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Neonatal problems

Neonatal problems. November 14 th 2012. Aims. Neonatal and 6-8/52 exam Common problems: Feeding Breathing Infection Constipation Skin Sleep SIDs. Newborn and 6/52 check. Head to toe… General Head Fontanelles Eyes Palate Tongue Ears Chest Abdo Umbilicus Genitals Anus .

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Neonatal problems

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  1. Neonatal problems November 14th 2012

  2. Aims • Neonatal and 6-8/52 exam • Common problems: • Feeding • Breathing • Infection • Constipation • Skin • Sleep • SIDs

  3. Newborn and 6/52 check • Head to toe… • General • Head • Fontanelles • Eyes • Palate • Tongue • Ears • Chest • Abdo • Umbilicus • Genitals • Anus • Spine • Hips & femorals • Feet • Skin • Tone

  4. HEAD • All tongue ties require referral for surgery. • False • Only requires surgery if interferes with feeding talking • If they need referral then send to ENT

  5. Cleft palates can be a routine OPA with paeds. • False • Refer into cleft palate specialist team – they link in with Leeds if requires surgery • Help with specialist feeding bottles and support • Cleft palate, unilateral cleft palate, bilateral cleft palate

  6. Absent red reflexes indicate congenital cataracts. • True • Requires referral to opthalmology

  7. Squints do not require referral to secondary care – they always correct themselves. • False • Require referral into paediatric optometry • Ask about: • FHx • Parents noted • Bilateral reflexes

  8. Chest • Only cardiac murmurs found after 6/52 need referral. • False • All murmurs (if I can hear them!) should be referred into paeds – particularly if doing neonatal check – when ductus arteriosus (aorta to pulmonary artery) closes baby could collapse. • Refer if there is no murmur but they are symptomatic including cyanosis, breathlessness, not feeding, ‘not quite right’ • 3 main causes : valve problems, narrowing (ie coarctation) holes – PDA/VSD/ASD • Take home points: if it’s loud/diastolic/harsh/sick ADMIT • Routine referral to Consultant of the Week

  9. Absent femoral pulses are diagnostic of Tetralogy of Fallot • False…indicates coarctation of aorta.

  10. Pelvis • Imperforate anus requires urgent referral to paeds and surgical intervention. • True • Remember to ask re bowel habits ie meconium…

  11. Bilateral undescended testes can be monitored until 1yr of age when requires referral to paeds. • False • Could be female baby • Could have CAH and at risk of fits/serious illness and death • If there is one that is present then refer at 1yr if unable to find the other one…routine referral

  12. Hypospadias requires urgent referral to paeds. False Routine referral to paeds Usually seen in combined clinic Surgery is timed to avoid problems with potty training Need to avoid being circumcised prior to repair Case study…

  13. Risk factors for DDH include: • Female gender • Breech • Twin • FHx • Oligohydramnios True All above are risk factors Look at leg creases Requires an USS at 6/52 Routine referral to paeds with results of USS

  14. Spine • Referral is required if cannot see the bottom of a sacral pit True Implication is of spina bifida Look for hair, tone & power of lower limbs Routine OPA

  15. All babies with talipes require a referral to paeds. False Check if positional in neonatal check If still present at 6/52 or not correctable then refer to paediatric physio via paeds

  16. Red Book • Weigh, measure and plot!

  17. Sticky eyes • Chlamydia, gonorrhoea, GBS, staph a and pseudomonas can all cause conjunctivitis in the neonate. True Swab for MC&S and treat with results Admit if unwell - obviously!!!!

  18. Blocked tearducts need to be referred if not resolved by 6 months. False Refer to opthalmology at 1yr if not resolved but most do Affects 1 in 5 babies Can be unilateral/bilateral Do nothing/ massage and keep eye clean

  19. Feeding • Breastfeeding is a piece of cake and anyone can do it straightaway. FALSE!!!! Baby Friendly Initiative implemented Good support from midwives and health visitors

  20. Up to 6/12 of age babies need 100mls/kg/24hrs False They need 150mls/kg but should feed on demand initially • Newborns feed three hourly, • 6/52 feed four hourly, • 6-16/52 reducing down as baby starts to sleep through the night • Some babies cluster feed in the evening

  21. GORD • Nearly all symptomatic reflux will have resolved by 1yr of age True • ? Related to feeding/posture/maturation of sphincter • Frequent small meals • Gaviscon • Mild sx responds to thickener • Carobel, Thick’n’easy, actimelantireflux • Cow’s milk free diet • Nutramigen

  22. Vomiting • Daily vomiting is not common in children at the age of 4/12 False Regurgitation occurs at least once per day: 50% of infants between 0–3months 67% of infants at 4months 5% at 10 to 12 months of age Often caused by rotavirus – will be vaccination soon

  23. Colic • Infantile colic occurs in up to 20% of children? • True • Differential diagnosis: • OM • Strangulated hernia • UTI • Anal fissue • Intussusception • Treat with infacol • Colief if they are lactose intolerant

  24. Oral candidisis • Oral thrush always needs treating in the baby False only treat if mum/baby is symptomatic (ie painful/affecting feeding Treat with nystatin solution for baby and topical miconazole for mum

  25. Breathing problems • 90% of cases of bronchiolitis are caused by respiratory syncytial virus True • Parainfluenza, influenza, rhinovirus, adenoviruses • Recovery lasts for 7-10 days

  26. Whooping cough vaccines need to be given to pregnant women between 28-32wks gestation. True Gives immediate but short-lived immunity to newborn Transmitted by droplets 7-14 day incubation period 5/7 exclusion (nursery) from start of Abx Azithromycin, clarithromycin, erythromycin

  27. Constipation • Red flags include: • From birth/first few weeks • Ribbon stools • No meconium within 48hrs • Locomotor delay/leg weakness • Abdominal distension with vomiting • Abnormal abdo, leg, spinal exam

  28. Faltering growth is an amber flag True Treat constipation Ix for hypothyroidism and coeliac disease Consider maltreatment • Refer urgently

  29. It is important to discuss diet and fluid intake with parents/guardians. True. • Medication steps include: • 1. macrogol • 2. lactulose • 3. senna • Behavioural measures

  30. Skin • Nappy rash can have secondary infection which requires treatment True Treat with antifungal (canestan/timodine) More likely to be fungal if spread to flexures Persists despite tx and hygiene measures/avoidance of detergents then non-urgent referral

  31. Naevus > 2cm need referral to paediatrics True At risk of malignant change Not usually before puberty

  32. Sleeping habits • Newborn babies sleep for 16hrs per day True • At about 8/52 babies should be starting to get used to sleeping in a cot and being put down to sleep whilst they are still awake… • Newborn babies should sleep in their parents bed until they are 1. • Ummm definitely not!!! • Sleep in the same room for first 6 months

  33. Newborn babies should sleep in their parents bed until they are 1. False Sleep in the same room for first 6 months Can lay on front if is being observed from about 8/52

  34. Cot death • 90% occur within the first 6/12 of life True Most occur during the second month then risk gradually reduces • Risk factors include: • Parental smoking • laying baby on front or side to sleep • Male • Prematurity • Low birth weight • Formula feeding

  35. Cot death

  36. Summary • If in doubt call the friendly paeds reg/consultant – better to be safe than sorry.

  37. References • Nice Guidelines: Routine postnatal care of women and their babies 2006 • www.patient.co.uk • Department of Health (2005) Reduce the risk of cot death: an easy guide. London: Department of Health. Available from: www.dh.gov.uk • Nice Guidelines: Constipation in children and young people

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