The Neonatal Period

Be able to define the neonatal period Know how and when jaundice can present and when to initiate treatment Be able to recognise gastro-oesophageal reflux and how to advise parents Be able to answer MCQs and clinical image questions Learning Outcomes

For term infants the neonatal period lasts from birth until 28 days of age For pre-term infants the neonatal period extends from birth to 44 post-menstrual weeks of age Neonatal Definitions

Pre-term = born before 37 completed weeks of gestation, accounting for 10% of births Term = born between 37 and 42 completed weeks of gestation Post-term = born >42 completed weeks of gestation, accounting for less than 5% of births Neonatal Definitions

Neonatal Jaundice

Yellow discoloration of sclera and skin Due to accumulation of bilirubin May indicate serious underlying disease Neonatal Jaundice

Physiological jaundice: – Presents at 2-3 days of age – In an otherwise healthy infant – Often associated with difficulty establishing feeds – Usually resolves within 2 weeks Neonatal Jaundice

Early jaundice: – Within 24 hours of birth – Always pathological Prolonged jaundice: – Lasts >14 days in term/>21 days in pre-term infants – Most common cause is breast milk jaundice Conjugated jaundice: – Usually due to neonatal liver disease Neonatal Jaundice

Investigation varies depending on: – Age at presentation – Duration of symptoms Investigations may include: – Bilirubin (conjugated/unconjugated/total) – FBC, blood group and DCT – U+Es Neonatal Jaundice

Management involves; – Treatment of the underlying cause – Correction of hyperbilirubinaemia Phototherapy Exchange transfusion Untreated jaundice may lead to kernicterus Neonatal Jaundice

Gastro-oesophageal Reflux

Non-forceful regurgitation of gastric contents into the oesophagus Occurs due to incompetence of gastro- oesophageal sphincter If persistent may result in gastro-oesophageal reflux disease Gastro-oesophageal Reflux

Presenting signs & symptoms include: – Non-forceful regurgitation – Irritability – Resistance and arching with feeding – Failure to thrive – Apnoeas – Cough and stridor Gastro-oesophageal Reflux

Diagnosis is clinical Potential investigations: – FBC – 24 hour oesophageal pH study – Manometry – Barium meal – Endoscopy Gastro-oesophageal Reflux

Management: – Conservative Reassurance, not overfeeding and upright positioning – Medical Thickeners, anti-regurgitation formula, gaviscon H2 receptor antagonists, proton pump inhibitors – Surgical Gastro-oesophageal Reflux

Practice Questions

30 seconds to 1 minute per mark Based on general neonatal topics 6 multiple choice questions 2 extended matching questions 3 clinical images Questions

1.Which of the following is a cause of early jaundice? a. Physiologicalb. Rubella c. Breast milkd. Biliary atresia 2.Which of the following is not a risk factor for gastro-oesophageal reflux? a. Obesityb. Cow’s milk allergy c. Pneumoniad. Prematurity Questions: MCQs

3.Which of the following is most likely to result in ‘small for gestational age’ infants? a. Maternal diabetesb. Large parents c. Maternal alcoholismd. Hydrops fetalis 4.Which of the following is a common cause of PR bleeding in the neonate? a. D & Vb. Cows milk protein allergy c. CFd. Hirschsprung’s disease Questions: MCQs

5.Which of the following is a risk factor for neonatal jaundice? a. Prematurityb. Bottle feeding c. Female genderd. GORD 6.Which is not a benefit of breastfeeding? a.  bondingb.  feed frequency c.  GI infectionsd.  autoimmune disease Questions: MCQs

a. Physiologicalb. Breast milk c. Sepsisd. G6PD deficiency e. Biliary atresiaf. Cephalohaematoma 1.A term infant presents at 16 hours of age with jaundice. The blood film shows Heinz bodies. 2.A term infant presents at day 3 of life with 15% weight loss, jaundice and chalk coloured stools. Questions: EMQ 1

a. Physiologicalb. Breast milk c. Sepsisd. G6PD deficiency e. Biliary atresiaf. Cephalohaematoma 3.A term infant presents at day 3 of life with jaundice. He is otherwise well. 4.A term infant presents at 3 hours of age with jaundice, decreased GCS and seizures. Questions: EMQ 1

a. Tracheosophageal fisula b. UTI c. Gastro-oesoph refluxd. Pyloric stenosis e. Possettingf. GORD 1.A 3 week old infant presents with decreased feeding, vomiting and fever for 3 days. Examination unremarkable. 2.A 3 month old presents with FTT, arching to feeds and an irritable cry for the last month. Questions: EMQ 2

a. Tracheosophageal fisula b. UTI c. Gastro-oesoph refluxd. Pyloric stenosis e. Possettingf. GORD 3.A 3 month old presents following a life threatening event. His mum reports vomiting after feeds for the last 6 weeks. Gaining weight. 4.A mum complains that her 3 day old ‘bubbles’ milk after feeding. She feeds well and is gaining weight. Questions: EMQ 2

Questions: Image 1 The following test is performed during the post-natal baby check. a. What is the test is shown in B? b. What condition is it used to screen for? A B

Questions: Image 2 a. What’s the diagnosis?

Questions: Image 3 a. What’s the diagnosis?

1.Which of the following is a cause of early jaundice? a. Physiologicalb. Rubella c. Breast milkd. Biliary atresia 2.Which of the following is not a risk factor for gastro-oesophageal reflux? a. Obesityb. Cow’s milk allergy c. Pneumoniad. Prematurity Answers: MCQs

3.Which of the following may result in small for gestational age infants? a. Maternal diabetesb. Large parents c. Maternal alcoholismd. Hydrops fetalis 4.Which of the following is a common cause of PR bleeding in the neonate? a. D & Vb. Cows milk protein allergy c. CFd. Hirschsprung’s disease Answers: MCQs

5.Which of the following is a risk factor for neonatal jaundice? a. Prematurityb. Bottle feeding c. Female genderd. GORD 6.Which is not a benefit of breastfeeding? a.  bondingb.  feed frequency c.  GI infectionsd.  autoimmune disease Answers: MCQs

a. Physiologicalb. Breast milk c. Sepsisd. G6PD deficiency e. Biliary atresiaf. Cephalohaematoma 1.A term infant presents at 16 hours of age with jaundice. The blood film shows Heinz bodies. 2.A term infant presents at day 3 of life with 15% weight loss, jaundice and chalk coloured stools. Answers: EMQ 1

a. Physiologicalb. Breast milk c. Sepsisd. G6PD deficiency e. Biliary atresiaf. Cephalohaematoma 1.A term infant presents at 16 hours of age with jaundice. The blood film shows Heinz bodies. 2.A term infant presents at day 3 of life with 15% weight loss, jaundice and chalk coloured stools. Answers: EMQ 1

a. Physiologicalb. Breast milk c. Sepsisd. G6PD deficiency e. Biliary atresiaf. Cephalohaematoma 3.A term infant presents at day 3 of life with jaundice. He is otherwise well. 4.A term infant presents at 3 hours of age with jaundice, decreased GCS and seizures. Answers: EMQ 1

a. Physiologicalb. Breast milk c. Sepsisd. G6PD deficiency e. Biliary atresiaf. Cephalohaematoma 3.A term infant presents at day 3 of life with jaundice. He is otherwise well. 4.A term infant presents at 3 hours of age with jaundice, decreased GCS and seizures. Answers: EMQ 1

a. Tracheosophageal fisula b. UTI c. Gastro-oesoph refluxd. Pyloric stenosis e. Possettingf. GORD 1.A 3 week old infant presents with decreased feeding, vomiting and fever for 3 days. Examination unremarkable. 2.A 3 month old presents with FTT, arching to feeds and an irritable cry for the last month. Answers: EMQ 2

a. Tracheosophageal fisula b. UTI c. Gastro-oesoph refluxd. Pyloric stenosis e. Possettingf. GORD 1.A 3 week old infant presents with decreased feeding, vomiting and fever for 3 days. Examination unremarkable. 2.A 3 month old presents with FTT, arching to feeds and an irritable cry for the last month. Answers: EMQ 2

a. Tracheosophageal fisula b. UTI c. Gastro-oesoph refluxd. Pyloric stenosis e. Possettingf. GORD 3.A 3 month old presents following a life threatening event. His mum reports vomiting after feeds for the last 6 weeks. Gaining weight. 4.A mum complains that her 3 day old ‘bubbles’ milk after feeding. She feeds well and is gaining weight. Answers: EMQ 2

a. Tracheosophageal fisula b. UTI c. Gastro-oesoph refluxd. Pyloric stenosis e. Possettingf. GORD 3.A 3 month old presents following a life threatening event. His mum reports vomiting and choking after feeds for the last 6 weeks. Gaining weight. 4.A mum complains that her 3 day old ‘bubbles’ milk after feeding. She feeds well and is gaining weight. Answers: EMQ 2

Answers: Image 1 The following test is performed during the post- natal baby check. a. What is the test is shown in B? Ortolani’s test b. What condition is it used to screen for? Developmental dysplasia of the hip A B

Answers: Image 2 a.What’s the diagnosis? Myelomeningocele

Answers: Image 3 a. What’s the diagnosis? Infantile seborrhoeic dermatitis a.k.a. Cradle cap

Neonatal jaundice is common Common causes include physiological jaundice and breast milk jaundice Jaundice in the first 24 hours is always pathological Treatment may be conservative, phototherapy or exchange transfusion Untreated may lead to disability and death Prognosis in the developed world is excellent Key Facts: Neonatal Jaundice

Non-forceful regurgitation after feeds Presents between 1-4 months of age If persistent may lead to GORD Management is usually conservative Usually resolves by months Key Facts: Reflux

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