Dr Marea Murray-neonatal

Dr Marea Murray-neonatal - Common Neonatal Problems Dr...

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Common Neonatal Problems Dr Marea Murray Staff Neonatologist Blacktown Hospital
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Concerning Congenital Heart Disease (CHD) A. Murmurs noted in the first day are usually pathological B. The Newborn examination picks up 90% of CHD C. Neonatal cardiac examination does not need to be repeated in the first week for those babies who are discharged early D. Reduced femoral pulses suggest coarctation and need urgent investigation E. Basal crepitations and peripheral oedema are the most reliable signs of CHF in a neonate
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Congenital Heart Disease Remember CHD may not be evident at birth Murmurs on day 1 often reflect the transitional changes and are not significant Early discharge has meant a higher rate of missed CHD on the Newborn check and the need to examine the baby again later in the first week of life Murmurs and other signs of CHD often evolve with age related to changing fetal communications eg closure of the ductus arteriosus Changes in pulmonary vascular resistance
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Clues to Significant CHD Is there a family history of CHD? Is the baby normal or is there a syndrome? Eg Downs Williams Velocardiofacial (C/S 22 deletion) Is the patient cyanosed?
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Clues to Significant CHD Are there symptoms / signs of CHF? Feeding difficulties Tachypnoea Tachycardia Hepatomegaly Sweating around the head Other signs to look for:- Blood pressure - Beware false readings on the dynamap Pericardial over activity / thrill Murmur
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Murmurs If the only abnormal sign is a murmur it is usually not urgent to refer to a Paediatric Cardiologist Cardiac murmurs are not synonymous with CHD Possible to use the local paediatricians to help screen these babies if uncertain Remember there can be significant CHD and NO murmur
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Investigation of CHD - Basic CXR Situs Position Contour Size Pulmonary vascularity Look for right sided aortic arch Found in 25% OF Tetralogy of Fallot and 40% of Truncus arteriosus
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Investigations - Basic ECG In rare situations may be diagnostic eg AV canal Ostium primum ASD and Tricuspid atresia = superior axis Look for ventricular hypertrophy Can be difficult to interpret in the newborn eg normal to have RAD and RV more dominant Hb and Film Can underestimate cyanosis with anaemia Polycythaemia causes over diagnosis of cyanosis Look for Howell Jolly Bodies- suggests asplenia, has association with complex CHD
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Investigations - Advanced Referral to Children’s Hospital for Paediatric Cardiology assessment Echocardiography
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Dr Marea Murray-neonatal - Common Neonatal Problems Dr...

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