Escolar Documentos
Profissional Documentos
Cultura Documentos
1. Neonatal jaundice
2. Protein energy malnutrition
3. Dengue hemorrhagic fever
4. Acute respiratory infection
5. Recurrent wheezing
6. Stridor
7. Cyanotic congenital heart ds
8. Acyanotic congenital heart ds (VSD)
9. Rheumatic heart ds
10.Acute diarrhea
11.Jaundice
12.Oedematous child
13.Pallor
14.Bleeding child
15.Fever with fits
16.Cerebral palsy
Take a history of newborn baby w NNJ
Initial approach
Introduce yourself, get permission from mother
HOPI
Onset
When was your baby born?
When did you start notice that the baby had jaundice?
(Preferably how many hrs after birth if it is in day 1)
Ddx different according to age of onset of jaundice.
How old is your baby now?
Is jaundice getting better or progressive?
Is the baby lethargic or irritable?
Does the baby cry with high pitch sound?
Does the baby feed actively?
Poor feeding can be a feature of early kernicterus.
Do you breast feed or bottle feed your baby?
Breast milk jaundice can cause prolonged NNJ.
Did the baby have any fits? If present, how frequent and how does it look like?
Convulsion is a feature of late kernicterus.
Any fever? its nature?
Fever may be d/t neonatal sepsis (one of the causes of NNJ).
Eg umbilical sepsis/omphalitis, staphylococcal skin infx
Did you notice any redness around umbilicus or discharge from it?
Did you notice any pustules, crusts or blisters over any part of baby?
Antenatal hx
Maternal illness
Do you (mother) have any febrile illness with skin rashes during pregnancy?
Viral infx eg rubella during 1st trimester may give rise to congenital infx that cause
prolonged NNJ.
Birth hx
What parity of this pregnancy? Any abortion or stillbirth?
Rh incompatibility causes jaundice in 2nd parity onwards.
ABO incompatibility causes jaundice in any parity.
Is the baby boy or girl?
G6PD def mainly in boys
How many hrs before delivery did mother start to have dribbling (PROM)?
Was there any fever or foul smelling discharge per vagina?
ROM>24hr before delivery => risk of perinatal sepsis in newborn
Other risk factors: maternal fever before or during labor & foul smelling vag discharge
Mode of delivery? Why?
Any instrumental delivery?
Any birth trauma?
Cephalhematoma is d/t difficult vaginal delivery and can cause jaundice.
Assisted instrumental delivery may indicate difficult labor which can lead to birth
asphyxia.
Did the baby cry immediately after birth?
Was the baby cyanosed?
Did the baby need any resuscitation?
Presence of birth asphyxia is a risk factor to develop kernicterus.
Is the baby born early/later than expected date?
Premature babies are more prone to develop NNJ and kernicterus.
Babys birth wt?
Family hx
Previous child with NNJ? Treated?
Jaundice d/t Rh incompatibility was more severe in 2 nd onward born babies.
Requiring exchanged transfusion indicates severe jaundice.
Blood groups of mother, father, baby?
ABO and Rhesus incompatibility if blood groups are different.
Summary
Baby John, 6d old boy was admitted for yellow discolouration of skin noticed on 4 th
day of age starting from face and now over abdomen. There was no history of lethargy and
irritability. He could suck well to breast milk and active. The baby was exclusively breast
fed and no feature suggestive of early kernicterus or sepsis.
The baby was born term via SVD at hospital with birth wt of 7lbs. there was no
history of PROM and no prolonged labour. He cried immediately after birth and could start
feeding with colostrums soon after birth. Blood group of both parents is O Rh +ve, babys
blood group was not known.
Pdx: physiological NNJ
Baby Mary, 3d old girl was admitted from yellow discoloration of skin noticed since
this morning which had spread over the abdomen. She was lethargic. Sucking was poor
and she was irritable. Both breast and formula milk were fed bcs mother thought her milk
production was poor.
The baby was febrile and mother also noticed foul smelling and redness around the
cord. She was the 3rd child of uneventful pregnancy. The baby was born term via SVD at
home by midwife. Mother had dribbling nearly one day before delivery and she was febrile
during labour. She was told that the liquor was dirty and foul smelling. Blood group of both
parents is O Rh +ve, babys blood group was not known.
Pdx: NNJ most probably d/t sepsis
Ddx
1. Physiological jaundice
2. Pathological jaundice
a. ABO incompatibility
b. Rhesus incompatibility
c. Sepsis (umbilicus, skin, septicemia, meningitis)
d. G6PD def
e. Prematurity
f. Birth trauma cephalhematoma
g. Prolonged NNJ (>14d in term, >21d in preterm)
i. Acquired infx
ii. Breast milk jaundice (dx of exclusion)
iii. Hypothyroidism
iv. Biliary atresia
v. Neonatal hepatitis syndrome
vi. Congenital syphilis
3. Complication kernicterus (spastic posture, high pitch cry, irritability, poor sucking)
Key points
HOPI
Yellow discolouration
Onset
Duration
Lethargy/irritability
Poor sucking
Breast/bottle fed
Fits
Fever
Discharge from umbilicus
Pustules on skin
Antenatal hx
Maternal illness
Birth hx
Parity
Sex
PROM
Mode of delivery
Term
Birth wt
Birth asphyxia
Birth injury
Family hx
Previous jaundiced baby
Blood groups
Age
(month
s)
04
Gross
motor
Fine motor/vision
Hearing and
speech
Social behaviour
Head
control
Responds to sound
Cooing
57
Rolls over
Sit with
support
(6mo)
Crawls/cree
ps (910mo)
Eyes follow an
object/follow mum
face
Grasps a rattle or
rings when placed in
hand
Reaches out to an
object and hold it
with both hand
Transfer and mouths
Points with index
finger
Turns to voice
Bi-syllables
(mama, baba)
Responds to own
name
Distraction hearing
test
Turns to sound of
name
Understands
several words
Utters 3 or more
words
Points to ear, nose,
mouth
Complete
sentences
Knows own name
Indicates toilet
needs
Follows simple
command
Can remove
garment
Knows full
name,sex,age
Normal speech
12
Pulls to
stand
Stands
without
support
Walks
holding
furniture
Climbs
onto chairs
Runs
A good pincer
Casting
24
Climb stairs
(2
feet/step)
36
Climbs on
alternate
feet
Tower of 6 cubes
Imitates vertical
stroke
Turns book pages
singly
Copies a circle
Matches 2 colours
18
Scribbles
Builds tower of 3
60
Riding
tricycle
Bounce &
catch ball
Copies triangle
Speak fluently
Name 4 colours