Hypothermia,congenital defects,oral thrush,diaper rash

1. Clinical problems with neonates
Dr Shambhavi Sharma

2. Hypothermia
• Demonstration and explanation of kangaroo
mother care by Pemba
• Help by Sundar

3. • Definitions

4. Signs/symptoms
• Body cool to touch.
• Mottling or pallor.
• Cyanosis.
• Poor Feeding.
• Abdominal distension.
• Hypotonia.
• Hypoglycemia.
• Seizure
• lethargy

5. PROBLEMS AND COMPLICATIONS
• Hypoglycaemia
• Neonatal sepsis
• Lethargy
• Seizures
• Hypotonia
• Breathing problems and cyanosis
• Metabolic acidosis

6. Prevention

7. Treatment
• Warm the neonate using radiant warmer
Supportive measures:
• Oxygen
• Treatment of sepsis with iv antibiotics
• Frequent feeding/Iv fluids to correct
hypoglycaemia
• Regular monitoring

8. Common concerns during
neonatal care
Dr Shambhavi Sharma

9. Weight loss in first week
8-10% loss in 1st week
Crying during micturition
crying before micturition: normal
crying during micturition: UTI
Bathing : preferred only after 7-10 days
important for prevention of hypothermia
Cosmetics ,oil massaging:
oil massaging increases human touch
avoid kajal,talcum powder,mediacated
soaps

10. • Umbillical cord stump care
• Usually falls by 7-10 days and wound heals by 15 days
• Infection of umbillical cord: omphalitis
• Cause: unclean handling and/or use of unclean
substances in cord stump
• Prevention: Naavi malam
keeping the stump dry
thorough cleaning of umbillical cord stump if
soiled

12. • Identification: area of redness,
induration
pus discharge

13. Treatment:
Redness < 1 cm and no signs of sepsis: local cleaning
with antiseptic solution
• Application of 0.5% gentian voilet QID till redness
subsides
• Area of redness> 1 cm and induration with persistant
discharge with signs of sepsis: pus c/s and staining
systemic antibiotics

14. Tetanus neonatorum
cause: clostridium tetani

18. • Break

19. • Frequent stools: enhanced gastrocolic reflex.
normal if normal growth and
baby is hydrated
• Breast discharge: due to transmitted maternal
hormones.
squeezing nipples must be avoided

20. Eye discharge
• Non infectious causes:
• Sticky eyes: clean with wet cloth
• Nasolacrimal duct obstruction: massaging of
inner canthi of eyelid
• Chemical conjunctivitis :
• mostly due to silver nitrate: redness and some
amount of pus may be present
• resolves spontaneously

21. Infectious causes(Ophthalmia
neonatorum)
Transmitted during birth via birth canal
Gonoccal conjunctivitis
cause:Neisseria gonorrhea
• Onset before 3rd day
• Both eyes are grossly swollen
• Red copious purulent discharge
• Gram positive cocci
Treatment:
• cleaning of eyes with sterile saline soaked cotton from
inner canthus to out along the edge of eye
• intravaenous antibiotics : ceftriazone

22. Chlamydial conjunctivitis
Cause :Chlamydia
• Onset after 3 days
• Starts as a watery discharge
Moderate amount of redness and swelling
bilaterally
No organism growth in c/s
Treatment
Cleaning
Oral erythromycin in 4 divides doses
Other causes: staphyococcus aureus

23. • Rashes and skin peeling:
• erythema toxicum on face, trunk on D2-D3 of
life is normal
• Peeling common with IUGR and post term
babies
• Pustules < 10 in number in places where dirt
accumulate with no signs of sepsis: clean and
apply gentian voilet locally
• Pustules >10 in number and signs of sepsis:
Systemic antibiotics

24. Erythema
toxicum
Pustular
lesions

25. Diaper rash
Skin creases are
spared
t/t:
•leave open
•Change diapers
frequently
•Zinc oxide
application
locally

26. t/t: nystatin cream QID till lesions subside

27. • Oral thrush
White patchy lesions on tongue and oral mucosa
that are difficult to wife off and leave
hemorrhagic spots when removed suggest
candidiasis
t/t : local application of nystatin qid after feed till
2nd day after resolution

28. Congenital defects
Refer immediatey if:
• Neural tube defects
• Choanal atresia
• Cleft lip and palate
• Tracheo esophageal fistula
• Congenital diaphragmatic hernia
• Hypertrophic pyloric stenosis
• Abdominal wall defects
• Anorectal abnormalities

29. Neural tube defect

30. Tracheo oesophageal fistula

31. H/O maternal polyhydraminos
X ray- coiled feeding tube in the esophagus
Definitive diagnosis by bronchoscopy
Treatment:
Maintain ABC and suctioning
Surgical correction- as soon as possible
Disconnection of fistula and anastomosis of both ends of the
esophagus.
Look for cardiac abnormalities

32. Congenital Diaphragmatic Hernia
Abnormality in development of the diaphragm
Defect in the diaphragm
Abdominal viscera herniate into the chest cavity
Pressure on the lung and shift of mediastinum
Pulmonary hypoplasia

33. • C/F:
• Respiratory distress and cyanosis
• Scaphoid abdomen, increased chest diameter
• Decreased breath sounds
• Bowel sounds + in the chest
• Evidence of mediastinal shift
• X ray is diagnostic.
• If doubtful – USG or CT scan of chest
• ABG

35. X ray findings:
• Loops of bowel in
the chest
•Significant
mediastinal shift

36. • Treatment:
• Insert NG tube and deflate the stomach
• Needs respiratory support
• DO NOT USE BAG AND MASK VENTILATION
• If needed intubate and ventilate
• Correct acidosis
• Surgical repair

37. omphalocele

38. Imperforate
anus

39. Thank you