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Neonatology BY: HUSNAA KHAN F1 DOCTOR, LEICESTER.TOPICS to be covered:  Neonatal baby check and resuscitation  Birth injuries  Neonatal Screening  Neonatal respiratory diseases  Neonatal JaundiceSystematic approach (Head to Toe examination) 1) General appearance: - Colour (pink is good) - Tone - Cry 2) Head: General appearance: size, shape, dysmorphology, caput succedaneum, cephalohaematoma Anterior and posterior fontanelles Sutures: Ears Eyes Mouth 3) Shoulders and Arms- Shoulder symmetry, Arm movements, Brachial pulses, Radial pulses, Palmar creases: 4) Chest - Oxygen saturations, observe breathing, Heart sounds, Breath sounds: 5) Abdomen - Observe the shape, Umbilical stump, Palpate, 6) Genitals - observe, palpate the testes and scrotum, inspect the penis inspect the anus ask about meconium 7) Legs - Observe the legs and hips , Barlows and Ortolani manoeuvres, Count the toes 8) Inspect the back 9) Reflexes Moro reflex: when rapidly tipped backwards the arms and legs will extend Suckling reflex: placing a finger in the mouth will prompt them to suck Rooting reflex: tickling the cheek will cause them to turn towards the stimulus Grasp reflex: placing a finger in the palm will cause them to grasp Stepping reflex: when held upright and the feet touch a surface they will make a stepping motionBirth injuriesNeonatal Blood Spot testingNeonatal respiratory diseases  1) RDS – respiratory distress syndrome  2) TT – transient tachypnoea of the newbornRespiratory Distress Syndrome  AETIOLOGY: Surfactant defiency due to premature birth  Predisposing factors: ✓ gender B>G ✓ C sections ✓ Hypoxia ✓ Maternal diabetes  Imaging: XR – ground glass appearance  PreventionAntenatal steroids (i.e. dexamethasone) given to mothers with reduces the incidence and severity of respiratory distress syndrome in the baby.  TREATMENT: steroids, oxygen and CPAPTransient Tachypnoea of the Newborn  AETIOLOGY: Delayed clearing of lung fluid, seen predominantly in C-section babies  Signs & Symptoms: Tachypnoea, overinflated chest, settles in 24-48 hours  XRAY: fluid in the horizontal fissure, ‘wet lung’  Usually resolves on its own, supportive care  *IMP* to differentiate between TT and cardiac failure and if necessary do a septic screen.  TREATMENT: preventionNeonatal Jaundice  Pathophysiology of jaundice  Conjugated vs Unconjugated bilirubin  Conditions associated with these  Complications Prolonged Jaundice Jaundice is “prolonged” when it lasts longer than would be expected in physiological jaundice. This is: • More than 14 days in full term babies • More than 21 days in premature babies  Remember Jaundice: 1) Pre Hepatic: excess breakdown of RBCs 2) Hepatic: conjugation issues 3) Post Hepatic: Obstruction to bile flow  Investigations: 1) LFTS unconjugated bilirubin – indirect bilirubin 2) Conjugated bilirubin – direct bilirubin 3) Total bilirubin – direct and indirectUnconjugated bilirubinamia  Physiological jaundice > 24 hours Immaturity of the hepatic conjugated system High Hb at birth and dehydration Conjugated component <25, low Usually diagnosis of exclusion  Breast milk jaundice Increased risk > 24 hours May persist 2-3 weeks conjugated component is very lowUnconjugated bilirubinamia (PATHOLOGICAL < 24 hours)  SEPSIS AND DIC Signs of poor feeding, lethargy, tachypnoea, hypotension and shock Urgent sepsis screen warranted Maternal hx of GBS  Hemolysis Rhesus and ABO incompatibility Fetal anaemia – increased red cell breakdown Hydrops fetalis – severe anaemia, high output cardiac failure, effusion and ascitesCONJUGATED BILIRUBINAEMIA  Typical presentation: Pale stools and dark urine  Bilirary atresia Prolonged jaundice > 14 days Poor appetite and growth Total bilirubin is normal, conjugated bilirubin is abnormally high IGX: bloods, LFTS, blood cultures, lactate Scans: USS of biliary tree and liver TXT: kasai procedure/ hepatoportoenterostomyTreating neonatal jaundice  1) Phototherapy  2) Exchange transfusion  Jaundice in the first 24 hours of life is pathological. This needs urgent Take home investigations and management. Neonatal sepsis is a common cause. Babies with message for jaundice within 24 hours of birth need treatment for sepsis if they have any other jaundice! clinical features or risk factors.Thank you Husnaa.khan@nhs.net