Postnatal ward paediatrics

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Information about Postnatal ward paediatrics
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Published on October 30, 2008

Author: adsie

Source: authorstream.com

Postnatal Ward Paediatrics : Postnatal Ward Paediatrics Baby check Common problems Baby Check 1 : Baby Check 1 “Screening test” – top to toe but specifically looking for problems that could otherwise be missed: e.g. Significant murmurs Dysplastic hips Abdominal masses Cataracts Pathological jaundice Parental reassurance Baby Check 2 : Baby Check 2 Take your time Look at case sheet Chat with mother, use baby’s given name Feeding, nappies Any relevant history, any other concerns? Make reassuring noises if all well (but avoid worrying noises) Record findings fully Baby Check 3 : Baby Check 3 If you find a problem If appropriate, discuss reassuringly Ask advice if at all unsure – record name of person asked as well as answer! Don’t bluff, don’t lie but don’t commit yourself till sure – be willing to admit ignorance! Document findings fully Most follow up will be arranged by Paediatric Office – if you have made urgent arrangements, document so not duplicated Listen to midwives! Single Umbilical Artery : Single Umbilical Artery Check for other dysmorphisms Reassure mother variation of normal but warn to expect “routine” appointment for renal ultrasound – usually normal and any abnormalities seldom of clinical importance but worth checking Cleft lip and / or palate : Cleft lip and / or palate If midline, check SaO2 Nurse with mother if at all possible Encourage to breast feed Inform senior who will contact Mr Morrant, Consultant Orthodontist a.s.a.p. Look for other dysmorphisms (particularly with midline clefts) If anyone suspects Down’s Syndrome : If anyone suspects Down’s Syndrome If mother unaware of query, don’t discuss with her unless she asks directly; get senior to see ASAP (consultant may get out of bed!) Common Problems 1 : Common Problems 1 Poor feeding Familiarise yourself with Baby Friendly guidelines Ask the midwife what she thinks! Involve seniors if unsure what to do! Common Problems 2 : Common Problems 2 Hypoglycaemia Follow guidelines Check temperature Consider cause – if not obvious, think metabolic - discuss with seniors Common Problems 3 : Common Problems 3 Weight loss Follow guideline If >12% discuss with seniors Worry more if bottle feeding Common Problems 4 : Common Problems 4 Jaundice Discuss if Day 1 >350 mmol/l > 10 days old (bottle fed, term) or > 14 days old (breast fed or preterm) Baby unwell Check blood group and Direct Coombs Test, consider infection If muddy green rather than sunny orange, notify seniors Sticky eyes : Sticky eyes Often resolve without treatment Swab, clean with N saline If profuse discharge with redness / swelling, consider chlamydia – special culture medium Most Staph. etc. respond to topical chloramphenicol or Neomycin Gonococcus – systemic Penicillin Chlamydia – systemic erythromycin (3/52) Ophthalmia neonatorum is notifiable Neonatal Abstinence Syndrome : Neonatal Abstinence Syndrome Modified Finnigan Score Non-pharmacological treatment Score >/= 12 – admit, pharmacological treatment Check SWD aware Consider and discuss Hep B immunization Unusual findings 1 : Unusual findings 1 Preauricular pit Occasional branchio-oto-renal syndrome ?FH Preauricular tag Cosmetic – will be offered Plastics appointment – no ultrasound Don’t tie off! Misshapen ears All babies have a hearing screen but special attention if abnormal pinnae Unusual findings 2 : Unusual findings 2 Polydactyly Enquire re family history Look for other dysmorphisms Don’t tie off! – will get routine Plastics appointment Syndactyly – fingers – Plastics referral – toes – referred only if severe Clynodactyly – Look for other dysmorphisms “Birth marks” Document appearance and site Unusual findings 3 : Unusual findings 3 Hypospadias Mainly coronal or glandular – if more severe, ask senior to see Observe urinary stream If OK, warn to expect routine Plastics appointment Undescended testes Unilateral – reassure likely to descend, to see GP at a year Bilateral – ask senior to see Hydrocoele - reassure Unusual findings 4 : Unusual findings 4 Imperforate hymen – ask senior to see Indeterminate genitalia – don’t guess! Urgent senior opinion (consultant may even get out of bed!) Ectopic anus – observe to pass meconium prior to discharge, warn to ’phone if constipated, appointment will be arranged Sacral pit – if base visible, reassure; discuss hygiene – otherwise ask senior to see Unusual findings 5 : Unusual findings 5 Hernias Inguinal – inform senior - surgical referral prior to discharge Umbilical – check for signs of hypothyroidism; reassure Unusual findings 6 : Unusual findings 6 Hips – “click” versus “clunk” Family history 1st o or > 1 x 2nd o relative Breech presentation or other risk factors Ultrasound before discharge if poss. If clinically unsure, ask senior to see DON’T write, “clicky hips”!!! Talipes Positional – manipulation / reassurance Structural – urgent orthopaedic referral Slide 20: Don’t allow the InPatient Ward to harrass you – be polite but assertive and work methodically Value the auxiliaries and work as a team Remember what a special time this is for the family – and enjoy it with them!!!

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