CME (Pediatrics)..............A beginning.

Dr.A.J.Chitkara MD, DNB

Consultant Pediatrician

Max Hospital & Sarvodaya Hospital, Pitampura

Email: drajchitkara@ rediffmail.com

COMMON NEONATAL PROBLEMS:

 

Neonates constitute the most vulnerable age group of patients. It will not be an exaggeration to say that for a family physician examining & treating a neonate can be a night mare. The poor little things do not communicate except crying, the symptoms & signs of any disease process are horribly few & non specific, benign lesions may appear serious while serious illnesses may have subtle presentations.

PEARLS OF WISDOM :

·                    Have a high index of suspicion while dealing with neonates

·                    Have due regard for mother’s description of “Baby not appearing well”.

·                    Failure to take feeds.

·                    Sluggish activity.

·                    Abnormal color, temperature, movements and behavior.

·                    Frequently examine the baby to be sure of abnormal signs & symptoms.

·                    If in doubt seek a specialist’s opinion.

·                    Remember the repercussions of loosing a life are much more than loosing a patient for follow up.

 

FEEDING DIFFICULTIES:

          The common causes of feeding difficulty in a newborn are:

·                    Faulty breast feeding technique especially in a primigravida. Counsel the mother for the proper technique.

·                    Retracted nipples, engorged breasts.

·                    Cleft lip & Palate.

·                    Nasal block may be the most common cause especially in winters.

·                    In the absence of above factors suspect a serious illness.

BREATHING DIFFICULTY:

·                    Nasal block is the most common benign cause of breathing difficulty in a newborn. Clearing the nose with saline nose drops or occasional use of nasal decongestants like xylo & oxymetazoline 0.05% suffices.

·                    Abnormal color, labored breathing and associated chest findings indicate a serious illness.

LOOSE STOOLS:

          It is not uncommon for mothers to bring breast fed neonates with complaints of frequent passage of watery stools. It may be transition stools during first 2 weeks or a normally exaggerated gastro colic reflex. If the baby is active, feeding & thriving well, reassure the mother. A stool examination showing no pus cells should further reassure the doctor as well as the parents. Use this opportunity to promote breast feeding & proper hygiene but avoid unnecessary medication. The perianal excoriation often accompanies this condition which can be helped by using an emollient like lanolin or a zinc oxide containing cream. Pus cells in stool and any alteration in baby’s feeding & activity should alert the family physician to an infective cause.

 

ABNORMAL COLOUR & RASHES:

·                    Most babies appear quite pinkish at birth.

·                    Yellowish discoloration indicates jaundice; evaluate each baby for physiological or pathological jaundice. (Details in further CME on NEONATL JAUNDICE)

·                    Bluish discoloration indicates cyanosis which is a serious sign but occasional bluish discoloration of feet & hand with a pink tongue & face may be because of exposure to cold.

·                    Erythematous rashes on face & body on 2^nd & 3^rd day may be toxic erythema of newborn – a benign condition requiring no treatment.

·                    Pustules merit proper attention. Pierce & apply povidone iodine. Multiple pustules would require antibiotics.

·                    Diaper rash is easy to diagnose because of its distribution in diaper area. Suggest proper hygiene & application of an emollient or zinc oxide cream.

·                    Miliaria, cutis marmorata (marbled appearance), Harlequin color change are other benign skin rashes requiring no intervention.

·                    Petechie, ecchymosis, bullous lesions are serious illnesses.

 

EXCESSIVE CRYING:

·                    Inappropriate clothing for the weather i.e. the baby feeling cold or heat.

·                    Hungry baby.

·                    Nasal block

·                    Insect bite- bed bugs or mosquito

·                    Soiled baby- passed stools or urine & feeling wet and uncomfortable.

·                    Abdominal colic especially top fed babies or improper feeding technique

·                    In the absence of above factors suspect serious illness & examine frequently for bulging fontanelle, injury etc.

IMPORTANT TIPS:

·                    Do not reassure the parents until you are confident of the benign nature of baby’s condition.

·                    Frequent examination of the baby always comforts the mother & helps develop faith in the doctor. The doctor benefits by picking up abnormal signs and also it is a good learning exercise.

·                    Timely intervention can save many morbidities & mortality.

·                    Learn to share responsibility.

 

 

    

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