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:

  • Macroglossia

  • Macrosomia

    • Birth weight and length greater than the 90th percentile

  • Midline abdominal wall defects

    • Omphalocele/exomphalos

    • Umbilical hernia

    • Diastasis recti

  • 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

      • 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

• Umbilical vein

  • Half of the blood enters the fetal ductus venosus and is carried to the inferior vena cava

  • The other half enters the liver, having joined the portal vein