Newborn Surprises 1

1. Newborn Surprises 1 Garth Asay, MD Chair, Division of Neonatal Medicine Mayo Clinic

2. Surprise • A completely unexpected occurrence or appearance

10. Newborn Surprises The Delivery Room

11. I wasn’t really supposed to be on call that night..... I was simply covering for a few hours until my colleague returned from an out-of-town meeting.

12. He said…. • “Don’t worry, I’ve got coverage for everything.” • “You will only get paged if there’s an unexpected problem with a newborn.”

13. There was a full moon that night.

14. A black cat crossed my path on my way to the hospital…

15. As I walked in the door, I received an emergency page to come to the birthing room.

16. Upon my arrival…

18. I’ve got to think fast… This baby has... 1 = an abdominal wall defect 2 = an omphalocele 3 = a gastroschisis 4 = cloacal exstrophy 5 = Ganser syndrome

19. I’ve got to think fast… This baby has... 1 = an abdominal wall defect 2 = an omphalocele 3 = a gastroschisis 4 = cloacal exstrophy 5 = Ganser syndrome

20. GastroschisisHở thành bụng • 4 per 10,000 live births • Umbilical cord intact • Rarely associated with other anomalies • Surgical correction • Survival rate is > 90%

21. The FIRST thing I must do is…. 1 = rush this baby to surgery 2 = pass an orogastric tube 3 = wrap the bowel with warm, sterile saline dressings 4 = start a peripheral IV

22. The FIRST thing I must do is…. 1 = rush this baby to surgery 2 = pass an orogastric tube 3 = wrap the bowel with warm, sterile saline dressings 4 = start a peripheral IV

23. I will also need to... 1 = monitor respirations 2 = wrap the bowel with warm, sterile saline dressings 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

24. I will also need to... 1 = monitor respirations 2 = wrap the bowel with warm, sterile saline dressings 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

25. Immediate surgical repair is possible…

26. But the postoperative course may be difficult…

27. Use of a silo for gastroschisis repair

28. Gastroschisis vs Omphalocele • We know we have been dealing with gastroschisis, because an omphalocele has intestines covered within a sac. • An omphalocele looks more like...

29. OmphaloceleThóat vị rốn

30. Omphalocele • 2 per 10,000 live births • Umbilical cord extends from the sac • 50 – 75% association with other anomalies • Trisomy 13, 18, 21 • Survival rate variable • Depends on underlying conditions

31. Treatment • Surgical repair • “Paint and wait”

32. “Paint and Wait”

33. “Paint and Wait”

34. “Paint and Wait”

35. “Paint and Wait”

36. “Paint and Wait”

37. BONUS Question!!!!! • A baby is born with • an omphalocele • macrosomia • a large tongue • What laboratory test should we be ordering at this point?

38. Blood glucose level

39. Beckwith-Weidemann

40. On to more cases….

41. Later that night, the nurse calls me about a newborn infant... • “....he coughed and spit up his first feeding ?” • “He has lots of secretions coming from his mouth?” • “I’ll be right over.”

42. What should I be thinking? • Is there an obstruction?

43. OK, lets get a chest and abdominal X-ray …and pass an orogastric tube first

45. This baby has... 1 = necrotizing enterocolitis 2 = a double-bubble sign 3 = a tracheo-esophageal fistula with esophageal atresia 4 = jejunal atresia 5 = pneumothorax

46. This baby has... 1 = necrotizing enterocolitis 2 = a double-bubble sign 3 = a tracheo-esophageal fistula with esophageal atresia 4 = jejunal atresia 5 = pneumothorax

47. What to do next? 1 = do a careful exam looking for other anomalies 2 = Use continuous suction to the “pouch” 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

48. What to do next? 1 = do a careful exam looking for other anomalies 2 = Use continuous suction to the “pouch” 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

50. VACTERL Association • Vertebral anomalies (70%) • Anal atresia (80%) • Cardiac (50%) • TracheoEsophageal fistula (70%) • Renal anomaly (50%) • Limb dysplasia (65%)