(精选)Care of the Newborn教学课件.pptVIP

Trunk and spine – sacral dimple Hips Extremities – talipes equinovarus Neuro / Sacral dimple Characteristics: depth, location, other findings Tethered cord association – stretching of the spinal cord with back pain, bladder dysfxn, leg weakness, sensory loss Management – consider US Ortho Congenital hip dysplasia – Ortilani/Barlow Club foot Management: Ultrasound for hips Refer to CHEO ortho prn Subgaleal hemorrhage Rupture of emissary veins (connections between dural sinuses and scalp veins) Initially progressive Scalp may feel firm to fluctuant, may have crepitus or fluid waves This space can hold 250 ml blood Blood may extend to orbital margins, nape of neck May develop severe hypovolemia eg. Pallor, tachycardia Add image Discharge considerations Review clinical pathway No stool or void in first 24 hours? No risk of GBS or subgaleal hemorrhage? XS weight loss/major feeding problems? Jaundice/hyperbilirubinemia risk factors? Social concerns? No follow-up? Post-procedure bleeding? ie. Frenotomy, circumcision Screening completed? Hospital Stay for Healthy Term Newborn Infants, American Academy of Pediatrics, Pediatrics, Vol 135, number 5, May 2015 Newborn care challenge Just prior to discharge the parents of the 1 day old infant ask you about circumcision. They have no religious affiliations. Do you encourage or discourage the practice? Circumcision CPS – Neonatal circumcision revisited 1996 “overall evidence of the benefits and harms is so evenly balanced that it does not support recommending circumcision as a routine practice for newborns” Benefits 1. UTI decreased 10-12 fold (1% vs. 0.1%), NNT appx 100 - Bacteria colonize under the foreskin - UTI incidence in newborns is 1-2 % 2. Reduced incidence of penile cancer (incidence 1 per 100,000) and HIV - RR penile cancer is 3.2 uncirc vs. circ - Role of HPV in penile cancer, vaccine now available Risk of complication is 0.2-2% Complications: bleeding infxn cosmesis ur