petechial (non-blanch)
Papular = fine
What other rashes do you get
Milia Milliari Transient neonatal pustular melanosis Erythema toxicum Sebaceous naves
What is milia
White papule on tip of nose
Hyperplastic sebaceous glands due to placenta hormone
What is miliari
Small vesicles and pustules over face / scalp and trunk
Due to immature sweat gland production
What is transient neonatal pustular melanosis
Pustules that heal with brown macules
Very common
What do you do if suspect staph infection
Start Ax
What is erythema toxicum
Maculopapular rash
Common in term babies
Rare in pre-term
Fades 1 week
What is sebaceous naevus and what do you do
Congenital plaque
Sensitive to androgen
Risk of malignancy into BCC so remove
What are common birth marks
Capillary haemangioma (Strawberry naevus) Melanocytic naevi Melanocytosis (Mongolian blue spot) - Document as can look like bruise Giant melanocytes naevus Port Wine stain (Naevus Flameus) Strok Marks (Naevus simplex / salmon) Cafe au last spots
What is a capillary haemangioma
Dilated capillaries that appear in 1st month
Red, raised, discrete edge
Regree 1 year
Rx
- Propranol to constrict
- Surgery if close to orbit or for cosmoses
What are melanocytes naevi
Moles
Round / oval / rough
What is melancoytosis
Mongolian blue spot
Blue / grey pigment on lower back due to accumulation of melanocyte
What is giant melanocytic naevus
Large area of dark pigmentation
Often hairy
What do you do if >1
MRI brain and spine
What are Naevus Flameus / Port Wine
Port WIne Present at birth Flat or slightly raised on face Dilated capillaries Do not regress
What is associate
Struger-Weber
How do Naevus Simplex present
Light colour capillary dilatation
Back of neck and midline of face
Fades within 1st 2 years
When do you think of cafe au lait
> 6 or >0.5cm neurofibromatosis
What is a Ebstein pearl
White nodule on roof of mouth
Midline
Doesn’t interfere
Can look like teeth
What is haemangioma
Eye lid tumor
Treat if vision under threat
What is laryngomalacia
- What does it cause
- How do you treat
Floppy upper larynx which collapses during inhalation
Stridor and feeding problems
Worse when supine, feeding, crying
Normal cry unlike if unwell will be high pitched
Normal sats
Resolves without Rx
What is tracheomalacia
Floppy trachea cartilage
Stridor worse when crying / cough
Improves by 2
What is bronchomalacia
- How does it present
- How do you treat
Weak bronchial cartilage Stridor Wheeze SOB Most likely need CPAP +- tracheostomy
What is a tongue tie and how is it treated
Short thick frenulum attached anterior at base of tongue
Cause poor feeding
No treatment or frenotomy
What causes cleft lip and what does it lead too
Maxillary and medial nasal process fail to merge
Leads to opening in top lip which can extend as far as the nose
Poor feeding
Poor swallowing
Poor speech
More prone to glue ear, ear infections and hearing problems
What is associated with cleft lip
Anti-epileptic use Rubella Smoking Benzo's Trisomy 13,18,15
When do you Rx
Repair early - 3 months
What causes cleft palate
2 palates of skull forming hard palate fail to merge
Palatine
Nasal septum
When do you repair
6-12 months
What are issues with cleft
Poor feeding Poor speach Special bottles but attempt breast Airway issues Associated anomalies - do ECHO / hearing Increased risk of otitis media
How does chonal atresia present
If bilateral - soft tissue / bone block
Cyanosis worse when feeding and better when cries
How do you Rx
Surgery
Look for other malformation
What is a cataract and how does it present and what do you do
Lens opacification
Absence red reflex
No Rx or artificial lens
Lead to blindness
What is retinoblastoma and how do you treat
Urgent opthmology referral if absent red reflex Rare eye cancer Absent red reflex Laser therapy Chemo Surgery
What is common after birth in the eye
Subconjunctival haemorrhage
Discharge due to immature ducts
Look for conjunctivitis
What are the symptoms of facial palsy
Decreased facial movement and forehead wrinkling on one side and eyelid elevation
Flattening of nasolabial fold and corner of mouth
Side appearing to droop = normal
What is asymmetric crying facies
Eye and forehead muscles unaffected
Caused by absence of depressor angel oris muscles
What may you see on chest
Prominent xiphersternum as thin skin
What might you see on skin
Blood vessels as thin skin
What might you see on abdomen
Swelling / hernia as muscles not formed if premature
What is a benign dimple
Lower back
Present at birth
Small and shallow
Can see the end
What is a worrying dimple
Large >2.5cm Red Swollen Off midlien Tender Fluid Higher than sacral Hairy tuff Abnormal neuro exam
What may it suggest
Spina bifida
Kidney issue
What do you do
USS within 6 weeks
If USS abnormal
MRI / MDT
What is cephalohaematoma
Localised swelling over one or both sides of the head
Limited by sutures as between periosteum and skull
Reaches max 3rd or 4th day
May take months to resolve
Soft
Non-translucent
When does cephalohaematoma form
After birth
Traumatic delivery
No intracranial bleed
Bleeding beneath pericrainium
How do you Rx
No Rx
May prolonged jaundice (intermediate) and cause anaemia
What is caput succadenum
Subcutaneous collection of fluid outside the periosteum Collects on the scalp Cross Sutures as above scalp Poorly defined Present at birth
What causes
Pressure of presenting part of scalp against cervix or forceps during traumatic labour
How do you Rx
No Rx
No complications
Resolves within days
What is Sub gleal haemorrhage
Above periosteum Very rare but more dangerous Large bleed Can cross suture as above bone Can cause anaemia and jaundice Do CT to distinguish from succadenum
What aother haemorrhage
Extradural and intra-cranial
Who gets USS of hips
All breech
FH of hip
+ve Ortalani or Barlow
