News

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 2nd & 3rd 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.