The Neonate

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The Neonate
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Plan for session

• Size and Gestation
• Changes at birth
• Common Neonatal Problems
• Neonatal Checks

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Its a matter of size

• 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
• ( lt 1 Kg)

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Maturity

• Term Gestation
• Preterm
• Post term

• 37 42 weeks
• lt 37 weeks
• gt 42 weeks

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

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Keeping Pink.
Fetal circulation

• Foetal circulatory changes
• The duct
• Congenital heart disease

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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

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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

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Jaundice

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

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The Gut

• Which milk?
• Necrotising enterocolitis
• Obstructions
• Very high
• Quite high
• The bottom

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Brains..

• Haemorrhage
• Peri-ventricular leukomalcia
• Asphyxia
• Hydrocephalus
• Predicting outcome!
• Follow up

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A few syndromes.

• Downs syndrome (tri 21)
• Turners syndrome (XO)
• Edwards (tri 18)
• Patau (tri 13)
• Foetal alcohol

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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

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Prematurity

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

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NEONATAL CHECKS

• Helen Chaplin
• Paeds SpR

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Baby checks

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

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• 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

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• 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

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Hips
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Barlows ( Back)
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Ortolanis ( Out)