the neonatal period. be able to define the neonatal period know how and when jaundice can present...

The Neonatal Period

• Be able to define the neonatal period

• Know how and when jaundice can present and when to initiate treatment

• Be able to recognise gastro-oesophageal reflux and how to advise parents

• Be able to answer MCQs and clinical image questions

Learning Outcomes

• For term infants the neonatal period lasts from birth until 28 days of age

• For pre-term infants the neonatal period extends from birth to 44 post-menstrual weeks of age

Neonatal Definitions

Pre-term = born before 37 completed weeks of gestation, accounting for 10% of births

Term = born between 37 and 42 completed weeks of gestation

Post-term = born >42 completed weeks of gestation, accounting for less than 5% of births

Neonatal Definitions

Neonatal Jaundice

• Yellow discoloration of sclera and skin

• Due to accumulation of bilirubin

• May indicate serious underlying disease

Neonatal Jaundice

• Physiological jaundice:

– Presents at 2-3 days of age

– In an otherwise healthy infant

– Often associated with difficulty establishing feeds

– Usually resolves within 2 weeks

Neonatal Jaundice

• Early jaundice: – Within 24 hours of birth– Always pathological

• Prolonged jaundice:– Lasts >14 days in term/>21 days in pre-term infants– Most common cause is breast milk jaundice

• Conjugated jaundice:– Usually due to neonatal liver disease

Neonatal Jaundice

• Investigation varies depending on:– Age at presentation– Duration of symptoms

• Investigations may include:– Bilirubin (conjugated/unconjugated/total)– FBC, blood group and DCT– U+Es

Neonatal Jaundice

• Management involves;– Treatment of the underlying cause– Correction of hyperbilirubinaemia• Phototherapy• Exchange transfusion

• Untreated jaundice may lead to kernicterus

Neonatal Jaundice

Gastro-oesophageal Reflux

• Non-forceful regurgitation of gastric contents into the oesophagus

• Occurs due to incompetence of gastro-oesophageal sphincter

• If persistent may result in gastro-oesophageal reflux disease


• Presenting signs & symptoms include:– Non-forceful regurgitation– Irritability– Resistance and arching with feeding– Failure to thrive– Apnoeas– Cough and stridor


• Diagnosis is clinical

• Potential investigations:– FBC– 24 hour oesophageal pH study– Manometry– Barium meal– Endoscopy


• Management:– Conservative• Reassurance, not overfeeding and upright positioning

– Medical• Thickeners, anti-regurgitation formula, gaviscon• H2 receptor antagonists, proton pump inhibitors

– Surgical


Practice Questions

• 30 seconds to 1 minute per mark

• Based on general neonatal topics

• 6 multiple choice questions

• 2 extended matching questions

• 3 clinical images

Questions

1. Which of the following is a cause of early jaundice?a. Physiological b. Rubellac. Breast milk d. Biliary atresia

2. Which of the following is not a risk factor for gastro-oesophageal reflux?a. Obesity b. Cow’s milk allergyc. Pneumonia d. Prematurity

Questions: MCQs

3. Which of the following is most likely to result in ‘small for gestational age’ infants?a. Maternal diabetes b. Large parentsc. Maternal alcoholism d. Hydrops fetalis

4. Which of the following is a common cause of PR bleeding in the neonate?a. D & V b. Cows milk protein allergyc. CF d. Hirschsprung’s disease

Questions: MCQs

5. Which of the following is a risk factor for neonatal jaundice?a. Prematurity b. Bottle feedingc. Female gender d. GORD

6. Which is not a benefit of breastfeeding?a. bonding b. feed frequencyc. GI infections d. autoimmune disease

Questions: MCQs

a. Physiological b. Breast milkc. Sepsis d. G6PD deficiencye. Biliary atresia f. Cephalohaematoma

1. A term infant presents at 16 hours of age with jaundice. The blood film shows Heinz bodies.

2. A term infant presents at day 3 of life with 15% weight loss, jaundice and chalk coloured stools.

Questions: EMQ 1


3. A term infant presents at day 3 of life with jaundice. He is otherwise well.

4. A term infant presents at 3 hours of age with jaundice, decreased GCS and seizures.

Questions: EMQ 1

a. Tracheosophageal fisula b. UTIc. Gastro-oesoph reflux d. Pyloric stenosise. Possetting f. GORD

1. A 3 week old infant presents with decreased feeding, vomiting and fever for 3 days. Examination unremarkable.

2. A 3 month old presents with FTT, arching to feeds and an irritable cry for the last month.

Questions: EMQ 2


3. A 3 month old presents following a life threatening event. His mum reports vomiting after feeds for the last 6 weeks. Gaining weight.

4. A mum complains that her 3 day old ‘bubbles’ milk after feeding. She feeds well and is gaining weight.

Questions: EMQ 2

Questions: Image 1

The following test is performed during the post-natal baby check.

a. What is the test is shown in B?

b. What condition is it used to screen for?

A

B

Questions: Image 2

a. What’s the diagnosis?

Questions: Image 3

a. What’s the diagnosis?

1. Which of the following is a cause of early jaundice?a. Physiological b. Rubellac. Breast milk d. Biliary atresia

2. Which of the following is not a risk factor for gastro-oesophageal reflux?a. Obesity b. Cow’s milk allergyc. Pneumonia d. Prematurity

Answers: MCQs

3. Which of the following may result in small for gestational age infants?a. Maternal diabetes b. Large parentsc. Maternal alcoholism d. Hydrops fetalis

4. Which of the following is a common cause of PR bleeding in the neonate?a. D & V b. Cows milk protein allergyc. CF d. Hirschsprung’s disease

Answers: MCQs

5. Which of the following is a risk factor for neonatal jaundice?a. Prematurity b. Bottle feedingc. Female gender d. GORD

6. Which is not a benefit of breastfeeding?a. bonding b. feed frequencyc. GI infections d. autoimmune disease

Answers: MCQs




Answers: EMQ 1

a. Physiological b. Breast milkc. Sepsis d. G6PD deficiencye. Biliary atresia f.

Cephalohaematoma



Answers: EMQ 1


3. A term infant presents at day 3 of life with jaundice. He is otherwise well.

4. A term infant presents at 3 hours of age with jaundice, decreased GCS and seizures.

Answers: EMQ 1


1. A 3 week old infant presents with decreased feeding, vomiting and fever for 3 days. Examination unremarkable.

2. A 3 month old presents with FTT, arching to feeds and an irritable cry for the last month.

Answers: EMQ 2


3. A 3 month old presents following a life threatening event. His mum reports vomiting after feeds for the last 6 weeks. Gaining weight.


Answers: EMQ 2


3. A 3 month old presents following a life threatening event. His mum reports vomiting and choking after feeds for the last 6 weeks. Gaining weight.


Answers: EMQ 2

Answers: Image 1

The following test is performed during the post-natal baby check.

a. What is the test is shown in B?Ortolani’s test

b. What condition is it used to screen for?Developmental dysplasia of the hip

A

B

Answers: Image 2

a.What’s the diagnosis?Myelomeningocele

Answers: Image 3

a. What’s the diagnosis?Infantile seborrhoeic dermatitis

a.k.a. Cradle cap

• Neonatal jaundice is common

• Common causes include physiological jaundice and breast milk jaundice

• Jaundice in the first 24 hours is always pathological

• Treatment may be conservative, phototherapy or exchange transfusion

• Untreated may lead to disability and death

• Prognosis in the developed world is excellent

Key Facts: Neonatal Jaundice

• Non-forceful regurgitation after feeds

• Presents between 1-4 months of age

• If persistent may lead to GORD

• Management is usually conservative

• Usually resolves by 10-18 months

Key Facts: Reflux

Thanks

the neonatal period. be able to define the neonatal period know how and when jaundice can present...

Documents

weeks neonatal jaundice

neonatal period slide

mcqs slide

physiological jaundice

cause of early jaundice

oesophageal sphincter

general neonatal topics

incompetence of gastro