Presentation

Newborn

Key Conditions

Key conditions are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a clinical approach. They highlight conditions that may be unique to paediatrics, that are essential, or that are common. Key Conditions can present in a number of ways – each is listed as under the most common Clinical Presentation.

Clinical Approach

Clinical approaches represent one of many methods to think through a clinical presentation, and narrow down a differential diagnosis. There are many conditions that can present with similar symptomatology. These presentations are not meant to contain an exhaustive list of differential diagnoses, but rather outline how to think through patient signs and symptoms, and understand some of the most common and important Paediatric conditions. There are many different ways to approach any clinical presentation, and these approaches are not meant to replace clinical judgement.

Vignette

You are looking after infants in the newborn nursery. You are seeing a 1 day old infant, born to first-time parents. They have many questions in regards to care of their newborn daughter.

Pre-Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Objectives

By the end of the Paediatric Clerkship, a medical student will be able to:

  • Propose an investigation and management plan for a baby with each of the following: respiratory distress, cyanosis, hypoglycemia, hypothermia, sepsis, hypotonia.
  • List the associated medical issues of a premature baby, a large for gestational age baby, and a small for gestational age baby.
  • Describe the management of an abnormal newborn screen.
  • Correctly perform a physical exam on a newborn.Recognize abnormal physical examination findings and list the significance of each abnormal finding.
  • Recognize and identify dysmorphic features in a newborn.
  • List the signs and symptoms that are suggestive of neonatal abstinence syndrome.
  • Explain why vitamin K is given immediately after birth.
  • Describe the risk factors for birth trauma and list the injuries a baby might sustain following a traumatic delivery.
  • List the congenital infections that are routinely screened for during pregnancy.

Half Day Cases

  • 1 day old baby boy was born at 36 weeks gestation to a 31 year old G3, P1 mother with premature rupture of membranes occurred 27 hour prior to delivery. The infant was pale and did not cry immediately. The infant has not nursed well for the last 12 hours, developed fever over the past 6 hours and noted to be lethargic.
  • 1 Hour old term baby boy birth weight was 4100g 38 weeks IDM was born by Caesarean section due LGA. Normal Apgar score. Needed routine resuscitation. On examination the baby is tachypnic and grunting. No heart murmur.
  • Newborn Preterm 31 week male (BW 1300g), Uncomplicated pregnancy. Required significant resuscitation including IPPV and Nasal CPAP+6 FiO2 30%. Placed on the warmer in the delivery baby started to have increased working of breathing with desaturation and bradycardia.
  • Preterm 25 weeks baby boy (BW 750g) born by Caesarean section due uncontrolled gestational hypertension GBS unknown. Mother did not receive antenatal steroids.
  • 2 days old baby girl term 39 weeks SGA BW 2400g was born by SVD to 21 years old mother. Uncomplicated pregnancy, Normal Apgar score. Needed routine resuscitation. Discharged physical exam was normal accept for abnormal red reflex.
  • 8 hours baby girl term baby 39 weeks (birth weight 4100g) born by SVD to mother 35 years old G3P2 her pregnancy was complicated with gestational diabetes and was controlled with insulin, baby was not feeding well and noticed to be irritable and jittery.

Resources

The following resources have been reviewed and collated by canuc-paeds. These resources are aimed to provide information at the level of the medical student. These include overviews of topics, clinical resources, and useful guidelines that contain relevant materials.

Papers 

  • Care of the well newborn. Phillpi WJB.  .
    ; Pediatrics in Review 2012; 33: 4-18. .
    Overview article; very comprehensive article covering many aspects of neonatal evaluation and care (antenatal care, early postpartum transitioning, anticipatory guidance, discharge readiness).
  • Respiratory Distress in the Newborn. . Hermansen C et. al.
    ; American Family Physician 2007; 76(7). http://www.aafp.org/afp/2007/1001/p987.pdf.
    Covers diagnosis and management of common causes of respiratory distress in the newborn (transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration) with good visuals (X-rays). Gives a good differential of less common causes.
  • Management of Neonates with Suspected or Proven early-onset Bacterial Sepsis. Polin RA.
    ; Pediatrics 2012; 129(5): 1006-15. .
    Discusses infants at risk for early-onset sepsis, including evaluation, treatment, prevention, as well as clinical challenges.

Videos 

No videos.