Neonates Flashcards
Why is jaundice seen in over 50% of newborns
Increase in breakdown of RBC as high Hb at birth
Red blood cells have shorter lifespan in neonates
Hepatic metabolism less efficient
What is kernicterus
Bilirubin encephalopathy as free unconjugated bilirubin can cross the BBB
How can kernicterus present
Moderate cases
- lethargy and poor feeding
Severe cases
- irritability
- increased muscle tone (oplsthotonos)
- seizures and comas
What is oplsthonos
When babies lie with arched back
What are long term effects of kernicterus
Choreoathetoid cerebral palsy
Sensorineural deafness
Learning disabilities
Where does jaundice typically present in a newborn
The head and then spreads downwards with increasing severity
Cephalocaudal
Referral guidelines for neonates with jaundice
If first showed signs within 24 hrs of life then admit to neonatal or paeds unit within 2 hours
If over 24 hours admit within 6 hours if
- first appeared at more than 7 days
- very unwell
- gestational age less than 35 weeks
- prolonged jaundice
- issues about weight
- pale stools and dark urine
If neither of these
- get transcutaneous bilirubin level with 6 hours if not refer to hospital for bilirubin level in 6 hours
Investigations in secondary care for jaundiced baby
FBC and blood film
Blood group
DAT
LFTs
G6PD levels
Cultures of urine/blood to look for cause of sepsis
What determines prolonged jaundice in neonates
Gestational age of 37 or more = 14 days
Gestational age of less than 37= 21 days
Difference in solubility between unconjugated and conjugated bilirubin
Unconjugated- fat
Conjugated- water
How does phototherapy work on jaundice
Converts uBR to lumirubin and photobilirubin but DOES NOT WORK on Conjugated bilirubin
What is problem with transcutaneous bilirubin measurements
Only shows levels of unconjugated- if urgent then do blood reading which will show split between conjugated and unconjugated
Causes of jaundice in first 24 hours of life
Infection
ABO or Rh incompatibility
G6PD or HS
Gilberts
Cirgler-Najjar
Differences between Rhesus incompatibility and ABO
Rhesus negative mums produce ABs against Rhesus positive baby- normally does not affect first pregnancy only subsequent
ABO occurs in type O mums with naturally occuring Anti-A/B ABS- can occur in any pregnancy
Rhesus not very common but extremely serious
ABO more common but reduced morbidity/mortality
Rfx for haemolytic disease of the newborn
Chorionic villous sampling
Amniocentesis
Vaginal delivery
Antenatal haemorrhage
How to diagnose haemolytic disease of the newborn
Coombs test- will show positive indirect antiglobulin test showing IgG in maternal blood
Antibodies in ABO incompatibility
Anti-A haemolysin IgG- more common
Anti-B haemolysin IgG
What triggers gilberts to cause neonatal jaundice
Normally infection
What is Criger-Najjar syndrome
Results in a complete dysfunction of the gene encoding UDP-Glucuronyl transferase
Difference between Criger-Najjar syndrome and gilberts
CN results in a complete dysfunction of the gene encoding UDP-Glucuronyl transferase whereas gilberts get some activity
In CN the hyperbilirubinaemia is massive
Treatment options for acute bilirubin encephalopathy
Immediate exchange transfusion
Phototherapy
Hydration
IVIG
Folic acid after to prevent anaemia
Things to tell parent if baby undergoing phototherapy
Not harmful but eyes will be covered with blood samples taken regularly so know when to stop
Breastfeeding every 3 hours
Need to measure bilirubin after to check for rebound hyperbilirubinaemia
Options for treating neonatal jaundice
Phototherapy
Exchange transfusion
Thresholds for determining when to
Common causes of jaundice neonatal jaundice
Physiological
Breast milk jaundice
Sepsis
Feeding difficulty
What is biliary atresia
Progressive fibrosis and obliteration of extra and intra hepatic ducts
Symptoms of biliary atresia
Pale stools
Dark urine
Mild jaundice
DONT GET VOMITING
Examination finding of biliary atresia
Hepatosplenomegaly
Mild jaundice
Can get cardiac murmurs
What are the types of biliary atresia
T1- common bile duct
T2- cystic dict
T3- fulla tresia where over 90%
Problems of biliary atresia
Progress to chronic liver failure in 2 years and then HCC
Faltering growth despite normal birth weight
Investigations for biliary atresia
USS
Lfts- elevated GGT
High conjugated CBr
TIBIDA SCAN
ERCP and biopsy
US finding of biliary atresia
Triangular chord sign
Gold standard for biliary atresia
TIBIDA isoptope scan also known as scintiligraphy
Confirmatory test for biliary atresia
ERCP and biopsy
Management of biliary atresia
1st line -Kasai hepatoportoenterostomy- involves ligating the fibrous ducts above the join with the duodenum and joining an end of the duodenum directly to the porta hepatis of the liver
If fails need liver transplant
Complication management
F Fat-soluble vitamins (levels monitored)
U Ursodeoxycholic acid promotes bile flow
P Prophylactic ABx to prevent cholangitis (co-trimoxazol
Causes of jaundice between 24 hours and 2 weeks
Physiological
Breastfeeding difficulty
Breastmilk jaundice
Metabolic- gilberts, HS etc
Biliary atresia
Congenital hypothyroidism
Infection
What causes breastfeeding jaundice
Where babies do not receive enough milk there is increased enterohepatic cycling of bilirubin
What is congenital hypothyroidism and why serious
A lack of thyroid hormones from birth
Lack of growth and neurological defects
Aetiology of congenital hypothyroidism
In order of most common
Thyroid gland defects (missing etc) (not inherited)
Thyroid hormone metabolism (TSH unresponsive) (inherited)
Transient
Hypothalamic/pituitary dysfunction (tumours, ischaemia etc)
What can cause transient hypothyroidism
Seen in neonates
Maternal anti-thyroid medication like carbimazole, PTU
Maternal ABs from hashimotos
Presentation of congenital hypothyroidism
Feeding difficulties
Lethargy
Constipation
JAUNDICE
Large fontanelles
Niche- umbilical hernia, coarse features (flattened nasal bridge), macroglossia, thin hair
Investigations for congenital hypothyroidism
High TSH and low T4
Measure thyroid autoantibodies ± US or radionucleotide scan
Management of congenital hypothyroidism
Thyroxine hormone replaced with levothyroxine OD, titrate dose to TFTs + regular monitoring
Monitor growth, milestones, development
Management of primary hypothyroidism in children
Thyroxine hormone replaced with levothyroxine OD, titrate dose to TFTs + regular monitoring
Monitor growth, milestones, development
Most common cause of acquired childhood hypothyroidism
Hashimotos
Rfx for hashimotos hypothyroidism
Down’s syndrome, Turner’s syndrome
Female
Risk of graves mums giving birth
1-2% can be born hyperthyroid due to circulating TSHr-Abs which can cross placenta
Signs of foetal hyperthyroidism
High CTG trace
Foetal goitre on USS
Signs of neonatal hyperthyroidism
Irritability
Tachycardia
Diarrhoea
Exopathalmos
HF
Medical managment of hyperthyroidism
Carbimazole or PTU
Can consider beta blockers if symptomatic
Other management is surgery or radioactive treatment
When does anterior fontanelle shut
9-18 mths
What does absent red reflex suggest in newborn check
Retinoblastoma
Could be congenital cataracts
Normal newborn head circumfrence
23-35 cm
Highest of 3 measurements
What is a cephalhematoma versus caput
Cephalhematoma is a bleed under the epicranial aponeuris and restricted to suture lines
Caput succundem- swelling under the skin/subcut tissue- crosses suture lines
What is concerning about cephalematoma
Cause may be skull fracture
White spots on the face of newborn
Milia
Management of cephalematoma
Monitor jaundice
What causes a bleed in sclera of eye- newborn
Subconjunctival haemorrhage
What is the barlow and ortolani manoever
Dislocate femur out of hip joint- check if weakness
How is hydrocele of newborn managed
Normally self limiting within a year however if not need surgery
What syndrome is port and winerash associated with
Sturg-weber
Signs of resp distress in children
Nasal flaring
Subcostal recession
Tracheal indenting
What are categories of preterm infant
Preterm under 37
Near term 34-36
Very preterm 29-33
Extremely preterm under 29
What causes TTN
Lungs still full of amniotic fluid
Transient tachypnoea of the fluid
What causes RDS
Lack of endogenous surfactant
Decreases surface tension and prevents collapse of alveoli
Rfx for RDS
Maternal DM
Preterm
Hypothermia- deactivates surfactant
Elective C section
Any cause of hypoxia
What is protective for RDS
Pre-eclampsia
Recurrent threatened preterm labour (as able to give steroids)
Symptoms for RDS
Tachypnoea
Grunting
Cyanosis
Head bobbing
Chest wall recession
CXR of RDS
Ground glass appearance with bronchogram
Risk of trophic feeds
Spontaneous pneumothorax
These are small volumes of mik given to stimulate bowels not for nutrition
What increases risk of IVH in kids
CSF produced in choroid plexus which are very fragile and vascular. As mature get more supported with connective tissue- until this is risk of rupture into
How are IVH graded
1- bleeding only in germinal matrix
2- bleeding can occur into ventricles
3- grade 2 but blocked ventricles and theyre now dilated
4- ventricles so dilated it compresses surrounding venous
When is post haemorrhagic ventricular dilation a problem
Grade 3 and 4 IVH
Rfs for NEC
LBW
Preterm
PDA as reduces blood flow
Symptoms of NEC
Quiet
Feeding intolerance
Bilious vomiting or in NG tube
Bloody stools
If really bad- distension,
AXR of NEC
Pneumoperitoneum
Treatment of NEC
Stop enteral feeds and medications
- give TPN if feeds stopped for over 24 hours
- if confirmed NEC stop feeds for 1 weeks
NG tube on free drain
Abx- cefotaxime and vancomycin
Resp support if abdo distended
Fluids- may need ionotropes
Surgery if perforation
Complications of NEC
Perforation
Recurrent strictures
Neuro-maldevelopment
Short gut syndrome if feeding
What is chronic lung disease
Ongoing oxygen needed for 28 days
Rfx of CLD
Ventilation injury
Infection
RDS
Fluid overload
Complications of CLD and how managed
Very susceptible to future infection
- vaccinate against flu at 6 months
- vacciante against RSV
Wheezy for first 3 months
What is ROP
Retinopathy of prematurity- refractive errors or squints
Risks for ROP
Low birth weight
preterm
Hyperoxaemia
Management of ROP
Treated for up to 2 years
MDT approach
Photocogulation
What antibiotics given in RDS
Benzylpenicillin and gentamicin
What is main risk factor for TTN
C-section or preterm
Treatment for TTN
Oxygen if needed
Treatment for CLD
Manage oxygen therapy- wean off if necessarty or give what necessary
Caffeine citrate
Nitric oxide if pulmonary hypoplasia or pulmonary HTN
CXR finding of CLD
Widespread opacification
Can be atelectasis, multicystic appearance, emphysema or pulmonary scarring
Management of NEC
Resp support and potential cardio
Stop enteral feeding and medications- switch to parenteral
NG tube left on free drain
Abx with good cover- cefotaxime and vancomycin
Surgery if needed
What is used to diagnose vesicoureteric reflex
Micturating cytourethrogram
Pathophysiology of vesicoureteric reflux
Where urine backlows from bladder into the ureters and kidney
Normally due to ureters entering bladder perpendicularly -> shorter intramural course -> VUR
How can vesicoureteric reflux present
antenatal period: hydronephrosis on ultrasound
recurrent childhood urinary tract infections
reflux nephropathy
What is a reflux nephropathy
term used to describe chronic pyelonephritis secondary to VUR which commonest cause of chronic pyelonephritis
How can reflux nephropathy affect blood pressure
A renal scar can produce increased quantity of renin
Complications of VUR
Renal scar (35%)
HTN from renal scar
Renal osteodystrophy
How is renal scar visualised
DMSA
A DMSA scan is a radionuclide scan that uses dimercaptosuccinic acid in assessing renal morphology, structure and function
How is HIE graded
Depends on response within first 48 hours
Mild- irritable infant, responds excessively to stimulation, staring eyes, hypertonia
Moderate- abnormailities of movement, hypotonic, seizures, cant feed
Severe- no normal movement, does not respond to pain, tone in limbs fluctuate, hypo to hypertonic, seizures
Prognosis of mild, moderate and severe HIE
Mild- expect full recovery
Moderate- recovery in 2 weeks good prognosis, if not not good
Severe- 80% cerebral palsy, 40% mortality
Criteria for therapeutic cooling
Must be over 36 weeks
Over 1800g
Moderate or severe HIE
What virus during pregnancy presents with limb defects
Acute varicella
What virus during pregnancy presents with cerebral palsy
Acute CMV
What virus during pregnancy presents with cataracts
Rubella
What infection during pregnancy presents with choroidoretinitis
Toxoplasmosis
How is PV19 virus diagnosed
Parvovirus B19 serology
What are 4 main things to check in newborn examination
Heart
Hip
Eyes
Testes
What are the types of cleft lip and palate
Most common =combined
cleft palate alone
cleft lip
Risk factors for cleft lip and palate
Maternal antiepileptic and BDZ use
What does cleft palate and lip increase risk of
Secretory otitis media
Management of cleft lip and palate
MDT- surgeons, ENT, orthodontist, SALT, feeding team
Orthodontic devices may be needed if feeding difficult
Speech and language therapy
Cleft lip repaired in first 3 months of life
Cleft palate between 6-12 months of life
Causes of pulmonary hypoplasia
Congenital diaphragmatic hernia- most common
Oligohydramnios
Tetralogy of fallot
Osteogenesis imperfecta
Diaphram agenesis
Who is palivizumab often given to
Premature infants
Infants with lung or heart abnormalities
Immunocompromised
How long does caput succedaneum take to resolve versus cephalaematoma
CS- days
Cephalhematoma- months
How does CF present in neo-nates
Meconium ileus with SBO
Antiobitcs for listeria infection in child
Amoxicillin and gentamicin if blood cultures or CSF comes back as positive
How does listeria monocytogenes present
Widespread rash
Pneumonia or meningitis
Meconium stained amniotic fluid
What can present with meconium stained amniotic fluid in preterms
Listeria infection
How does erythema toxicum present
Often combination of erythematous patches, papules or pustules
Starts on face and spreads down
Will disappear in a few days without treatment
Differentials for neonate with breathing difficulty
Common
- TTN
- Pneumonia
- Sepsis
Uncommon
- meconium aspiration
- pneumothorax
- congenital abnormality like diaphragmatic hernia
Management of congenital diaphragmatic hernia
First line- NG tube drip and suck
If cyanosed use ventilation
Manage pulmonary hypertension with inhaled NO or ECMO
Surgery to repair
Management of bacterial conjunctivitis in the neonate
Same day referral to opthalmologist
Mild- chloramphenicol eye drops
Moderate-severe- give systemic abx according to organism
Chlamydia- oral erythomycin
Gonoccocal- single dose parenteral ceftriaxone
Pseudomonal- gentamicin eye drops with systemic abx
Management of viral opthalmia neonatorum
Topical antihistamine with artificial tears
What is biphasic presentation of group b streptococcus
Newborn- pneumonia or meningitis-> both often causes sepsis
3 months- meningitis or osteomyelitis/septic arthritis
What is given to babies with signs of group b strep infection
Penicillin and gentamicin
If CSF positive then swithc to benzylpenicllin and gentamicin
Risk factors for group b strep infection
Maternal fever during delivery
Choriamniitis
Previous GBS infection in pregnancy
Preterm
How is HIE graded
Mild (everything excessive)
- hyper alert
- hypertonia
- increased reflexes
- weak such reflex
- tachycardia
- no seizures
Moderate (dampened down)
- lethargic
- mild hypotonia
- strong distal flexion
- weak reflexes
- pinpoint eyes
- bradycardia
- focal seizures
Severe
- comatose
- absent reflexes
- difficult to control seizures
- unequal and unreactive pupils
- flaccid posture
Management of HIE for all patients
Resus
- consider early ventilation
- ionotropic support
- maintain BP with dobutamine
- fluids (40ml/kg)
Extra management of moderate HIE
Treat complications
- seizures and consider EEG
- maintain normoglycaemia
- treat hypocalcaemia
- measure LFTs and coagulation (IM phytomenadione)
- withold feeding as increased risk of NEC
Complications of HIE acute
Liver injury
Hypoglycaemia
Hypocalcemia
Hypotension
Resp failure
How can intraventricular haemorrhage present
Silent picked up on routine US
Symptomatic
- altered consciousness
- hypotonia
- abnormal eye movements
Catastrophic deteriation - coma
- irregular respirations
- apnoea
- flaccid weakness
- seizures
Pathophysiology of retinopathy of prematurity
Vascular development of retina begins at 15-18 weeks and continues until term
If baby is born preterm then vascular development continues after birth and sometimes this is abnormal
Who is ROP screened for
In babies under 1500g Birth weight
Under 32 weeks gestation
Opathalmoscope will show abnormal retinal vessel proliferation
Complications of IVH
Clots in grade 3 and 4 can lead to hydrocephalus
If haemorrhagic IVH leads to cerebral palsy 50% of cases
Management of IVH
Fluids replacement
Treat seizures
Shunt if hydrocephalus or raised ICP
Neonatal hypoglycaemia management
Less than 1.5
- admit to neonatal unit
- confirm with lab blood glucose assay
- IV 10% glucose 2ml/kg bolus
- followed by infusion of 3.6ml/kg/hr
- monitor regularly
Between 1.5 and 2.5
- feed immediately
- recheck glucose after 30 mins and if still low consider admitting and starting IV glucose
What to do if persistent neonatal hypoglycaemia
Refer to endo for further investigation
What to do if secondary hyperinsulinaemia causing hypoglycaemia in neonates
Either
- glucagon infusion
- diazoxide and chlorthiazide
- somatostatin analogue
How should neonatal hypoglycaemia be prevented
Encourage feeding 30 mins after birth
Cyanosis after birth with absent heart murmurs and signs of HF
Persistent pulmonary hypertension
Exam findnigs of CLD
Scattered rales
Expiratory wheeze
What defines CLD
Need for oxygen supplementation after 36 weeks postmenstrual age
Can be also seen as sats dropping below 90% after an hour on room air
Pathophysiology of pulmonary hypertension of the newborn
Pulmonary vascular resistance doesnt decrease after birth which can cause right to left shunting via PDA or patent foramen ovale
Causes of persistent pulmonary hypertension of the newborn
Idiopathic
OR
Secondary to neonatal pulmonary conditions
- meconium aspiration
- ttn
- congenital diaphragmatic hernia
- RDS
How can whether a childs condition is duct dependant be assessed
Pre and post ductal blood saturations
Saturations taken from the right hand and foot
If duct dependant then saturations will be lower in the foot as this is after the duct
How can persitent pulmonary hypertension of the newborn be investigated
Pre and post ductal saturations will show lower saturations in the feet than in the right arm
Echo will show increased pressure in the pulmonary artery
Management of persistent pulmonary hypertension
Oxygen
Intubate for ventilation
Surfactant
Suction of secretions
Fluids and ionotropes
Inhaled nitric oxide
What can be used for oxygenation in neonates with PPHN where no improvement with normal ventiation
High frequency oscillatory ventilation
When insert chest drain for pneumothorax
Tension pneumothoraces
Ventialted or preterm infants with non-tension pneumothoraces who deteriorate
Risk of ventilation in children
Pneumothorax
- keep pressure as low as possible
Complications of meconium aspiration
Atelectasis
Infection
PPHN
Pneumothorax
Pneumomediastinum
Risk factors for meconium aspiration
Post term delivery
Prolonged rupture of membranes
Chorioamnionitis
Oligohydramnios
Investigations for meconium aspiration
CXR- shows atelectasis, hyperinflation and patchy consolidation
Culture
Antibiotics for meconium aspiration
IV ampicillin and gentamicin
Symptoms of meconium ileus
Not passed meconium
Bilious vomiting
Can even vomit the meconium
Associations of meconium ileus
Biliary atresia
CF
Management of meconium ileus
1st line - gastrograffin enema
2nd line- surgery
Ddx for bilious vomiting in neonate
NEC
Duodenal atresia <6hrs
Jejunal or ileal atrsia <24 hrs
Meconium ileus 24-48 hrs
Malrotation volvulus 3-7 days
AXR of duodenal atresia
Double bubble sign
AXR of jejunal and ileal atresia
Air fluid levels
CXR finding of meconium aspiration
Hyperinflation
Atelelctasis
Consolidation
Pneumothorax
Pneumomediastium
Complications of diaphragmatic hernia
RDS
Stomach volvulus
Intestinal obstruction
How do diaphragmatic hernias present
Concave chest
Resp distress at birth
What goes into the apgar score and how is it rated
A- apearance (colour)
P- pulse
G- grimace (reflex irritability)
A- activity (tone)
R- respiration
Done between 1st and 5th minute of life- the higher the better
If low then repeat at 10 minutes
Neonatal resus
- Dry baby
- Assess tone, resp rate, HR
- If gasping or not breathing 5 INFLATION breaths
- Reassess
- If HR less than 60 bpm start chest compression and VENTILATION breaths at rate of 3:1
What to do if saturation very low in first few minutes after birth
Very normal for cyanosis after birth as adjusting- reassess in a few minutes
Investigation for cranial swelling
CRUSS if anterior fontanelle not shut, if has then do MRI
What is neurological finding seen in shoulder dystocia
Erb-duchenne palsy from damage to the brachial plexus
Abnormalities in erb palsy
Arm medially rotated and adducted
Extension at elbow
Classical presentation of congenital syphillis
Rash on palms and soles
Blood stained rhinitis
Hepatosplenomegaly
Glomerulnephritis
Meningitis
Bossing of forehead
Small widely spaced teeth (Hutchinsons teeth)
Saddle nose deformity
Anterior bowing of shins (Saber shins)
Symmetrical knee swelling (cluttons joints)
Triad for congenital toxoplasmosis
Hydrocephalus
Microcalcifications
Choroidretinitis
Can also present with liver issues and jaundice
Most common cause of congenital infection
CMV
Congenital infections acronym
TORCH
Toxoplasmosis
Other (syphilis)
Rubella
CMV
H- HIV,HBV
Most likely cause of hydrops fetalis
Parovirus
Could also be CMV
How are cephalhaematomas differentiated from subgaleal bleeds
Subgaleal bleeds cross fontanelles
How can congenital herpes present
3 main presentations
- skin eye mouth disease
- CNS disease
- disseminated systemic disease
Presentation of choledochal cyst
Abdo pain
Abdo mass
Jaundice
Investigation for choledochal cyst
USS
Management of choledochal cyst
Surgical excision with roux en y anastamosis to biliary duct
What is infection of the umbilicus
Omphalitis- normally s.aureus
How is omphalitis managed
Sepsis 6
What is it when urine passes through the umbilicus
Urachus
What is it when mass of red/grey tissue by the umbilicus
Umbilical hernia
Caused by umbilicus recovering post birth
Complications of breech presentation
DDH
Femur fractures
Erb palsy
Causes of HIE
Anything which reduces oxygenated blood flow around birth
Immediate management of a neonate
Immediately- dry baby, note time and start clock
Within 30 seconds- assess tone, breathing effort and HR
Within 60 seconds- if gasping not breathing give 5 inflation breaths
When is only time treat IVH
Hydrocephalus or raised ICP
Put shunt in
Risks of drinking in pregnancy
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations
Epicanthic folds
Sooth philtrum (area between nose and mouth)
Small palpebral fissue
What is the palpebral fissue
Distance between outside of eye and inside
Risks of smoking in pregnancy
IUGR and LBW
Preterm
Miscarriage
What congenital infection will present with an asymptomatic mother
Toxoplasmosis
How does TTN appear on CXR
Hyperinflated
Fluid in horizontal fissue
What worried about in acute macrocephaly
Raised ICP
- hydrocephalus etc
What is craniosyntiosis
When sutures of the brain fuse prematurely
What are the 2 types of craniosyntiosis
Sagittal (AP suture)- long flat head
Lamdoidal synostosis (posteriorly, goes laterally)- appears like plagiocephaly
What tends to cause sagittal craniosyntosis
Premature infants lying on their sides
Management of duodenal atresia
A-E
NG tube for decompression
Duodenoduodenostomy- anastamosis between non-obstructed parts of duodenum
What is difference between low and high anorectal anomalies
Low- at level of anus it has close in, may be a fistula to the surrounding skin
High- bowel has closed off higher up, associated with fistulas to bladder etc
What are retractile testes
Testes which have descended but then go in and out of scrotum
Management of retractile testes
Reassurance and follow-up annually
Surgical management of undescended testes
If in inguinal canal- orchidopexy
If anywhere else- laparoscopy
Difference between early and late onset sepsis
Within 72 hours of birth is early
What needs to be done if have port and wine rash
MRI to rule out intracranial haemangioma
If have patient with TTN what need to do
Septic screen as impossible to differentiate- can give abx in meantime
What determines what bilirubin measuring device used
Within 24 hours of life or born under 35 weeks- serum reading
After 24 hours- transcutaneous bilirubinometer
What is cutoff on transcutaneous bilirubinometer to do serum reading
250
Most common cause of opthalmia neonatorum
Chlamydia
Management of chlamydia opthalmia neonatorum
Oral erythomycin
Management of gonococcal opthalmia neonatorum
IV cefotaxime single dose
Newborn baby with isolated skin disease. Widespread vesicles and pustules on face with salmon patch on left eyelid. what TORCH
HSV
What is a chignon
A swelling on head from where vetnouse was attached
How do umbilical granulomas present
Red lump leaking clear fluid
What is main problem if bottle feed over 6 months
Vitamin D deficiency
What is periventricular leukomalacia
Where get hypoxic injury to white tissue making it very soft
What is potter sequence
It is the result of the force from oligohydramnios
What is presentation of potter sequence
Pulmonary hypoplasia
Renal agenesis
Clubbed feet
Low set ears
Flattened nose
Downwards epicanthal folds
How often is bilirubin checked in phototherapy
Every 4-6 hours
What is chorioretinitis
Posterior uveitis
What is main risk factor for contracting congenital toxoplasmosis
Maternal exposure to cat faeces
Investigation for meconeum ileus
AXR
‘bubbly’ appearance of the intestine with a lack of air-fluid levels
Meconeum ileus
What does yellow amniotic fluid suggest
Haemolysis
Signs of haemolysis on newborn examination
Yellow amniotic fluid
Hepatosplenomegaly
Hydrops fetalis
With phototherapy what bilirubin level aim for
50 micromoles below target
Management of phototherapy in neonate
Once 50 micromoles below can stop then re measure in 12-18 hours
If this is 50 below then no further measurement required
If less than 50 below remeasure in 12 hours
Management of meconium aspiration
Attempt to suction meconium from mouth
Transfer to NICU
Administer oxygen
Gentamicin and ampicillin
How does mycoplasma pneumonia present
Insidious onset compared to normal pneumonia
