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 - 2.5 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 processBirth processFluid squeezed from Fluid squeezed from

lungslungsCord clampedCord clamped

Tactile stimulusThermal stimulus

HypoxiaIncrease 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)