Neonatology 5 Flashcards
What does vit K deficiency result in?
Haemorrhagic disease of the newborn- this disorder can occur during the 1st week of life, or from week 1-8
Bruising, haematemesis and melaena, or prolonged bleeding of the umbilical stump or after a circumcision However, some suffer from intracranial haemorrhage – 50% of whom are permanently disabled or die
Infants of mothers taking anti-convulsant disease or those with liver disease
How can vit k deficiency be prevented?
Vit K given by Im injection- given to all newborns after birth
Can request oral dose- 3 doses needed over first 4 weeks
Mothers on anti-convulsant therapy should receive oral prophylaxis from 36 weeks
What is the hearing screening?
• Evoked optoacoustic emission (EOAE) testing- when an earphone is placed over the ear and a sound is emitted which evokes an echo or emission from the each if cochlear function is normal, used as the initial screening test
If initial test isn’t normal- testing with automated auditory brainstem response (AABR) audiometry, using computer analysis of EEG wave forms evoked in response to a series of clicks, is performed, with referral to a paediatric audiologist if abnormal
What is the guthrie test?
Blood sample taken by heel prick when feeding has been established on day 5-9
o Hypothyroidism
o Haemoglobinopathies sickle cell & thalassaemia
o Cystic fibrosis (trypsin- raised in pancreatic duct obstruction)
o Inherited metabolic diseases
Phenylketonuria (PKU)
Medium-chain acyl-CoA dehydrogenase deficiency (MCAD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystinuria (HCU)
What is US used for in antenatal screening?
o Show the babies measurements o Number of babies o Any abnormalities- particularly head & spine o Show the position of the baby o Check for normal development o Cleft lip palate o Cardiac problems o Spina bifida o Bowel problems o Down syndrome
What is erythema toxicum?
neonatal urticaries
A common rash appearing at 2-3 days of age- consisting of white pinpoint papules at the centre of an erythematous base
• The fluid contains eosinophils, the lesions are concentrated on the trunk- the come and go at different sites
What are mongolian blue spots?
- Blue/black macular discolouration at the base of the spine and on the buttocks- occasionally occur on the legs and other parts of the body
- Usually, but not invariably in Afro-Caribbean or Asian infants
- They fade slowly over the first few years- they are of no significance unless misdiagnosed as bruises
What are capillary haemangiomas?
• Pink macules on the upper eyelids, mid-forehead and nape of the neck-
common and arise from distension of the dermal capillaires
• Those on the eyelids gradually fade over the first year- those on the neck become covered in hair
• Sometimes called ‘Strawberry birthmarks’
What are the soft tissue injuries of newborns?
- Caput succedaneum- bruising & oedema of the presenting part extending beyond the margins of the skull bones, resolves in a few days
- Cephalhaematoma- haematoma from bleeding below the periosteum, confined within the margins of the skull sutures, it usually involves the parietal bone and the centre of the haematoma feels soft- resolves over several weeks
- Chignon- oedema & bruising from Ventouse delivery
- Abrasion to the skin from scalp electrodes applied during labour or from accidental scalpel incision at C- section
- Forceps marks to face from pressure of blades- transient
- Subaponeurotic haemorrhage (very uncommon)- diffuse, boggy swelling of scalp on examination, blood loss may be severe and lead to hypovolaemic shock and coagulopathy
What are nerve palsies that can occur in newborns?
Brachial nerve palsy- breech delivery or shoulder dystocia
Upper nerve root (C5/6)- Erb palsy, phrenic nerve palsy-elevated diaphragm
Facial nerve palsy- compression against mother’s ischial spine
Cervical spine- lack of movement below level of lesion
Most palsies resolve- refer if not by 2-3 months
How does a facial nerve palsy present?
It is unilateral and there is facial weakness on crying, but the eye remains open
it is usually transient, but methylcellulose drops may be needed for the eye
What are the fractures that can occur in newborns?
Clavicle- shoulder dystocia. Snap may be heard, reduced arm movement, lump from callus formation at several days- no treatment needed
Humerus/femur- mid-shaft, breech deliveries, fracture of the humerus at shoulder dystocia. Deformity, reduced movement and pain. Heal rapidly with immobilisation
What is sticky eye?
Starting on 4/5 day
Yellow discharge, formation of crust- small tear ducts become blocked by fluid and debris during birth (struggle to produce tears)
Bacterial infections- s.aureus, p. aeruginosa or strep
eye should be bathed with sterile water
What is rhesus haemolytic disease?
where antibodies in a pregnant woman’s blood destroy her baby’s blood cells
can cause the baby to become anaemic and develop jaundice, hepatosplenomegaly
• Antibodies may develop to Rhesus antigens other than D and to the Kell & Duffy blood groups, but haemolysis is usually less severe
occurs when a mother is Rhesus –ve and gives birth to a Rhesus +ve child
What is ABO incompatibility?
blood groups of mother and baby are not compatible
• Most ABO antibodies are IgM and do not cross the placenta, but some group O women have an IgG anti-A- haemolysin in the blood, which can cross the placenta and haemolyse the RBCs of a group A infant, occasionally, group B infants are affected by anti-B haemolysins
Jaundice- 12-72hrs
• The direct antibody test (Coombs’ test) is positive, Coombs’s test demonstrates antibody on the surface of
RBCs
