Paeds: Neonatology

Question 1

A mother is concerned about a swelling she has noted on her newborn’s head. The girl was born four hours ago, using forceps delivery due to a prolonged second stage of labour. On examination, there is a swelling in the parietal region which does not cross the suture lines. The consultant tells her that it may take several months to resolve. Which type of head injury is this likely to be?

Answer 1

Cephalohaemotoma

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This newborn that has had a prolonged delivery which eventually required instrumental extraction. This predisposes to extracranial injuries. Extracranial injuries can include caput succedaneum which is a bleed in the subcutaneous tissue, a subgaleal bleed which occurs in the subaponeurotic space, or cephalohaematoma which occurs between the periosteal membrane and cranial bone.

Question 2

A mother notices that her newborn boy has small eye openings, a small body and low-set ears. On examination the paediatrician also notes a flat philtrum, a sunken nasal bridge, short palpebral fissures and a thin upper lip. What is the most likely cause?

Answer 2

Fetal Alcohol Syndrome

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Fetal alcohol syndrome

Maternal alcohol abuse during pregnancy.

Presentation: IUGR, microcephaly, midfacial hypoplasia, micrognathia, smooth philtrum, microphthalmia, short palpebral fissures, thin upper lip, irritability, ADHD.

Question 3

You are the F2 in the paediatric clinic. A mother comes in saying that she thinks her 6-month-old son has colic. She shows you a video on her phone. The video shows a 6-month-old baby crying, which stops abruptly and the child draws his chin into his chest, throws his arms out. The child then relaxes and starts crying again, and over the course of the minute long video this is repeated around 10 times. The mother also reports that the child has been referred to the community paediatric clinic due to slight delay in reaching developmental milestones. Which one test is most appropriate for you order to help confirm your diagnosis?

Answer 3

EEG

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Differentiates between Infantile spasms and infantile colic

Infantile spasms (Wests syndrome) will show a hypsarrythmic pattern.

Question 4

A 4 month old baby girl is admitted to the Emergency Department after her mother noted that she stopped breathing. The baby was fit and well earlier. Unfortunately, advanced life support failed to resuscitate the baby. Her temperature on admission was 36.8ºC. The child was previously fit and healthy and up-to-date with vaccinations. On post-mortem, retinal haemorrhages were noted in the baby’s eyes bilaterally. Which of the following would explain the likely primary mechanism that have lead to the baby’s death?

Answer 4

Aggressive shaking (Shaken baby syndrome)

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Honourable mentions:

Meningitis (Nil fevers, nil rash, nil infection history)

Retinoblastoma (Bilateral retinal haemorrhages suggest against?)

pneumonia (Nil resp signs or fevers)

Fall on head (Nil external bruising)