Common Presentations in Neonates Flashcards by Eilidh Seaton

What is there a close relationship in neonates

Hypothermia
Hypoglycaemia
Hypoxia

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What can affect colour of skin

Jaundice - seen easiest in sclera, then periphery then palms
Pallor
Plethora
Cyanosis

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What is plethora (deep rosy red) associated with

Polycythaemia

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What is pallor associated with

Anaemia

Bleeding
Bone marrow failure
Destruction
DIC
Blood sampling

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When do you not worry about cyanosis

Peripheral

Common in first 24 hours due to vasomotor changes

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What type of rash do you worry about

Petechial (non-blanch)

Papular = fine

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What other rashes do you get

Milia
Milliari
Transient neonatal pustular melanosis
Erythema toxicum 
Sebaceous naves

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What is milia

White papule on tip of nose

Hyperplastic sebaceous glands due to placenta hormone

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What is miliari

Small vesicles and pustules over face / scalp and trunk

Due to immature sweat gland production

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What is transient neonatal pustular melanosis

Pustules that heal with brown macules

Very common

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What do you do if suspect staph infection

Start Ax

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What is erythema toxicum

Maculopapular rash
Common in term babies
Rare in pre-term
Fades 1 week

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What is sebaceous naevus and what do you do

Congenital plaque
Sensitive to androgen
Risk of malignancy into BCC so remove

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What are common birth marks

Capillary haemangioma (Strawberry naevus) 
Melanocytic naevi
Melanocytosis (Mongolian blue spot) 
- Document as can look like bruise 
Giant melanocytes naevus
Port Wine stain (Naevus Flameus) 
Strok Marks (Naevus simplex / salmon)
Cafe au last spots

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What is a capillary haemangioma

Dilated capillaries that appear in 1st month
Red, raised, discrete edge
Regree 1 year
Rx
- Propranol to constrict
- Surgery if close to orbit or for cosmoses

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What are melanocytes naevi

Moles

Round / oval / rough

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What is melancoytosis

Mongolian blue spot

Blue / grey pigment on lower back due to accumulation of melanocyte

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What is giant melanocytic naevus

Large area of dark pigmentation

Often hairy

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What do you do if >1

MRI brain and spine

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What are Naevus Flameus / Port Wine

Port WIne
Present at birth
Flat or slightly raised on face
Dilated capillaries
Do not regress

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What is associate

Struger-Weber

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How do Naevus Simplex present

Light colour capillary dilatation
Back of neck and midline of face
Fades within 1st 2 years

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When do you think of cafe au lait

> 6 or >0.5cm neurofibromatosis

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What is a Ebstein pearl

White nodule on roof of mouth
Midline
Doesn’t interfere
Can look like teeth

What is haemangioma

Eye lid tumor | Treat if vision under threat

What is laryngomalacia - What does it cause - How do you treat

Floppy upper larynx which collapses during inhalation Stridor and feeding problems Worse when supine, feeding, crying Normal cry unlike if unwell will be high pitched Normal sats Resolves without Rx

What is tracheomalacia

Floppy trachea cartilage Stridor worse when crying / cough Improves by 2

What is bronchomalacia - How does it present - How do you treat

``` Weak bronchial cartilage Stridor Wheeze SOB Most likely need CPAP +- tracheostomy ```

What is a tongue tie and how is it treated

Short thick frenulum attached anterior at base of tongue Cause poor feeding No treatment or frenotomy

What causes cleft lip and what does it lead too

Maxillary and medial nasal process fail to merge Leads to opening in top lip which can extend as far as the nose Poor feeding Poor swallowing Poor speech More prone to glue ear, ear infections and hearing problems

What is associated with cleft lip

``` Anti-epileptic use Rubella Smoking Benzo's Trisomy 13,18,15 ```

When do you Rx

Repair early - 3 months

What causes cleft palate

2 palates of skull forming hard palate fail to merge Palatine Nasal septum

When do you repair

6-12 months

What are issues with cleft

``` Poor feeding Poor speach Special bottles but attempt breast Airway issues Associated anomalies - do ECHO / hearing Increased risk of otitis media ```

How does chonal atresia present

If bilateral - soft tissue / bone block | Cyanosis worse when feeding and better when cries

How do you Rx

Surgery | Look for other malformation

What is a cataract and how does it present and what do you do

Lens opacification Absence red reflex No Rx or artificial lens Lead to blindness

What is retinoblastoma and how do you treat

``` Urgent opthmology referral if absent red reflex Rare eye cancer Absent red reflex Laser therapy Chemo Surgery ```

What is common after birth in the eye

Subconjunctival haemorrhage Discharge due to immature ducts Look for conjunctivitis

What are the symptoms of facial palsy

Decreased facial movement and forehead wrinkling on one side and eyelid elevation Flattening of nasolabial fold and corner of mouth Side appearing to droop = normal

What is asymmetric crying facies

Eye and forehead muscles unaffected | Caused by absence of depressor angel oris muscles

What may you see on chest

Prominent xiphersternum as thin skin

What might you see on skin

Blood vessels as thin skin

What might you see on abdomen

Swelling / hernia as muscles not formed if premature

What is a benign dimple

Lower back Present at birth Small and shallow Can see the end

What is a worrying dimple

``` Large >2.5cm Red Swollen Off midlien Tender Fluid Higher than sacral Hairy tuff Abnormal neuro exam ```

What may it suggest

Spina bifida | Kidney issue

What do you do

USS within 6 weeks

If USS abnormal

MRI / MDT

What is cephalohaematoma

Localised swelling over one or both sides of the head Limited by sutures as between periosteum and skull Reaches max 3rd or 4th day May take months to resolve Soft Non-translucent

When does cephalohaematoma form

After birth Traumatic delivery No intracranial bleed Bleeding beneath pericrainium

How do you Rx

No Rx | May prolonged jaundice (intermediate) and cause anaemia

What is caput succadenum

``` Subcutaneous collection of fluid outside the periosteum Collects on the scalp Cross Sutures as above scalp Poorly defined Present at birth ```

What causes

Pressure of presenting part of scalp against cervix or forceps during traumatic labour

How do you Rx

No Rx No complications Resolves within days

What is Sub gleal haemorrhage

``` Above periosteum Very rare but more dangerous Large bleed Can cross suture as above bone Can cause anaemia and jaundice Do CT to distinguish from succadenum ```

What aother haemorrhage

Extradural and intra-cranial

Who gets USS of hips

All breech FH of hip +ve Ortalani or Barlow