12.09.12 Teaching notes

Neonatal jaundice

    • Timescale

      • Abnormal in first 24 hrs

      • Abnormal after 3 weeks

        • But start to worry after 2

    • Causes

      • Biliary atresia

      • HDN

      • Infection

      • Hyperthyroidism

        • Checked at birth

    • Diagnosis

      • Check split bili

        • Biliary atresia => Rise in CONJUGATED bilirubin

Cow's milk allergy

    • Presents around 4-6 weeks

    • Symptoms

      • Rectal bleeding

    • Try switching to Neocate

      • But need to demonstrate return of symptoms on switching back for a diagnosis

Hydrocoele

    • 20-25% at birth

    • Most are non-communicating

    • Most fix slowly after birth

    • Hernia is the only differential

      • Varicocoele => Characteristic "bag of worms"

Abdominal hernias

    • Umbilical (true)

      • Come out at right angles

      • Umbilicus right at the tip

    • Supra-umbilical

      • Just above umbilicus

      • Gives a crescent-shaped skin fold round the umbilicus

    • Epigastric

      • Far above umbilicus

    • Umbilical hernias almost never strangulate

      • Can safely leave for a while

Beckwith–Wiedemann syndrome

  • Overgrowth disorder usually (but not always) present at birth

  • Characterized by an increased risk of childhood cancer and certain congenital features

  • Five common features:

Inguinal hernia

    • R testis descends later => Hernias more common on R

    • Spot incarceration by red surface

      • Necrosis => Toxin release => Vasodilatation

    • Frequency:

      • 1% for girls

      • 3.5% for boys

    • 50% risk of incarceration @ six months

      • => Always operate

      • Do it FAST if you can't reduce it

    • Kids don't need canal repair or mesh

Pyloric stenosis

    • Features

      • Typically presents at 3-6 weeks

      • Milky projectile vomits after feeding

      • Olive-shaped upper abdominal mass

      • Dry nappies (oliguria)

    • Chemical:

      • Hypochloraemic metabolic alkalosis

        • Loss in vomit

      • Hypokalaemia

        • Kidneys (aldosterone)

      • Dehydration

    • Size cut-off for diagnosis

      • 4 x 16 mm at 6 weeks

    • Typically in first-born male child

      • Combination of genetics + maternal placental factors

    • Treatment leaves the thick muscles in place

      • Just cut (longitudinally) to release presure

      • It will slowly thin over time

Notes

    • Erythromycin can be used to encourage gastric emptying (off-label)

      • ONLY agent indicated in kids

    • If BP falls in a child, PANIC

      • They're really good at compensating

    • There are TWO umbilical arteries

      • Attach to each of the internal iliacs