Trainee Intern Web Sites
About this site
This site is designed to provide
online reference material. These links provide good reviews of both the more
common as well as some less common neonatal problems. Most general reading
should concentrate around the list of recommended reading; additional reading
may have to be done regarding specific cases. In addition, a list of journal
articles and textbooks are listed at the end of the site. Some of the journal
articles may be available in the library or online at certain hospitals. Please
check with your librarian for further information. Please remember that some web
sites, journals and books may provide viewpoints and management options that may
differ from your hospital. Therefore it is important to review the protocols at
your assigned hospital.
General Sites
These are a number of good general sites for neonatology listed below. Specific
topics from some of these sites are also referenced later.
Examination of the Newborn
The physical examination of the
newborn is very important as a screening test, in detecting disease, identifying
'pre-symptomatic' disease and reassuring parents about their new baby.
Resuscitation
The Low Birthweight Infant
Intrauterine Growth Restriction (IUGR)
Most people define IUGR as below the 10th
centile (in particular WHO and the International Classification of Disease
(ICD-10)). However some use the definition of below the 3rd
percentile (as this puts it 2 standard deviations from the mean). It is more
important that you understand the problems these babies have, and some of the
causes.
Prematurity
Infant Nutrition and
Feeding
Breastfeeding
Feeding
Feeding the Premature Infant
Respiratory Disease
Ventilation and Physiology
Although this topic is not listed
in the reading topics, these sites are good for an introduction to mechanical
ventilation and x-rays, which may help you understand babies in the level III
nursery.
Respiratory Distress Syndrome
(RDS)
RDS, also known previously as
hyaline membrane disease (HMD) and often referred to as surfactant deficiency,
is very common in premature infants, especially those below 30 weeks’ gestation.
It is important to distinguish RDS from other respiratory diseases; chest x-ray
is generally diagnostic for RDS.
Transient Tachypnoea of the
Newborn
Chronic Lung Disease/BPD
Chronic lung disease is a common
sequelae of premature babies with RDS. Its definition is an oxygen requirement
at 36 weeks corrected age (or sometimes 28 days old) with x-rays consistent with
the diagnosis.
Meconium Aspiration Syndrome
Persistent Pulmonary
Hypertension of the Newborn (PPHN)
Hypoglycaemia
Jaundice
Jaundice is one of the most common
problems in the neonatal period. It is important to recognize the difference
between pathological jaundice and nonpathological jaundice as well as the
different between unconjugated and conjugated hyperbilirubinaemia.
General
Biliary atresia
One of the causes of conjugated
hyperbilirubinaemia. It is important to recognise biliary atresia as early
(surgical) treatment results in a better prognosis.
Infection in the
Newborn
General
Congenital Toxoplasmosis
HIV Management in Infants and
Children
Cardiac Disease
Pictures, X-rays and
Echocardiograms
Heart murmurs
Cyanotic Heart Disease
Patent ductus arteriosus
Coarctation of the aorta
Common
Congenital Malformations
Orthopaedic Problems
Dysplastic Developmental Hips (DDH)
(previously called Congenital Dislocated Hips (CDH), talipes (clubfoot) and
brachial plexus injuries make up a significant amount of neonatal morbidity.
Cleft Lip and Palate
Fairly common condition, up to 40%
of which however are associated with other congenital malformations.
Down Syndrome
Neural Tube Defects
Tracheo-oesophageal fistula
Diaphragmatic Hernia
Other Topics
Apnoea of Prematurity
This can be a persistent problem in a premature baby, but can also be a
symptom of early infection.
Neonatal seizures
Necrotising Enterocolitis (NEC)
Retinopathy of Prematurity (ROP)
Intracranial haemorrhage/Intraventricular Haemorrhage (IVH)
Additional Topics
Rashes
Neonatal Conjunctivitis
Abnormal red reflex
Urology
Undescended Testes
Hypospadias
Hypospadias is a very common
condition (1 in 300 male births). There may well be ventral displacement of the
urethral opening, or in mild cases it may only show as a 'hooded' prepuce or
ventral curvature. Circumcision is contraindicated in case the foreskin is
needed for the surgical repair.
Hemorrhagic Disease of the Newborn
Other Gastrointestinal Problems
Malrotation
Hirschsprung disease
Duodenal atresia
Gastroschisis and Omphalocele
These Anterior abdominal wall defects are often diagnosed by antenatal
ultrasound, and require prompt medical and then surgical management to
provide the best prognosis.
Hypoxic ischaemic injury (HIE)
Congenital Hypothyroidism
One of the conditions screened for
on the newborn heal-prick blood test. Again, early treatment produces the best
results.
Renal Tract Abnormalities
Infants of Drug-addicted Mothers
Inborn Errors of Metabolism
These are individually rare but as
a group they constitute a big problem. Usually due to absence of a specific
enzyme, inherited as a single gene defect with autosomal recessive pattern of
inheritance. Early recognition is very important as it may prevent death or
significant handicap. Correct diagnosis is important for genetic counselling and
possibility of antenatal detection.
Nearly all babies manifest poor feeding and lethargy; vomiting and
tachypnoea are frequently present. Think of a metabolic problem when:
- There is consanguinity (Ask
"Where you and your husband related before you got married? Or "Do you have
any relatives in common?")
- FHx of an unexplained neonatal death or sibling with unexplained mental
retardation
- Unexpected illness in a term
baby after being fed
- Sudden onset of overwhelming illness
- Hypotonia, coma, seizures,
vomiting, diarrhoea, rapid respiration, apnoea, hepatomegaly
The main differential diagnoses are septicaemia and severe congenital heart
disease.
Ministry of Health
