Tip 86: audiology 2

10% of babies who have neonatal bacterial meningitis will develop sensorineural hearing loss. They should be referred for early formal audiology assessment.

Reference: Newborn Hearing Screen Programme Clinical Group, (June 2012). Newborn Hearing Screening and Assessment: Guidelines for surveillance and audiological referral of infants and children following the newborn hearing screen. Version 5.1. NHS.

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Tip 84: VZIG 2

~50% neonates exposed to maternal chicken pox will become infected despite VZIG prophylaxis.

In up to 2/3 of these, infections are mild or asymptomatic but rare fatal cases have been reported in the period four days before to two days after delivery. Early treatment with
IV aciclovir is recommended for neonates in this exposure category who develop varicella infection despite VZIG prophylaxis.

Reference: Chapter 34, Immunisation against infectious disease (The Green Book) Public Health England, August 2015.

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Tip 83: varicella zoster immunoglobulin (VZIG)

VZIG is recommended for infants whose mothers develop chickenpox (but not shingles) in the period seven days before to seven days after delivery.

VZIG is also recommended for VZ antibody-negative infants exposed to chickenpox or shingles in the first seven days of life (other than in the mother) or while still on NNU. Most infants <28/40 will be antibody-negative.

Reference: Chapter 34, Immunisation against infectious disease (The Green Book) Public Health England, August 2015.

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Tip 82: supraventricular tachycardia (SVT)

Presentation varies from antenatal hydrops and tachycardia, neonatal heart failure within the first 12-24 hours, to being asymptomatic.

The termination of SVT is usually easily achieved by vagal manoeuvres or intravenous adenosine. Unusually DC shock is needed, especially with evidence of cardiovascular compromise.

Reference: Kothari, D.S., Skinner J.R., 2006. Neonatal tachycardias: an update. Arch Dis Child Fetal Neonatal Ed; 91(2): F136-144.

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Tip 81: congenital varicella

With maternal Varicella Zoster Virus (VZV) primary infection (chicken pox) at <20/40, congenital varicella syndrome can occur which includes limb hypoplasia, microcephaly, cataracts, growth retardation and skin scarring. The mortality rate is high.

In the late 2nd and 3rd trimesters VZV infection can occur in an otherwise healthy infant. In a week before to a week after delivery severe and even fatal disease can occur.

Reference: Chapter 34, Immunisation against infectious disease (The Green Book) Public Health England, August 2015.

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February doctors’ changeover

Dear all,

For those of you changing jobs today, I wish you all the best for safe travels, a nice welcome to your new team and a good start to the job.

If you have found Neonatal Tips useful over the past 6 months, please tell your colleagues.

As always, please feedback to me likes, dislikes and suggestions, using the comment box below each post, or on the “about” page.

Warm regards,

Hazel 🙂

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Tip 80: hydrops fetalis

Hydrops fetalis is defined as the accumulation of abnormal fluid in at least two different fetal compartments (e.g. subcutaneous oedema, pleural effusion, pericardial effusion, ascites). Polyhydramnios is often associated.

Reference: Désilets, V., Audibert, F., Wilson, R., Brock, J. A., Carroll, J., Cartier, L., … & Senikas, V. (2013). Investigation and Management of Non-immune Fetal Hydrops. Journal of obstetrics and gynaecology Canada: JOGC= Journal d’obstetrique et gynecologie du Canada: JOGC, 35(10), 923-936.

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