Newborn Diseases (other than Jaundice)

Newborn - Diseases other than Jaundice
Q&A COUNT: 46
*This part will not be kept as cases in exams. Still, questions from this part can be asked for any of your newborn case

NEONATAL SEPSIS:

What are the types of sepsis?

1. Early onset (<72 hours)
2. Late onset (>72 hours)

Drugs for Sepsis (in order)

1. Pencillin/ gentamicin / amikacin
2. If not improved - Cephalosporin
3. If not improved - Meropenem and Imipenem
4. If not improved - Tazobactam
5. If not improved - lastly antifungals

Signs of sepsis

1. Apnoea
2. Abdominal distension
3. Bradycardia
4. Convulsions
5. Umbilical discharge
6. Periumbilical erythema
7. Fever
8. Skin pustules/ purpura/ skin mottling
9. Sclerema

Sepsis screen:

1. WBC count - Leukopenia more often than leukocytosis
2. Platelet count - low
3. CRP - elevated
4. Blood culture
5. Lumbar puncture - for convulsions

Role of CRP in sepsis:

1. Elevated CRP is seen in sepsis (>5)
2. Can assess how baby responds to antibiotics. If CRP is lowered after therapy, there is good response

HYPOGLYCEMIA:

HYPOGLYCEMIA - Causes 
Preterm, Birth asphyxia, hyperinsulinism, Infant of Diabetic Mother, Metabolic causes

Hypoglycemia - Management: 

10% Dextrose

2 ml/kg in case of no convulsions

Or

5 ml/kg in case of any convulsions

Cutoff:

<45 mg/dl - newborn

<54 mg/dl - older children

CAUSES OF PERSISTENT HYPOGLYCEMIA:

1. IDM
2. LGA baby
3. Galactosemia or Fructose intolerance
4. Congenital DM
5. Insulinoma

Drugs for persistent Hypoglycemia - Diazoxide, Glucagon, Octreotide

HYPOCALCEMIA:

HYPOCALCEMIA - Causes
Preterm Birth asphyxia, hyperinsulinism, Infant of Diabetic Mother, Metabolic causes

Cutoff for Hypocalcemia:

<8 mg/dl - Term baby

<7.5 mg/dl - Preterm baby

Treatment:

1. To prevent Hypocalcemia: In all infants, Calcium with IV fluids given
2. For hypocalcemia - Calcium gluconate IV for 3 days at 2 ml/kg per infusion under slow push and HR monitoring. If persists - give orally
3. If not cured - give Magnesium I.M*

Persistent Hypocalcemia:

1. Hypoparathyroidism (low PTH)
2. Pseudohypoparathyroidism (normal PTH)

NEONATAL SEIZURES:

Neonatal seizures - Causes:

1. Birth asphyxia and Trauma (most common)
2. Intracranial bleeding
3. Electrolyte disturbances
4. Inborn metabolic error
5. Intrauterine infections
6. Deformities of brain
7. Narcotic withdrawal in mother
8. Aminophylline given for apnea
9. Pyridoxine dependency (day 1 seizures)
10. Local anesthesia injected into fetal scalp (day 1 seizures)
11. Benign sleep myoclonus
12. Benign 5th day seizure (due to low Zn2+ level)
13. Benign familial neonatal convulsions

Neonatal seizures - Investigations?

1. CBC (leukopenia more common than leukocytosis, low platelets)
2. CRP increased
3. Lumbar puncture (can be done even when there is no convulsion but just sepsis, because 50% sepsis cases involve meningitis)

Newborn convulsions - Management:

1. Phenobarbitone 20 mg/kg - 1st bolus
2. In case of recurrence - Phenobarbitone 10 mg/kg
3. In case of recurrence again - Phenobarbitone 10 mg/kg
4. In case of recurrence again - Phenytoin 20 mg/kg + Normal saline 
5. In case of recurrence again - Midazolam (maintanence dose 5 mg/kg in two divided doses)

Other drugs - Paraldehyde , Sodium valproate

Drugs stopped in reverse order**

Antibiotics of choice in Neonatal seizures?

1) 3rd generation Cephalosporins (Cefotaxime) (200 mg/kg)
2) Vancomycin
3) Ampicillin (for Listeria) (200 mg/kg)
for 14-21 days

Why GTCS cannot occur in a newborn?

Reason: Myelination is incomplete**

Types of newborn seizures:

1. Blink eyes, conjugate movements
2. Orobuccal
3. Facial

What are SUBTLE SEIZURES?

Clinically missed forms of mild seizures
Can be in the following forms:

This picture is taken from Google search

DEFORMITIES/ DEFECTS AT BIRTH:

Dangerous deformity in leg:

Equinovarus > Calcaneovalgus

Calcaneovalgus is self correcting

Epispadias and Hypospadias - Definition 
Epispadias - Urethra ends in opening on the upper aspect (dorsal side) of the penis
Epispadias - Urethra ends in opening on the lower aspect (ventral side) of the penis

Epispadias and Hypospadias - 3 types (each)

HYPOSPADIAS (more common)

1. Glanular (least severe)
2. Mid shaft
3. Peno scrotal (most severe)

EPISPADIAS

1. Glanular (least severe)
2. Penile
3. Pubo-penile (most severe)

Grading in Hypospadias?

1. Grade 1 - Glanular (least severe)
2. Grade 2 - Mid shaft 
3. Grade 3 - Peno scrotal (most severe)

Life threatening causes of undescended testis in newborn

1. Congenital adrenal hyperplasia (salt losing type) (can result in hyponatremia - hypotensive shock and death if unnoticed)
2. Addison's disease (dark pigmented scrotum or external genitalia seen)
3. Hypopituitarism (can cause hypoglycemia and adrenal crisis - both result in death)

Symptoms of Cleft palate:

Difficulty in feeding and Aspiration pneumonia

Importance of Posterior urethral valve

If undetected at birth, can cause Renal failure by 5 years of age

PUV is diagnosed by MCU

Phimosis - age of surgery?

Wait till 3 years - then operate

Phimoses till 2 years is normal

What do you suspect when newborn doesnt move one limb?

SEPTIC ARTHRITIS

NECROTIZING ENTEROCOLITIS

What is NEC?

NECROTIZING ENTEROCOLITIS

Occurs in 2nd/3rd week of life

Presents with Abdominal distension

Treatment is to stop Breastfeeding and start antibiotics

Xray abdomen reveals - PNEUMATOSIS INTESTINALIS

Triad of NEC

Triad of NEC - low Sodium, acidosis and thrombocytopenia

IUGR:

IUGR baby - complications:

1. Hypoglycemia
2. Hypocalcemia
3. Polycythemia
4. Jaundice
5. Infection
6. Asphyxia
7. Hypothermia
8. Later prone for DM, Metabolic syndrome

Types and Causes of IUGR

Symmetrical IUGR - caused by TORCH INFECTIONS, chromosomal disorders (poor growth potential)

Assymetrical IUGR - Insult in 3rd Trimester (good growth potential)

What is PONDERAL INDEX and its inference?

Ponderal index = [Weight (kg)/ Height (cm) in cubes] x 100
Normal >2.5
Borderline PEM 2-2.5
Severe PEM <2

Drugs causing IUGR:

Phenytoin, Phenobarbitone

Are all LBW babies are IUGR babies?

NOPE 

ADMISSION CRITERIA TO NICU (IN RSRM hospital, Chennai)

"Prevent ALL MISBIRTHS"

P - Preterm, PROM/PPROM/ MRO >18 Hours, Perinatal Depression, Precious Baby

A - Anomalies (congenital)

L - Low Birth Weight (<1.8 kg)

L - Large for Gestational Age (LGA)

M - Meconium Stained Amniotic fluid (MSAF)

I - Intrauterine Growth Retardation (IUGR)

S - Sepsis Screening

B - Birth asphyxia, Bad Obstetric history (BOH)

I - IDM (Infant of Diabetic Mother)

R - Respiratory Distress (RD)

T - Twins (Discordant Terms)

H - HbsAg Positive

S - SGA (Small for Gestational Age) & LGA

OTHERS:

Consequences of Meconium stained AF aspiration

1. Chemical pneumonia
2. Bacterial pneumonia
3. Atelectasis
4. Emphysema
5. Pneumothorax
6. Persistent fetal distress

Scores used to assess RDS in babies

1. Silverman score - preterm baby
2. Downey's score - Term baby

Describe Silverman score

0-3: Mild distress, 4-6: Moderate distress, 7-9: Impending Respiratory failure, 10 - Severe Respiratory distress (We do not own any copyright for this image taken through Google search)

Describe Modified Downey's score

<4: No, 4-7: Respiratory distress, >7: Impending failure (We do not own any copyright for this image taken through Google search)

VITAMIN GIVEN FOR TERM BABY:

VITAMIN D - 400 IU/day

Shock management:

Oxygen, Dopamine or Dobutamine

Sodium bicarbonate in case of intracranial hypertension

What is Periventricular Leukomalacia?

What it leads to?
Periventricular leukomalacia is brain injuryaround ventricles that affects premature infants
It leads to Cerebral palsy

Umbilical granuloma - management:

Presents as Red swelling

Rx - Copper Sulphate or silver nitrate crystals applied