common neonatal medical problems *

When should majority of meconium be passed?

By 48 hours of life

What is the cause of delay in passage of meconium?

1. Meconium plug syndrome > abnormal consistency, dysmotility

2. Hirschsprung disease > failure of neural crest cells to migrate completely

3. Gastrointestinal malformation > intestinal stenosis, atresia, malrotation

How to investigate a meconium ileus?

Plain abdominal radiograph

How to investigate a hirschrpung disease?

Contrast enema and/ manometry

How to investigate an intestinal obstruction?

Plain abdominal X-ray > double bubble sign & dilated loops of bowel with air fluid levels

How to investigate a malrotation?

Plain abdominal radiograph using barium enema

What is the management of malrotation?

Ladd’s procedure

What is the management of Hirschsprung?

Resect the affected segment of the rectum and colon

What is the management of meconium ileus? (2)

Non-operative > administration of hyperosmolar enema

Operative > MI not clearing with medical care

What is the management of meconium plug?

Contrast enema

When do majority of neonates pass urine?

24 hours

Define anuria

Absence of urine output by 48 hours of age

How may you investigate the causes of delayed urine? (3)

1. Renal anomalies > agenesis, renal dysplasia, polycystic kidneys

2. Oligohydramnios > decreased renal perfusion, obstructive uropathy

   1. Maternal medications like ACE inhibitors & NSAIDS

Define omphalitis

Infection of the umbilicus and surrounding tissues causes by polymicrobial infection

What are the risk factors for omphalitis? (5)

1. Lowe birth weight

2. Prolonged rupture of membranes

3. Nonsterile delivery

4. Umbilical catheterization

5. Improper cord care

What are the clinical features of omphalitis? (3)

1. Purulent discharge from stump

2. Erythema, tenderness

3. Lethargy, fever, irritability, poor feeding

What are in the investigations to diagnose omphalitis? (2)

1. Culture from discharge

2. Blood & CSF culture

What is the treatment of omphalitis? (2)

Penicillin & aminoglycosides (10-day course)

What are the complications of omphalitis?(5)

1. Sepsis

2. Portal vein thrombosis

3. Liver abscess

4. Peritonitis

5. Necrotising fasciitis

Define umbilical granuloma

Granulomatous (moist, pink) tissue that persists at the base of the umbilical after cord separation

What is the management of an umbilical granuloma?(2)

75% silver nitrate 1 or 2 times per week for several weeks

Ligation / reaction if silver nitrate fails

Define nappy dermatitis

Convex skin surfaces in direct contact with the diaper sparing the skin folds (buttocks, lower abdomen, genitalia, upper thighs)

What does nappy dermatitis exacerbate? (2)

Seborrheic dermatitis

Atopic dermatitis

What are the risk factors for nappy dermatitis?(3)

1. Infrequent diaper changes

2. Diarrhoea

3. Dietary (formula fed)

   
   

If the nappy dermatitis persistent for more than 3 days despite standard treatment, what could it mean?

Secondary infection > C.albicans, A. Aureus, S pyogenes