Common Neonatal Problems

Mohamed Khashaba, MD
Professor of Pediatrics/ Neonatology
Head of NICU
Mansoura University
 Key elements to prevent severe
hyperbilirubinemia
.Promote and support breast feeding- 1
Measure total bilirubin for infants jaundiced in- 2
.the first 24 hour
.Interpret level according to age in hours- 3
Provide parents with written and oral- 4
informations, stress paid to ABO
.incompatibility
.Appropriate follow up- 5
 Respiratory Distress

(.Tachypnea (RR >60/min •

.Flaring, grunting and retractions •
Fractured Clavicle
Abdominal distension, visible loops
What is the most frequent cause of 1st visit
?to the clinic during the first 3 months
 Case 1
A 15 month aged infant presented with delayed
.motor milestones of development
The baby was 36 week gestation, born by C/S
and presented 3 days after birth with jaundice.
TSB was 29.9 mg/dl, no neurologic signs
.were noted
DVET was done using O blood, PETSB was19
. mg/dl
.The baby was discharged home after PEPTh
Throughout the 1st year, the infant received
multiple doses of vitamin D, cerebral
stimulants!! For delayed motor
..development
 Case 2
Maisels et al, NEJM 358:920-928
A male infant weighing 3400 g was born at 37
weeks' gestation after an uncomplicated
pregnancy.
The mother is a 24-year-old primipara who has
type A Rh-positive blood.
The infant's course in the hospital nursery was
uncomplicated. Although his mother needed
considerable help in establishing effective
breast-feeding, he was exclusively breast-fed.
• Jaundice was noted at the age of 34 hours. The
total serum bilirubin level was 7.5 mg per
deciliter (128 µmol per liter). The infant was
discharged at the age of 40 hours and is seen in
the pediatrician's office 2 days later, now with
marked jaundice. The results of his physical
examination are otherwise normal, but his
weight, at 3020 g, is 11% below his birth
weight.
• His total serum bilirubin level is 19.5 mg /dl.
(333 µmol /l), conjugated bilirubin level 0.6
mg /dl (10 µmol /l).
• CBC and peripheral-blood smear are normal.
• The infant has type A Rh-positive blood.
• The pediatrician consults a neonatologist
regarding the need for phototherapy.
 Case 3
.Male infant born 2/2/2009 to a G1P2 lady by SVD
Pregnancy was uneventful apart from PPROM for
which she received macrolide prophylaxis,
.delivery at 35 weeks
The baby needed facial O2, Apgar 5 (1min.) and 8
.(.(5 min
In the delivery room, he was given vit. K, started
.eye prophylaxis
At 2 hours of age, examination revealed a 2.4
kg, male baby. Vital signs and the rest of
.examination were reassuring
CRP and CBC were normal
At 4 hours of age, both baby and mom were
.discharged home in good status
At Day 4 OL
Baby presented to OC with jaundice, visual evaluation
revealed mild jaundice, the baby was discharged
.home with the instructions frequent breast feeding
At day 5 OL
Mom noticed abnormal movements, duskiness and
.weak suckling
.Physical examination at discharge.1
.Accurate gestational age estimation. 2
.No discharge before 48 hrs.3
.Normal vital signs for 12 hrs preceding discharge. 4
.At least 1 stool passed spontaneously. 5
.Twenty four hours of successful feeding. 6
Weight loss >7% during birth hospitalization. 7
. should be assessed for dehydration

. Blood glucose screening.8

.Risk assessment for jaundice.9

.Metabolic screening performed.10

Family,enviromental and social risk factors.11

.assessed
 Common Clinical Risk Factors for
Severe Hyperbilirubinemia
Jaundice in the first 24 h
Visible jaundice before discharge
Previous jaundiced sibling
Gestational Age 35-38 ws.
Exclusive breast feeding.
Bruesing and cephalhematoma.
Male gender.
PEDIATRICS Vol. 108 No. 3 September 2001, pp. 763-765
 (Late preterms (34 - <37 ws
Approximately 500 000 born prematures in
USA/year (12.5 % of live birth)
More than 70% are late preterms (350 000)
 frequency %
frequency %PEDIATRICS Vol. 108 No. 3
September 2001, pp. 763-765
.Feeding diffic 32 7
Hypoglycemia 16 5
Jaundice 54 38
Temp. instability 10 0
Apnea 6 0.1>
Iv fluids 27 5
Evaluation for 37 13
sepsis
.Mechanical vent 3.4 0.9
 AAP Guidelines
Any infant who is jaundiced before 24 hours
requires a measurement of the serum
bilirubin level and, if it is elevated, the
infant should be evaluated for possible
hemolytic disease.
Follow-up should be provided within 2 to
3 days of discharge to all neonates
discharged at <48 hours after birth.
 .(AAP Guidelines ( cont

Early follow-up is particularly important for infants <38

weeks' gestation.
The timing of follow-up depends on the age of discharge
and the presence of risk factors.
In some cases, follow-up within 24 hours is necessary

PEDIATRICS Vol. 108 No. 3 September 2001, pp. 763-765

Every pregnant lady should have her ABO
.blood group known before delivery
In case of O group, ABO group of the
.husband should be determined
,In case of ABO incompatibility
The newborn baby should be considered at
.risk of early jaundice and kernicterus
 Irradiance
Spectral irradiance is the irradiance delivered
in certain wave length to the surface of the
.infant
Measured with Radiometer as µW/ cm2/nm.
Standard PT deliver 10 µW / cm2/nm.
Intensive PT delive 30 µW / cm2/nm.
 Factors affecting PT efficacy
1. Infant's distance from the light .
2. Infant's eyes protected with opaque eye patches.
3. Area of skin exposed (hence the need for a light
source beneath the infant for intensive
phototherapy).
4. If the total serum bilirubin level continues to rise
despite treatment, the diaper should be removed.
5. Aluminum foil or white cloth placed on either side
of the infant to reflect light .
.(Factors affecting PT efficacy (cont
6.Blue light is most effective for phototherapy,
best wavelengths to use are probably in the range of 460 to
490 nm.
7.Light rays should be perpendicular to the surface of the
incubator in order to minimize loss of efficacy due to
reflectance.
8.Term and near-term infants are treated in a bassinet, to
allow the light source to be brought to 10 to 15 cm of the
infant .
 Sunlight
Will lower the serum bilirubin level.
Practical difficulties preclude the use of
sunlight.
 Key elements to prevent severe
hyperbilirubinemia
.Promote and support breast feeding- 1
Measure total bilirubin for infants jaundiced in- 2
.the first 24 hour
.Interpret level according to age in hours- 3
Provide parents with written and oral- 4
informations, stress paid to ABO
.incompatibility
.Appropriate follow up- 5