Categories
- Antenatal (157)
- Cardiac (65)
- Congenital anomalies (191)
- Dermatology (19)
- Endocrine (21)
- Fun (17)
- Gastrointestinal (83)
- Haematology (67)
- Infection (153)
- Management (23)
- MCQs (16)
- Metabolic (84)
- Neurology (94)
- Nutrition (55)
- Ophthalmology (26)
- Prematurity (267)
- Renal (24)
- Respiratory (111)
- Screening (80)
- Trials (38)
- Uncategorized (67)
Category Archives: Cardiac
Tip 114: pre- and post-ductal oxygen saturations
Pulse oximetry from the right upper limb (pre-ductal) and lower limbs (post-ductal) can identify a right-to-left shunt through the ductus arteriosus. In a right-to-left shunt, the post-ductal circulation contains mixed blood from the right-side (pre-lung) and the left-side (post-lung) and hence the … Continue reading
Posted in Cardiac
Leave a comment
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 … Continue reading
Posted in Cardiac
Leave a comment
Tip 78: PDA medical treatment
Treatment of a symptomatic PDA in a preterm infant is usually by fluid restriction (and waiting for spontaneous closure) or ibuprofen (indomethacin is no longer available in the UK.) The Cochrane review below included the following findings. IV ibuprofen showed a … Continue reading
Posted in Cardiac, Prematurity
Leave a comment
Tip 76: PDA 2
Due to an increased left (aorta) to right (pulmonary artery) shunting, a significant PDA is associated with renal impairment / failure, intestinal perforation / NEC, and severe IVH / PVL, possibly due to systemic ‘steal’. The increased pulmonary blood flow can … Continue reading
Posted in Cardiac, Prematurity
Leave a comment
Tip 75: patent ductus arteriosus (PDA)
The incidence of PDA in term infants is ~6: 10,000 live births. In preterm infants, especially <1500g, the incidence can be up to 33%. Over half of infants weighing <1kg are symptomatic and require medical treatment for PDA closure. Reference: … Continue reading
Posted in Cardiac, Prematurity
Leave a comment
Tip 41: congenital heart disease
The prevalence of structural congenital heart disease is approximately 5 per 1,000 total births (~0.5%). The antenatal diagnosis of serious congenital heart disease is only 50%. The incidence of heart murmurs on day 1 examination, however, may be as high as … Continue reading
Posted in Antenatal, Cardiac, Congenital anomalies
Leave a comment
Tip 196: cyanotic congenital heart disease 2
The cyanotic causes of congenital cardiac disease in the neonatal period can be split into: Those with right to left shunt: Pulmonary atresia Tricuspid atresia Ebstein’s anomaly Those with common mixing: Truncus arteriosus, double inlet / outlet ventricles Transpositon of the Great Arteries (TGA) Total … Continue reading
Posted in Cardiac, Congenital anomalies
Leave a comment
Tip 194: cyanotic congenital heart disease
Clinical features suggesting a cardiac cause of cyanosis include: Little / absence of respiratory distress Cyanosis not improving with oxygen delivery Hypo / normocapnia on blood gas Presence of shock / metabolic acidosis Abnormal heart shadow / lung vasculature on … Continue reading
Posted in Cardiac, Congenital anomalies
Leave a comment
Tip 193: PDA 3
The clinical features of a patent ductus arteriosus include: Bounding pulses Active precordium (presence of ventricular heave) Continuous / systolic murmur in pulmonary area (left infraclavicular) Respiratory distress failing to improve or deteriorating at 5 – 10 days of life, including apnoea … Continue reading
Posted in Cardiac, Prematurity
Leave a comment
Tip 159: pulse oximetry screening
PulseOx was a large multicentre UK study of pulse oximetry screening (~20,000 neonates >35/40) published in 2011. 53 had major congenital heart disease (24 critical), a prevalence of 2·6/1000 live births. 35 of these were already suspected from antenatal ultrasound scan. After … Continue reading
Posted in Cardiac, Congenital anomalies, Trials
Leave a comment
Neonatal Tips 