Common Neonatal Problems and Parental Concerns

Question 1

What is irritant diaper dermatitis?

Answer 1

“Ammoniacal dermatitis” Maceration of skin 2° to prolonged exposure to urine and stool
- skin creases usually spared

Question 2

How is irritant diaper and fungal dermatitis differentiated?

Answer 2

Sparing of groin crease: Irritant diaper dermatitis

Satellite lesions (sites of rash adjacent to main rash): Fungal

• but both often co-exist

Question 3

What is fungal dermatitis?

Answer 3

Fungal infection usually involving moist areas
- confluent, scaly, erythematous plaques
- usually have satellite lesions (sites of rash adjacent to main rash)
- may coexist with irritant dermatitis

Question 4

What is Seborrheic Dermatitis “Cradle cap”?

Answer 4

Greasy yellow scales on erythematous base (±pruritis)
- usually 1-2mths-1year on face and scalp
- fissures may develop and get infected

Question 5

How is Seborrheic dermatitis treated?

Answer 5

1) Olive oil on scalp to soften crust then wash after 1 hr

2) 1% Hydrocortisone cream sparingly

Question 6

What is an infantile hemangioma?

Answer 6

Blanchable macule
- 1-2mths till 3-5 years
- self-limiting/involute without treatment (UNLESS in dangerous areas eg. eyes, nose)
- more common in preterm babies

Question 7

What are 2 common causes of neonatal eye discharge?

Answer 7

1) Nasolacrimal duct blockage
- persistent discharge
- treat with Crigler’s massage

2) Conjunctivitis

Question 8

What are 4 common causes of conjunctivitis in a neonate and how are they treated?

Answer 8

1) Bacterial: SA, S. viridans, E.coli
- topic ABs

2) Chlamydia (>3wks; ±pneumonia)
- oral erythromycin

3) Gonococcal (severe, 1st week, blindness)
- IV ceftriaxone

4) HSV (severe)
- IV acyclovir

Question 9

How can dangerous infantile haemangiomas be treated?

Answer 9

Medical therapy
1) ß-blockers (propanolol, timolol)
2) Topical steroids

Surgical resection

Question 10

What is torticollis?

Answer 10

Face turns away from affected side, tight SCM
- PT for passive stretching or release surgery if persistent
- usually diagnosed at 1-2 mths

Question 11

What are 5 red flags in infrequent bowel movements in a neonate?

Answer 11

1) Irritable
2) Vomiting
3) Bilious vomitting
4) Abdominal distension
5) Failure to thrive

Question 12

What are 8 red flags for a vomiting neonate?

Answer 12

1) Bilious vomiting
2) Blood in stools or vomitus
3) Projectile vomiting
4) Abdominal distension or tenderness
5) Failure to thrive
6) Suspected metabolic disorder
7) Occult infection: UTI
8) Presence of abnormal neurological signs

Question 13

How do you differentiate between milk curds and oral candidiasis?

Answer 13

Uniform and coating: milk residue

Non-painful and no effect on feeding: milk residue

On cheeks and lips: candidiasis

Question 14

True or false: Vaginal discharge, bleeding and breast swelling in a 7day old are all indications for further evaluation and treatment.

Answer 14

False: all physiological due to transfer of maternal hormones

Question 15

How would you differentiate constipation from physiological infrequent bowel movements in a neonate?

Answer 15

Stools have to be well-formed for it to be constipation.

Question 16

True or false: A congenital umbilical hernia is not a cause for concern or further investigation.

Answer 16

True: usually self-limiting unless signs of strangulation