some common problems with neonates
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This document discusses various clinical problems that can occur in neonates, including hypothermia, weight loss, crying during urination, umbilical cord care, eye discharge, rashes, and several congenital defects. For each issue, the document provides definitions, signs and symptoms, causes, prevention methods, and treatment options. Common concerns are explained such as the causes of frequent stools, breast discharge, and different types of rashes. Serious congenital defects like neural tube defects, tracheo-esophageal fistula, and congenital diaphragmatic hernia are also outlined.
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some common problems with neonates
- 1. Clinical problems with neonates Dr Shambhavi Sharma
- 2. Hypothermia • Demonstration and explanation of kangaroo mother care by Pemba • Help by Sundar
- 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
- 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
- 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