Common Presentations in Neonates Flashcards
What is pallor associated with [6]
Anaemia secondary to
- 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 types of rash do you worry about [2]
Petechial (non-blanch)
Papular = fine
What other rashes do you get [5]
Milia Milliari Transient neonatal pustular melanosis Erythema toxic Sebaceous naves
What is milia [2]
White papule on tip of nose
Hyperplastic sebaceous glands due to placenta hormone
What is miliari [2]
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 sebaceous naevus and what do you do [3]
Congenital plaque
Sensitive to androgen
Risk of malignancy into BCC so remove
What are common birth marks [6]
Capillary haemangioma (Strawberry naevus) Melanocytic naevi Melanocytosis (Mongolian blue spot) Giant melanocytes naevus Port Wine stain (Naevus Flameus) Stork Marks (Naevus simplex / salmon) Cafe au lait spots
What is a capillary haemangioma or strawberry naevus?
Ax RF [3] Sxs [5] Prognosis Management [2]
Ax: dilated capillaries
Risk factors: female, premature, mother underwent chorionic villus sampling
Sxs: Red, raised, discrete edge. Multi-lobed lesion can appear on any site in body. Appear in 1st month
Regress over next few years (95% by 10 yo)
Mx: no mx required unless visual field obstruction where can use PROPRANALOL or topical beta blocker TIMOLOL
What are melanocytes naevi [2]
Moles
Round / oval / rough
What is melancoytosis [2]
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 giant melanocytes naevus
MRI brain and spine
What are Naevus Flameus [5]
Port wine stains Present at birth Flat or slightly raised on face Dilated capillaries Do not regress
What is associated with Naevus Flameus?
Struger-Weber
How do Naevus Simplex present [3]
Light colour capillary dilatation
Back of neck and midline of face
Fades within 1st 2 years
What is an Ebstein pearl? [5]
White nodule on roof of mouth
Midline
Doesn’t interfere
Can look like teeth
Hemangioma
What is the natural course? [2]
Site
Mx
Starts as flat red mark that grows into spongy rubbery bump
Rest phase then disappears
Site: anywhere
Mx: remove if obstructing vision
What is laryngomalacia [3]
- What does it cause
- How do you treat
Floppy upper larynx
Stridor and feeding problems
Resolves without Rx
What is tracheomalacia [3]
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 associated with cleft lip? [5]
What Trisomies are associated with cleft lip? [3]
What is a complication of cleft lip/palate?
Anti-epileptic use Rubella Smoking Benzo's Trisomy 13,18,15
Cx: OM
What are issues with cleft [3]
Definitive management [1]
Poor feeding
Poor speech
Airway issues
Surgical repair at 5 yo
How does choanal atresia present [2]
If bilateral - soft tissue / bone block
Cyanosis
What is common after birth in the eye [2]
Subconjunctival haemorrhage
Discharge due to immature ducts
Look for conjunctivitis
What are the symptoms of facial palsy in a neonate? [3]
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 and what is it caused by? [2]
Eye and forehead muscles unaffected
Caused by absence of depressor angle oris muscles
How do you treat hypoglycaemia [4]
Breastfeed / formula feed
Maintain skin to skin
NG / IV dextrose / glucagon
Hydrocortisone
What may you see on chest
Prominent xiphersternum as thin skin
What is craniocyntosis
Premature fusion of skull bones
What is plagiocephaly
Also known as flat head syndrome, is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull.
Ipsilateral forehead and ear forward
What is a benign dimple [4]
Lower back, sacral area
Present at birth
Small and shallow
Can see the end
What do you do?
USS within 6 weeks
If USS abnormal
MRI
NTD
Risk factor [2]
Ax
Classification [3]
RF:
- FHx (either parent or siblings)
- maternal: anti-epileptic drugs, DM, thalassaemia trait, obesity
Aetiology: insufficient folic acid intake
Classification
- Spina bifida
- Encephalocele
- Anencephaly
NTD
Classification of spina bifida [3]
- Occulta (benign): incomplete vertebral arch covered by skin
- Meningocele: herniation of dura and arachnoid through bony defect; RARE
- Myelomeningocele: meningocele + cord involvement
NTD Presentation of myelomeningocele Urology [2] Neuro [3] MSK [7] Other [2]
Nerve roots in cyst are exposed and cause complications
o Urology: urinary incontinence (affected above S1), urinary tract problems
o Neuro: hydrocephalus, Chiari II malformation, tethered cord
o MSK: kyphosis, lordosis, scoliosis, hip dislocation, reduced bone density and increased # risk, hip and knee contracture, calcaneomegavalgus, pes cavus, club foot, toe clawing, heel/foot ulcers
o Other: LATEX ALLERGY (3/4), learning disability (1/5)
