Newborn / Neonate Flashcards
Newborn Screening Cards
48-72 hours post birth
- Phenylketonuria
- Cong Adrenal Hyperplasia
- Cong Hypothyroidism
- CF
- FFA and organic acid disorders
- Galactosaemia
Neonatal Conjunctivitis
- Obtain conjunctival swabs for gram stain, giemsa stain and cultures, and gonococcal and chlamydia PCR if clinical suspicion
- Gonococcus, chlamydia and herpes simplex can cause invasive disease and may require septic work up.
- Chlamydia = PO azithromycin 20mg/kg daily for 3/7
- Gonococcal = stat dose of ceftriaxone 25-50mg/kg
- HSV = IV aciclovir 20mg/kg
- Others = TOP chloramphenicol 0.5% eye drops 4–6 times per day for 5–7 days
Physiological Jaundice
Normal transitional phenomenon:
- Increased turnover foetal RBCs
- Shorter life span
- Immaturity of liver to metabolise (conjugate) Br
- deficiency of UGT1A1 - does not reach adult levels until 14 weeks
- Increased enterohepatic circulation
- Inc unconjugated Br due to limited bacterial converison of conjugated Br to urobilin
Breastmilk jaundice
Not fully understood
May be:
- high concentrations of beta D-glucuronic acid
- mutation of UGT1A1 gene
Jaundice treatment
Septic infant ABx
BRUE
BRUE DDx
- Airway: obstruction, inhaled foreign body, laryngospasm, congenital abnormalities, infection
- Cardiac: congenital heart disease, vascular ring, arrhythmias, prolonged QT
- Abdominal: intussusception, strangulated hernia, testicular torsion
- Infection: pertussis, sepsis, pneumonia, meningitis
- Metabolic: hypoglycaemia, hypocalcaemia, hypokalaemia, other inborn errors of metabolism
- Toxins/Drugs/Ingestions: accidental or non-accidental
- Inflicted injury
Jaundice Red Flags
Gestation <36/40
First 24 hours
Pre-discharge TSB or TcB in high risk zone
Blood group incompatibility
Previous sibling receiving phototherapy
Cephalhaematoma
Exclusive BF esp if nursing not going well
Febrile infant risk stratification
Neonatal Vomiting
Non-Emerent Causes Vomiting
NEC
Introduction
Necrotizing enterocolitis (NEC) causes significant disease in premature and very low birthweight infants but can occur in healthy term infants as well
Term infants with decreased intestinal perfusion caused by conditions such as cardiac or gastrointestinal diseases, perinatal hypoxia, sepsis, and intrauterine growth restriction may be at increased risk of NEC
It most commonly occurs during the first two weeks of life
Clinical Manifestations
NEC may be characterized by abdominal distention, emesis, and bloody stools
Patients may also present with lethargy and cardiopulmonary collapse
Diagnosis
Diagnosis is made by abdominal radiographs, which can show nonspecific findings including distension and thickened bowel wall (Figure 1)
Pneumatosis intestinalis is pathognomonic for NEC, and is characterized by bowel wall lucencies (Figure 2)
Bowel perforation may lead to pneumoperitoneum, and radiography may also show portal venous gas
Management
Management includes resuscitation, supportive care with bowel rest and gastric decompression, and antibiotics
Bacteremia may be seen in up to 30 percent of neonates with NEC, and antibiotics should be broad-spectrum and cover intestinal flora
Surgical management is necessary for patients with bowel necrosis, and may include primary peritoneal drainage and/or laparotomy
Midgut malrotation + volvulus
