VIVA Aide Memoir Incidence and Risk factors Flashcards
Congenital Cataract
Incidence and Risk Factors
Approximately 2 or 3: 10000 babies born in England have congenital cataracts in one or both eyes (NHS 2018). In 50% of these both eyes are affected.
1/5th of affected babies will have a family history of cataracts.
Risk factors:
In 50% of the cases is idiopathic cataract with no identifiable cause.
- Family history (first-degree relative)
- Prematurity
- Low birth weight (BW<1.5Kg)
- Genetic syndromes
- Extensive port wine stains involving eyelids which can cause glaucoma
- Viruses in pregnancy such as rubella, toxoplasmosis, or CMV
- Neurodevelopmental conditions or sensorineural hearing loss
- Retinoblastoma (malignant retinal tumor which causes a white reflex)
- Coloboma (malformation of the eye, whole in structure of the eye, causing a white reflex)
- Aniridia (absence iris)
Jaundice
Incidence and Risk Factors
6:10 term babies (8:10 preterm) babies will develop physiological jaundice.
Risk factors:
- Previous babies with neonatal jaundice requiring phototherapy
- ABO incompatibility and RH status
- BF exclusively
- prematurity
- sepsis (TORCH status)
- G6PD deficiency which is an enzyme that helps RBC to work
- liver (Hep)
- birth trauma and obstruction
- defect in the biliary system
- blood disorder
- hypothyroidism
- Gilbert’s syndrome.
- Crigler-Najjar Syndrome
Complications can be kernicterus and bilirubin encephalopathy
Babies with risk factors only should have an assessment at D2
Cryptorchidism
Incidence and Risk Factors
Undescended testes affect approximately 2-6% of male babies born at term.1:100 of these babies will have testes that stay undescended unless treated. (Sijstermans 2007; NIPE standards 2018)
30% of preterm infants- as do not descend until the end of pregnancy.
Around 80% of cryptorchid testes descend within the first year of life (the majority within 3 months), thus true incidence is around 1%.
Risk factors:
* first-degree family history of undescended testes (baby’s father or sibling)
* low birth weight and SGA
* preterm birth
Although practitioners should be aware of these risk factors, they do not alter the NIPE national testes screening pathway.
Acrocyanosis
Incidence and Risk Factors
Common in newborn babies
Risk factors:
No predisposing factors but poor perfusion, cold, CHD, hypoxia, and immature vascular system can be contributory factors.
Milia/Epstein’s Pearls
Incidence and Risk Factors
40% of newborns (Epstein’s pearls)
50% of newborns (Milia)
Risk factors:
No predisposing risk factors
Hyperpigmented macule
Incidence and Risk Factors
The most common birthmark is seen in an estimated 90% of Asian and African American, 50% of Hispanic, and 10% of Caucasian infants.
Risk factors:
No predisposing factors, except gene heritage.
Erythema Toxicum Neonatorum
Incidence and Risk Factors
Found in up to 70% of the newborns
Risk factors:
No predisposing factors
Hydrocele
Incidence and Risk Factors
2-5% of male infants (Lomax) and most will resolve spontaneously
Risk factors:
- Preterm
- low birth weight
- undescended testes
- Hx maternal STIs
- Maternal Ehlers-Danos syndrome
CHD Congenital Heart Disease
Incidence and Risk Factors
CHD is one of the most common types of birth defects.
8: 1000, Overall range from non-significant to major/critical
2-3: 1000 will be symptomatic within the first year. Critical CHD accounts for 15-25% of these and is a leading cause of morbidity and mortality.
Mainly to be idiopathic 90%.
Risk factors:
- Family hx (first-degree relative)
- Foetal TS21 (40-50%) or other syndromes (Marfans/Noonan’s)
- Cardiac abnormality suspected from AN anomaly USS (with the Foetal Anomaly Screening Programme FASP, the specific cardiac abnormality detection rate is at least 50%)
- Maternal exposure to viruses (rubella)
- Maternal conditions (T1DM, epilepsy, SLE)
- Drug-related teratogens during pregnancy (AEDS (sodium valproate) and psychotropic (lithium))
- Medication during the conception of pregnancy *Nasal spray, phenylephrine not recommended – use the saline spray in pregnancy or cetirizine it’s safe to use.
It can also be a range of other causes- environmental, genetic, infectious, nutritional etc.
DDH Developmental Dysplasia of the Hips
Incidence and Risk Factors
3-5: 1000 lives births may require Pavlik Harness
1-2: 1000 live births may require surgery
(GOV.UK NIPE standards)
2% of the DDH are extreme complete irreducible teratologic dislocation and they are usually accompanied by other serious malformations such as neuromuscular disorder.
Risk factors:
- First-degree f/hx of hip problems in early life
- Breech presentation on USS or palpation 36w irrespective of presentation at birth or mode of delivery (includes ECV)
- Breech presentation at birth 28w
- All babies in multiple pregnancies in which one of the babies needs investigation for DDH
Other risk factors are oligohydramnios, females (x4/5 times more likely to have DDH than males; Hip Dysplasia Institute), or packaging disorders such as torticollis, metatarsus adducts, or talipes equinovarus.
Talipes Equinovarus
Incidence and Risk Factors
1-2: 1000 newborns, and in those 50% is a bilateral talipes
Risk factors:
- Family history (baby with a parent or sibling with a hx of congenital talipes is 20 times more likely to have it)
- males are 2 times more likely to have talipes than females
- Restricted conditions in utero can cause the foot/ankle to sit in an abnormal position which is then maintained post-birth: multiple pregnancies, positions in utero such as breech or transverse.
- Nervous system disorders such as cerebral palsy and spina bifida.
Hypospadias/Epispadias
Incidence and Risk Factors
It is the second most common birth abnormality of the male reproductive system, affecting about 1:250 males at birth. (Lomax)
8.2:1000 (Tappero)
1:3000 (BAPRAS)
Risk factors:
The causes of hypospadias in most infants are unknown apart from gene heritage (the risk of further children presenting the same is 6-17%).
