COMMON OFFICE PROBLEMS ENCOUNTERED DAILY

1. OFFICE PRACTICES IN
NEONATOLOGY
DR.PRITESH PATEL
MBBS, MD (PEDIA), FIAP NEONATOLOGIST
NEOCARE NICU AND CHILDREN HOSPIAL
NAVSARI, GUJARAT

2. NORMAL
CLINICAL PHENOMENON

3. WEIGHT LOSS IN FIRST WEEK
 Normally babies lose 8-10% of birth weight in the first
week of life
 Because of passage of meconium, urine and reduction of
extracellular fluid volume.
 Weight is regained by 10-14 days age.
 Subsequently there should be gain of 20-40gr/day.

4.  Bluish discoloration of hands, feet
 Particularly the palms and soles are
blue.
 The skin and mucosa are spared.
 Due to immature peripheral micro circulation.
 Exacerbated by cold temperatures.
 Disappearing over the next few hours.(not present
after 1st 24 hr)
ACROCYANOSIS

5. HICCUPS & SNEEZING
• Hiccups occur immediately
after a feed due to stomach
distension and irritation of
diaphragm.
• Sneezing occurs due to
irritation of nostrils.

6. VAGINAL BLEEDING
 Menstrual like vaginal bleeding may
due to withdrawal of maternal estrogen.
 occur in about ¼ female babies after 3-5 days of birth.
 The bleeding is mild and lasts for 2-4 days.
 The local aseptic cleaning of genitals is advised .
 If bleeding seems excessive, vitamin K deficient bleeding
or other coagulopathy should be considered.

7. MUCOID VAGINAL SECRETION
 Most female babies have thin grayish white mucoid
vaginal secretions.
 These should not be mistaken for purulent discharge.

8. EXCESSIVE
SLEEPINESS
• Some baby sleeps after a few
suck.
• The baby should kept arouse
during feed by tickling on the
soles and behind the ears.

9. CAPUT
SUCCEDANEUM
• Boggy diffuse edematous
swelling of soft tissues of
scalp over the presenting part.
• Usually come to normal in few
days.

10. MILIA
 Affect 40% of newborns
 found most commonly over the cheeks
,forehead, nose, and nasolabial folds
due to blocked sebaceous glands
 Known as Epstein’s pearls when they
occur in the oral cavity(palates).
 self-limited and are reabsorbed
by 3 months of age

11. ERYTHEMA TOXICUM
 Very common rash occurs in almost 50% of
newborns
 Small white/yellow papules on a red base
seen on face, trunk and limbs.
Sparing palms and soles.
 Usually develop 2 – 3 days after birth .
 Lesions seem to migrate by disappearing
within Hrs and then reappearing elsewhere.

12. NORMAL PEELING
 Most commonly post term
infants can exhibit excessive
peeling of skin.
 Usually occurs after 24-36 hours
 Some time a few erythema toxicum are seen with feeling.
 Will resolve spontaneously and does not need any creams,
oil, ointment or lotions.

13. CUTIS MARMORATA
 Bluish mottling of skin in response to
chilling, stress or overstimulation.
 Resolves quickly with warming.
 Onset during first 2 to 4 weeks of life;
 Due to immaturity of the autonomic
nervous system of newborns.
 If persists after the infant is warmed
implies an obstruction to blood flow such
as hyper viscosity.

14. MONGOLIAN SPOTS
 Infiltration of melanocytes deep in dermis
 Blue to blue-black macules occur anywhere
on the body,mostly on the back and buttocks
 Often fade within 1st few yrs due to
decreasing transparency of skin
rather than true disappearance

15. PRE AURICULAR TAG
 Soft , non tender, pedunculated skin tag near tragus of ear
 1st or 2nd brachial arch anomaly
 Associated with cleft lip, cleft palate, coloboma of eye, hand
or digit anomaly, mandibular hypoplasia
 Warrantes investigations when 2 or more minor anomalies
or 1 major anomalies renal sonography and hearing
assessment

16. COMMON COMPLAINS
IN
OFFICE PRACTICE

17. SUBCONJUNCTIVAL HEMORRHAGE
 Newborns often have small, bilateral hemorrhages, presumably
from the pressure of uterine contractions
 But is more common after a traumatic
delivery.
 This condition is seen in 5% of newborn
infants.
 The blood gets reabsorbed after a few days without leaving any
pigmentation.

18.  Bilateral fullness of both breasts.
 Overlying skin shows no signs of inflamations
 The condition resolves spontaneously and no intervention is
required.
 Results by high levels of maternal hormones.
 Massage or squeezing the breasts or nipples is not
recommended
BREAST ENGORGEMENT

19. VOMITING
Due to faulty techniques of
feeding.
Stenosis, intestinal
obstructions, infections like UTI,
Treatment: proper techniques
of breast feeding in proper
position.
Avoid bottle feeding.

20. DIARRHOEA 1. Passage of motions 8-10 times
per day in otherwise actively
feeding baby is normal
2. Put on exclusive breast feed.
3. Avoid bottle feeding maintain
hygiene
4. Wash nipple after each feed.

21. NEONATAL CONSTIPATION
 Due to insufficient milk intake, on Iron
supplement or Anal ring, and rarely
hirschprung disease
 More common in formula/bottle fed
infant.
 Management: milk of magnesia one
teaspoon twice a daily.
 Apply lubricant over anal region.

22. SORE BUTTOCK
Due to frequent loose stools.
Poor hygiene.
Treatment: change position
from time to time .
Put baby in Lateral Or prone
position.
Apply coconut oil, zinc oxide
cream

24. FAILURE TO PASS URINE
 Fetus voids urine regularly in –utero after 12 weeks of gestataion.
 After birth most babies void on the first but all babies must pass
urine by 48 hours of age.
 Babies with delayed passage of urine should investigated for obstructive
uropathy and renal agenesia.
 Normal babies void 6-12 times/day.
 Some babies cry before passing urine due to discomfort of full bladder.
 starts crying again after having passed urine due to wet napkins.

25. FAILURE TO PASS MECONIUM
 Passage of some amount of meconium usually occurs within the
first 12 hours of life,
 99% of term infants and 95% of preterm infants passing
meconium within the first 48 hours of life.
 followed by yellow and seedy stools for next 1-2 days.
 Failure to pass Meconium by 24 hours of age is an indication
for doing appropriate investigation to exclude any pathology
 Failure to pass Meconium can occur as a result of imperforate
anus, functional intestinal obstruction (i.e., Hirschsprung
disease), illness, or hypotonia.

26. DEHYDRATION FEVER
 Some healthy babies may develop fever on the 2nd or 3rd day of life
 Due to poor heat dissipation mechanisms ,higher rate of insensible
losses ,inadequate intake of breast milk during the phase of physiologic
lactational inadequacy.
 The baby remains active, alert and cries for feeds.
 The baby should be dressed with light and loose cotton clothes and his
environment kept cool in summer.
 Frequent breast feeding

27. UMBILICAL GRANULOMA
• Sign: area around umbilical
cord. Becomes moist and
may swell, oozing and
bleeding may occur too.
• Treatment:
Crystalline salt application
treat with silver nitrate
Surgical removal if persist

28. ACNE NEONATORUM
 Multiple discrete Erythematouse papules
 develop between 2 and 4 weeks of life.
 transient increases in circulatory
androgens contribute.
 Usually resolves within four
months without scarring.
 Oils and lotions do not help, may aggravate the condition.

29. SEBORRHEIC DERMATITIS
(CRADLE CAP)
 Greasy ,yellow plaques on the scalp with
some degree of hair loss.
 highly prevalent during the first 4 weeks of life
 Primarily affect head and intertriginous areas.
 Treatment options include gentle scrubbing, applying
vaseline and using soft brush to remove scales
 Occasionally topical mild corticosteriod or antifungal is
indicated

30. NATAL TEETH
 Erupted teeth at birth
 Usually lower incisors
(c.f. Neonatal teeth: Erupt during 1st mth)

31. FEEDING
Q.Can I feed water to my baby?
 Breastfeeding preferred
 Infant formula
 Only milk till 4-6mths old
 No water or other food/drinks
 Wean from 4-6mths

32. FEEDING
Q. Should I Wake baby up for a feed?
 During the 1st month
 Should be fed at least every 2-3 hrs
 If baby sleeps longer than 3-4hrs &
starts missing feeds, wake baby up to
feed

33. BURPING
 Q. My baby takes very long to burp or doesn't
burp easily?
 Babies do not always need to burp after feeding
 Unnecessary to persist if baby doesn’t burp
after a 20 minutes
 Breastfed babies swallow less air

34. COLIC
 Usually begins from 2-4wks & stops by
3mths
 Cause: Uncertain
 Reassure parents if baby otherwise well
& fine in between crying

35. ANY
DOUBT