Neonatal Presentations

Question 1

Describe the different colors you could see in a neonate? [4]

Answer 1

• Yellow (Jaundice - see separate deck)
• Pale
• Red (Plethora - Polycythaemia)
• Cyanosed

Question 2

It’s very common (50-70%) for babies to develop a red maculopapular rash after birth. What do we call this and how is it managed? [2]

Answer 2

Erythema Toxicum

Reassure, it clears by it’s self within 1-2wks

Question 3

Babies of races with pigmented skin are often born with blue-grey patches on lower back/buttocks. What is this?
Caused by [1]
Management [1]

Answer 3

Mongolian blue spots

Due to accumulation of melanocytes

less obvious as skin darkens, most fade by 2yo

Question 4

Sometimes babies are born with light pink marks on the back of the neck or midline of face, what do we call this [3] and what do we do?

Answer 4

Stork Marks (or Naevus Simplex or capillary naevi)

It’s just dilated capillaries, leave it and it should disappear within 2 yrs

Question 5

What are the major causes of hypoglycaemia in newborns? [4]

Answer 5

• Small/Large for Gestational Age, premature
• Diabetic mum –> Hyperinsulinaemia
• Hypothermia
• Sepsis

Question 6

What might a hypoglycaemic baby look like? [6]

Answer 6

Jittery or lethargic
Hypothermic, hypotonic!
Apnoea or irregular breathing
Poor feeding and vomiting
High pitched weak cry
If severe hypoglycemia --> Seizures

Question 7

How do we screen for hypoglycaemia in paediatrics? [2]

When is hypo normal

Answer 7

Bedside skin prick glucose. If its <2.6mmol/L we send for a lab sample to confirm

Transient in 1st few days
Observe and encourage feed

Question 8

Babies often present hypothermic following birth, how do we prevent this? [5]

Answer 8

During resuscitation:

• Dry quickly
• Remove wet linens
• Use warmed towels
• Provide a radiant warmer
• Use heated/humidified O2

Question 9

What is a “tongue tie”

Answer 9

A short or thick frenulum, it may be attached too anteriorly to the base of tongue

Question 10

What’s the problem of a tongue tie and how do we treat it? [2]

Answer 10

They can make feeding difficult

In which case we would do a frenotomy

Question 11

What are the types of Cleft lip/palate and what causes it? [5]

Answer 11

Incomplete
Unilateral
Bilateral

Maxillary & Medial Nasal processes fail to fuse around wk 5

Question 12

Cleft lip baby - management approach [3]

Answer 12

Use special bottle/teat

Check for airway problems

Check for ass anomalies with hearing screen, cardio exam, echo & exam for signs of trisomies

Question 13

What is the most common problem picked up on ophthalmology exam in babies?
What can we do? [2]

Answer 13

Lack of red reflex, usually meaning cataracts

We can do lens removal and give an artificial lens

Question 14

Mum finds some bloody mucousy discharge in her baby girls nappy. What can it be?

Answer 14

Probably pseudomenstruation

Very common and due to hormones from mum. It’ll clear up itself

Question 15

Spinal Dimples can be a sign of nothing or a sign of something more serious, when [4] and how would we investigate [2]?

Answer 15

US & MRI if:

• Large, red, tender or swollen
• Off midline or above sacral area
• Pigmented
• Fluid

Question 16

What are the 2 common benign causes of a newborn with a swollen head? [2]

Answer 16

Cephalohaematoma (Haemorrhoage under pericranium)

Caput Seccedaneum (Serosanguinous fluid collecting subcutaneously)

Question 17

What characterises a Cephalohaematoma? [4]

Answer 17

Localised, soft, non-translucent
Peaks at DoL 3/4

Limited by cranial bones (usually parietal bone)
Doesn’t cross suture lines

Question 18

How long does a cephalohaematoma take to disappear [1] and does it have any complications [2]
NB NOT associated with intracranial bleeds

Answer 18

3-4wks

Can lead to jaundice via haemolysis of the haemorrhage

Question 19

What characterises a Caput Succedaneum [4]

Answer 19

Present at birth

Over midline, crosses suture lines

Resolves over 2d

RF: vacuum/ventouse delivery

Question 20

What causes caput succedaneum? [1]

Answer 20

Pressure of scalp against dilating cervix, long difficult labour

Question 21

What are the types of Talipes classified according to management? [2]

Answer 21

Physiological - I.e. you can straighten the foot - only needs physio
Fixed - Needs Ortho i.e. strapping, casting or surgery

Question 22

How do we confirm and treat a DDH? [3]

Answer 22

US to confirm dislocation
Pavlik harness & Surgical reduction
To relocate head of femur into acetabulum

Question 23

Name 5 causes of failure to pass stool in a newborn?

Answer 23

Constipation
Large bowel atresia
Imperforate anus
Hirshsprung's disease
Meconium Ileus (from CF)