August Changeover

Thinking of you all today as you either start a new job or work hard to care for your patients while the newbies have induction.

Please email me any feedback and tell incomers to neonatal medicine about Neonatal Tips!

All the best,

Hazel 🙂

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Tip 17a: antenatal steroids

Antenatal steroids are recommended for women in suspected or established preterm labour, are having a planned preterm birth or have premature prolonged rupture of membranes (P‑PROM) in order to reduce morbidity in the baby.

To be definitely offered between 26+0 and 33+6 weeks’ gestation.

To be considered between 24+0 and 25+6, and between 34+0 and 35+6 weeks’ gestation.

Reference: National Institute for Health and Care Excellence (2015). Preterm labour and birth. NICE guideline NG25. London: NICE.

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Tip 16: metabolic bone disease of prematurity

Premature babies are at risk of osteopenia due to lack of minerals normally accumulated in the last trimester. This increases the risk of fractures in the short-term and short stature in the long-term.

All enterally fed very preterm babies should receive phosphate as a supplement to breast milk in addition to their routine vitamin D.

References: Bishop N. Metabolic bone disease. In Rennie J, Rennie & Roberton’s Textbook of Neonatology, 5th edition, 2012. Elsevier: London.

Larmour, K., Shaw, V., 2016. Enteral nutrition for the preterm infant, version 2.0. Great Ormond Street Hospital for Children NHS Trust: London.

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Tip 15: hypothermia in preterm infants

Why are we so careful to keep preterm babies warm?

The first Epicure study revealed that an admission temperature <35ÂșC was independently associated with the risk of death. Morbidity is also worsened, especially respiratory distress syndrome and chronic lung disease.

A study in 2007 showed that admission temperature was inversely related to mortality (28% increase per 1ÂșC decrease) and late-onset sepsis (11% increase per 1ÂșC decrease).

References: Costeloe K et al. The Epicure study: Outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;106:659-671.

Laptook AR, Salhab W, Bhaskar B. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119(3):e643-9.

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Tip 14: brachial plexus injury

Complete resolution at 6 months of age: only 65% for Erb’s palsy and <10% for total palsy +/- Horner’s syndrome.

Reference: Foad SL. Prognosis following neonatal brachial plexus palsy: An evidence-based review. J Child Orthop, 2009; 3: 459–463.

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Tip 13: cleft lip and palate

Cleft lip with/without cleft palate is diagnosed antenatally in 70% of cases.

So, the rest are diagnosed on routine neonatal examination – don’t just palpate – look!

They should all be referred to a regional service.

External links: Cleft Lip and Palate Association (CLAPA)

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Tip 12: congenital anomaly register

Public Health England took over the national congenital anomalies register (previously BINOCAR) from April 2015, called ‘The National Congenital Anomaly and Rare Disease Registration Service’.

Overall, about 1 in 20 babies are born with a congenital anomaly.

External link: National Congenital Anomaly and Rare Disease Registration Service (NCARDRS)

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