Newborn Lecture

Newborn Lecture need to know things about the mother age maternal problems in pregnancy illness, infections, immunisation, smoking, alcohol and drugs in general inspection colour CANNOT TELL UNLESS WE DO A PULSE OXIMTERY dysmorphism resp distress growth when checking for growth parameters -> account for prematurity as may deem the child as small for prematurity behaviour febrile or afebrile milia sebaceous oil very common will go away stalk marks skin tags tie them off with black silk to make sure that there is no cartilage in them go away strawberry naevus most go away beta blockers help make them go away café et laute worrying if there is more than 3 would go looking for TSC -> fibrous lumps -> we get them in the heart, lungs and brain hence do ultrasound early on -> as soon as suspected or see more than 3 Mongolian spots Suprapubic aspiration do we do it at 45 degrees and point down or do we do it at 90? Conjugate we allow upto 20 mmol/L and a 20% fraction To do a kasai procedure the child has to be less than 2 We want them to be less than 60 days before there is too much accumulation of bilirubin and would have cause cirrhosis (within 2 to 3 months) Cataracts are the most common cause leukocoria Absence of a red reflex But the most concerning diagnosis that we must rule out is retinoblastoma This is because it has a high malignancy potential DO NOT BIOPSY BECAUSE IT CAN SPREAD Bell’s palsy Facial nerve against mum’s bone -> but this does not convince whitehall Usually self resolves. Ears begin around the neck Cleft between 1 and 2 is what forms the ears When the baby is being delivered, there is intense force form te mum on the baby’s neck -> causes tearing of the SCM 15% of the population has only one palmar crease Having tight clenched with grasped reflex is very abnormal -> that is strongly indicative of Down syndrome Heaves felt for in RVH -> for example in pulmonary stenosis TTN is not a simple matter Can be a very significant thing Resp distress TTN HMD Give surfactant to reduce electrostatic forces CXR: ground glass appearance Pierre Robin Sequence Hypothermia Oesophageal tracho -atresia 3Cs – chocking, cyanosis and coughing -> tracheoesophageal fistula If cannot get NGT down -> oesophageal atresia WE DO NOT USE BARIUM -> AS THAT CAN GET INTO THE LUNGS In CXR Once you find one abnormality, look for others Diastasis recti Separation of the recti muscles They are mobile Usually self resolves If the there is erythema of the umbilical cord this indicates infection UNLESS THE CORD IS DRY If there is no meconium within 24 hours, we go look for an imperforate anus Anal atresia Myelomeninicocele Paraplegic Autonomic system involved Difficulty passing urine -> urinary retention -> goes to the kidney Difficulty passing stools -> bowel obstruction and perforation Rise in CSF pressure – hydrocephalus -> brain swelling Examine the sacral area for dimples or sinus For any “funny” thing in this area get an U/S and an opinion from someone more senior or more specialised. Hip displacement X ray not a good way to look at it? U/S are a better way? Genitourinary Questions that one should ask: From where does the urine come? Does it come from the end of the penis? Are the testes down? -> IMPORTANT AS THEY MAY NOT HAVE IT May be the inter-sex stuff -> may be initially thought that it is a boy but in reality it is a girl. Female genitila There may be some hyperpigmentation FISH studies Looks for genetic conditions Turner syndrome DiGeorge syndrome Prader Willi/ Angelman syndromes Sex chromosome abnormalities How it works: Sample of baby’s blood is taken