Neonatal jaundice- Timescale
- Abnormal in first 24 hrs
- Abnormal after 3 weeks
- But start to worry after 2
- Causes
- Biliary atresia
- HDN
- Infection
- Hyperthyroidism
- Diagnosis
- Check split bili
- Biliary atresia => Rise in CONJUGATED bilirubin
Cow's milk allergy - Presents around 4-6 weeks
- Symptoms
- 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
- 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:
- Macroglossia
- Macrosomia
- Birth weight and length greater than the 90th percentile
- Midline abdominal wall defects
- Ear creases or ear pits
- Neonatal hypoglycemia
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
- Hypokalaemia
- Dehydration
- Size cut-off for diagnosis
- 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
- Umbilical vein
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