Level 2 - Neonates Flashcards
Define HIE?
- Gas exchange is compromised resulting in cardiorespiratory depression
- Brain injury secondary to hypoxia
Mortality of HIE?
- Severe HIE has 30-40% mortality rate and 80% of survivors have learning impairments, particularly cerebral palsy
Aetiology of HIE? (4)
o Failure of gas exchange across placenta (excessive or prolonged contractions)
o Interruption of umbilical blood flow (cord compression, prolapse)
o Inadequate maternal perfusion
o Inadequate postnatal cardiopulmonary circulation
Symptoms of mild, moderate and severe HIE? General features?
Mild HIE
- Irritable, excessive response to stimulation, hyperventilation, impaired feeding
Moderate HIE
- Abnormal tone, movement, cannot feed and seizures
Severe HIE
- No normal spontaneous movements or response to pain, abnormal tone, prolonged seizure, multi-organ failure
Cyanosis, low heart rate, acidosis
Describe the signs in HIE?
Abnormal neurological signs and seizures Persistent pulmonary hypertension Hypotension DIC Renal Failure Low glucose, Ca, Na
Investigations in HIE?
Blood gas - Acidosis aEEG - Used to confirm encephalopathy or identify seizures CT/MRI
Management of HIE?
Resuscitation - Baby will have respiratory depression Hypothermia Anticonvulsants Fluid Restriction Treat electrolyte imbalances - Low glucose, calcium, sodium
Define birthmarks?
- Birthmarks are coloured marks that are visible on the skin. They’re often present at birth or develop soon afterwards
Two types of birthmarks?
o vascular birthmarks (often red, purple or pink) caused by abnormal blood vessels in or under the skin
o pigmented birthmarks (usually brown) caused by clusters of pigment cells
Name the common vascular birthmarks?
Salmon patches
Infantile haemangioma
Port-Wine stain
Name common pigmented birth marks?
Cafe-au-lait spots
Mongolian spot
Congenital melanocytic nevus
What is Salmon patch? How common? What happens to them?
o Flat red or pink patches that can appear on a baby’s eyelids, neck or forehead at birth
o They’re the most common type of vascular birthmark and occur in around half of all babies
o Most salmon patches will fade completely within a few months, but if they occur on the forehead they may take years
o Often more noticeable when a baby cries because they fill with blood and become darker
What is an infantile haemangioma? How common and who do they tend to affect? Any treatment?
o Red to purple papules or plaques with a normal epithelial surface
o Compression leads to partial emptying and the colour becomes less prominent
o Haemangiomas are common, particularly in girls, and affect around 5% of babies soon after birth
o If they get bigger rapidly, or those that interfere with vision or feeding may need treatment
What are Port-wine stains?
o Deep pink or red patch present at birth and grows as the child grows
o May darken to purple, is flat; the overlying skin is normal. Later in life more papular lesions can occur within the patch
o Present for life and has no tendency toward involution
o Usually unilateral with a clear demarcation at the midline
Investigations in Port wine stain?
o If Sturge-Weber syndrome is suspected, MRI scan of the brain is required
o Optical coherence tomography
o Regular ophthalmic checks to exclude glaucoma should be carried out in the first three years of life
Management of Port wine stains?
o Refer as young as possible, usually around 1 year old, to a centre which has the laser and anaesthetic facilities
o Tunable pulsed dye laser (PDL)
o Surgical excision with or without cosmetic reconstruction may be required for lesions resistant to laser therapy
What are Cafe-au-lait spots? When should you see your GP? What could it be linked with?
o Caused by an increase in melanin content, often with the presence of giant melanosomes
o Coffee-coloured skin patches
o Common but if >six have developed by the time the child is five, you should see your GP
o Could be due to neurofibromatosis 1
What are mongolian spots?
o Caused by melanin within the deep layer of the skin (dermis)
o A benign, flat, congenital birthmark, with wavy borders and an irregular shape
o More commonly seen in darker-skinned people and usually covers the lumbosacral, buttocks, sides and shoulders
Colour and prognosis of Mongolian spot? What must happen?
o Normally disappears three to five years after birth and almost always by puberty
o Colour is blue, although they can be blue-grey, blue-black or deep brown
o They’re completely harmless and don’t need treatment
o May sometimes be mistaken for a bruise so NEED to be documented in notes if found
What are congenital melanocytic nevus?
o Initially appear as flat, pigmented lesions
o As the lesion ages, it tends to become raised and may become hairy
o Located in the area of the head and neck 15% of the time
Management of melanocytic nevus?
o Need to be aware of ABCD changes in malignant melanoma
o Typical small/medium lesions with no suspicious features usually require no investigation
o Dermoscopy and biopsy of suspicious lesions
o No treatment usually but can have done if suspicious
What is Sturge-Weber syndrome?
Neurocutaneous disorder classically presenting with:
Facial port wine stain affecting facial skin
Vascular abnormalities
Ipsilateral occipital leptomeningeal angioma
Venous hypertension
What complications of Sturge-Weber syndrome?
Develop progressive problems including glaucoma, seizures, stroke, and intellectual disability
How is diagnosis of SWS made?
Diagnosis of SWS is made if the cutaneous port-wine stain is associated with either brain or eye involvement (USS then MRI/CT needed)
Management of SWS?
Cosmetic camouflage creams can be used to help to conceal the port-wine stain
Carbamazepine
Pulsed dye laser (PDL) treatment is used for port-wine stain
General management of birthmarks?
Most haemangiomata require no treatment unless the patient is concerned about their appearance
Port-wine stains are usually treated by camouflage but the patient may wish to be referred for laser therapy
Definiton of cephalohaematoma?
- Subperiosteal swelling on foetal head and its boundaries
- Spread is restricted by suture lines that are adherent, so it is limited to the surface of one cranial bone
Where is cephalohaematoma most common?
- Commonest over parietal bones
Risk factors of cephalohaematoma?
o Malposition o Large infant o Instrumental delivery (forceps/Ventouse) Ventouse more likely to cause injury o Breech delivery o Prematurity o Primagravida
Symptoms and signs of cephalohaematoma?
- Centre feels soft
- Blood loss can cause anaemia and even hypotension
- Could have jaundice following blood breakdown
DDx of cephalohaematoma?
Caput succedaneum (extends beyond bone margins) Chignon (following forceps delivery)
Investigations of cephalohaematoma?
- Underlying skull fracture may be present. If suspected and thought to be depressed, CT or MRI scanning is required and surgery may be indicated
Management of cephalohaematoma?
- Usually resolves over several weeks
- Rarely this may require surgical removal for cosmetic reasons
- Jaundice needs treatment
