The Neonate

Plan for session Size and Gestation Changes at birth Common Neonatal Problems Neonatal Checks

It’s a matter of size … Normal Birth weight –(2.5 kg - 4 kg) Low Birth Weight –(1.5 Kg Kg) Very Low Birth Weight –(1 Kg – 1.5 Kg) ELBW –( < 1 Kg)

Maturity Term Gestation Preterm Post term 37 – 42 weeks < 37 weeks > 42 weeks

First Breath….. Birth process Fluid squeezed from lungs Cord clamped Tactile stimulus Thermal stimulus Hypoxia Increase in systemic BP Breathing established

Problems with breathing What is respiratory distress? –Tachypnoea –Subcostal / intercostal recession –Expiratory grunt –Cyanosis Respiratory Distress Syndrome Wet lung (TTN) Meconium Aspiration Pneumothorax Congenital lung disorders Chronic lung disease

Keeping Pink……. Foetal circulatory changes The duct Congenital heart disease Fetal circulation

Keep me warm….. What determines body temperature? –Heat production vs Heat loss How do neonate loose Heat? –Radiation –Convection –Evaporation –Conduction Who looses too much heat / does not produce enough heat? –Preterm –IUGR –Wet babies –Cold atmosphere –Infection / hypoxia Consequences ? Thermoneutral environment

Fluid,Nutrition and Growth Prevent hypoglycaemia Need 110 – 120 Kcal/kg Fluid balance Loose weight initially up to 10% body weight Regain birth weight by 2 weeks

Jaundice Foetal haemoglobin & rbc turnover Conjugating capacity Entero hepatic circulation Think about –Blood groups –Any bruises –Is the baby well –Gaining weight –Breast fed

The Gut………… Which milk? Necrotising enterocolitis Obstructions –Very high –Quite high –The bottom

Brains………………….. Haemorrhage Peri-ventricular leukomalcia Asphyxia Hydrocephalus Predicting outcome! Follow up

A few syndromes…. Downs syndrome (tri 21) Turners syndrome (XO) Edwards (tri 18) Patau (tri 13) Foetal alcohol

Oh yes the mother and family…. History, history and history Medical history –Diabetes –Pre-eclampsia –Immune Thrombocytopenic Purpura –Myaesthenia gravis –Thyrotoxicosis….. Family history Obstetric history Antenatal and perinatal history Social history

Prematurity Limits of viability Withdrawing life support Wishes of the family Emotions –Anger –Anxiety –Distress –Blame and guilt

NEONATAL CHECKS Helen Chaplin Paeds SpR

Baby checks Head –Eyes –Ears –Mouth –Head –Dysmorphic features Neck Arms, hands Abdo Genitals –Testes Legs, feet Hips General examination Back

Downs Facial Palsy Milia Cataract Conjunctival bleeds Epicanthic folds Cleft palate Pierre Robin Neonatal tooth Tongue Tie Pre-auricular pits / tags Cephalhaematoma Caput Cystic hygroma Sternocleidomastoid tumour

Erbs palsy Single palmar crease Syndactyly Polydactyly Overlapping digits Blue Spots Hydrocele Hypospadias Rocker bottom feet Talipes Congenital dislocation hip Hypotonia Jaundice Erythema toxicum Spinal abnormalities

Hips

Barlow’s (= Back)

Ortolani’s (= Out)