Tip 79: oligohydramnios

Severe, prolonged oligohydramnios/anhydramnios is likely to cause pulmonary hypoplasia with high early neonatal mortality. There may also be IUGR, limb contractures (arthrogryposis) and typical Potter’s facies (abnormal ears, flattened nose and epicanthic folds).

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

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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 reduction in failure rate to close PDA compared with placebo (RR 0.71 (95% CI 0.51 – 0.99)). 1 study, 134 babies.
  • Ibuprofen is as effective as indomethacin in closing a PDA, and has a reduced risk of NEC (RR 0.64 (95% CI 0.45 to 0.93)). 16 studies, 948 babies.

Reference: Ohlsson AWalia RShah SSIbuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infantsCochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD003481. DOI: 10.1002/14651858.CD003481.pub6.

 

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Tip 77: clinodactyly

Although 5th finger clinodactyly is associated with some syndromes (e.g. Down syndrome), it is a common minor abnormality with a UK population incidence of ~1%

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

 

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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 increase pulmonary blood flow can lead to alveolar pulmonary oedema, decreased lung compliance, difficulty weaning off mechanical ventilation and subsequently chronic lung disease.

Reference:  Hamrick S., Hansmann G., 2010. Patent Ductus Arteriosus of the Preterm Infant. Pediatrics; 125 (5): 1020 – 1030.

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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:  Hamrick S., Hansmann G., 2010. Patent Ductus Arteriosus of the Preterm Infant. Pediatrics; 125 (5): 1020 – 1030.

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Tip 74: phenylketonuria (PKU)

PKU is caused by mutation to the phenylalanine hydroxlase (PAH) gene on chromosome 12q. It has autosomal recessive inheritance. Incidence is ~1:10,000 – 1:15,000 (USA).

Early and life-long treatment with a low phenylalanine diet prevents serious outcomes (intellectual disability, seizures). Temporary non-adherance to the diet leads to behavioural changes, which may appear like ADHD.

References: Genetics Home Reference. Phenylketonuria.

The National Society for Phenylketonuria

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Tip 73: antenatal umbilical artery Doppler

In normal pregnancy, there is a progressive increase in end-diastolic velocity due to growth and dilatation of the umbilical circulation.

In some pregnancies with IUGR and/or pre-eclampsia, there is a reduction in the diastolic velocity and in severe cases there is absent or reversed end diastolic velocity.

Dopplers

Reference: McCowan, L., 2001. Doppler Studies in High Risk Pregnancies. Guideline from Auckland and District Health Board: Neonatal Intensive Care.

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