The Neonate

1. The Neonate

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

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

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

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

6. 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

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

9. 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

10. 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

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

12. The Gut………… • Which milk? • Necrotising enterocolitis • Obstructions • Very high • Quite high • The bottom

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

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

15. 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

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

17. NEONATAL CHECKS Helen Chaplin Paeds SpR

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

19. 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

20. 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

21. Hips

22. Barlow’s (= Back)

23. Ortolani’s (= Out)