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Disorders of the Neonate

Disorders of the Neonate. Grace Singleton. Objectives. Neonatal Jaundice The “Baby Check” Problems of Prematurity: Immediate Developmental. Neonatal Jaundice. 50-60% affected in 1 st week Aetiology. Jaundice Treatment. General Avoid Dehydration

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Disorders of the Neonate

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  1. Disorders of the Neonate Grace Singleton

  2. Objectives • Neonatal Jaundice • The “Baby Check” • Problems of Prematurity: • Immediate • Developmental

  3. Neonatal Jaundice • 50-60% affected in 1st week • Aetiology

  4. Jaundice Treatment • General • Avoid Dehydration • Avoid drugs that will displace bilirubin from albumin • Phototherapy (450nm) • Converts unconjugated bilirubin to harmless water-soluble pigment • Exchange Transfusion

  5. Bilirubin toxicity (Kernicterus) • Symptoms • Lethargy, poor feeding, irritability, ↑ muscle tone • Pathophysiology • Level of unconjugated bilirubin exceeds binding capacity of albumin; free bilirubin cross BBB • Complications • Cerebral Palsy, LD, Sensorineural deafness

  6. The “Baby Check” • Why? • Identify congenital abnormalities • Check for problems arising from maternal/familial disease • Ask questions, relieve concerns • What? • Clinical Examination • Guthrie Test • Hearing Test

  7. Clinical Examination

  8. Guthrie Test • Day 5-9, heel prick test • Cystic fibrosis • Phenylketonuria • Hypothyroidism • Sickle Cell (&Thalassemia) • MCAD deficiency

  9. Problems of Prematurity • General;Infection, Inability to maintain body heat • CV;PDA, Anaemia • Respiratory;Immature Lung (e.g. Respiratory Distress Syndrome) • GI; Jaundice, NEC, Immature GI tract • Neurological; Intraventricular Haemorrhage, ROP

  10. Respiratory Distress Syndrome • Signs • Tachypnoea • Nasal flaring • Subcostal and intercostal recession • Expiratory Grunting • Tachycardia • Cyanosis

  11. Respiratory Distress Syndrome • Investigations • Chest X-Ray; Ground Glass, broncograms and obliteration of heart boarder • Oxygenation (continuous monitoring) • Blood gas • ECG

  12. Respiratory Distress Syndrome • Treatment • Antenatal steroids • Neonatal resuscitation team • Oxygen (warm/humidified) • CPAP/Intubation with ET • Exogenous surfactant replacement • Supportive Care

  13. Developmental Problems of Prematurity

  14. Corrected Age • Chronological vs. corrected age • Chronological age: 24 weeks • Number of weeks premature: 11 • Corrected age: 24 – 11 = 13 weeks • Developmental age: 3 months • Premature infants catch up developmentally by 2 – 3 years of age

  15. Developmental Milestones Revision Guide: Paediatrics. Glasgow University (Downloaded from vale)

  16. Developmental Milestones

  17. Thank You! Questions?

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