Tip 36: sucrose as analgesia

A Cochrane review showed that oral sucrose (with or without non-nutritive sucking) significantly reduced pain scores associated with heel lancing, venepuncture and IM injections but not ROP screening.

The effects on extremely preterm infants or the long-term effects on any infant of repeated dosing are not known.

Reference: Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub5.

 

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Fun 3: Badger

Sometimes, Dave felt that Badger was getting too much for him.

IMG_0853

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Tip 35b: NAIT

There is a high risk of intra-cranial haemorrhage, so cranial USS should always be done & plts maintained >30 x 109/L (or >50 if evidence of bleeding) with HPA-1a-negative plts.

Reference: Chakravorty, S. and Roberts, I., 2012. How I manage neonatal thrombocytopenia. British Journal of Haematology, 156(2), pp.155-162.

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Tip 35a: NAIT

Neonatal alloimmune thrombocytopenia (NAIT) is the platelet version of haemolytic disease of the newborn, occuring in 1:1000 – 1:1500 pregnancies. The most common antibody is anti-HPA-1a.

Reference: Chakravorty, S. and Roberts, I., 2012. How I manage neonatal thrombocytopenia. British Journal of Haematology, 156(2), pp.155-162.

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Tip 34b: thrombocytopenia (term)

Early-onset thrombocytopenia  (<72h, plts <150 x 109/L) in term infants (especially if  plts <50) needs investigating as it is more likely to be due to neonatal alloimmune thrombocytopenia (NAIT) which carries a high risk of intra-cranial haemorrhage.

Reference: Chakravorty, S. and Roberts, I., 2012. How I manage neonatal thrombocytopenia. British Journal of Haematology, 156(2), pp.155-162.

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Tip 34a: thrombocytopenia (preterm)

Early-onset thrombocytopenia (<72h, plts <150 x 109/L) in preterm infants is most likely due to placental insufficiency, perinatal asphyxia, perinatal or congenital infection, and should resolve within 14 days.

Reference: Chakravorty, S. and Roberts, I., 2012. How I manage neonatal thrombocytopenia. British Journal of Haematology, 156(2), pp.155-162.

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Tip 33b: congenital CMV

>90% infants with infection are asymptomatic but can still develop sensorineural hearing loss.

Other symptoms/signs are: IUGR, microcephaly,  thrombocytopenia, jaundice, hepatitis, pneumonitis, periventricular calcification, chorioretinitis and cataracts.

Reference: Rennie & Roberton’s Textbook of Neonatology, 5th Ed, 2005. London: Churchill.

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