Common Neonatal

Problems
Dr. D.Hazarika
Dept of Pediatrics
Jorhat Medical College & Hospital
 The knowledge regarding various developmental
variations and physiological conditions and their evolution
is important for giving proper advice, guidance and
assurance to the mother.
Most mother observe their babies carefully and are
often worried by minor physical peculiarities, which may
be of no consequence.
Her complains, must be listened to carefully and
should not be ignored lightly without doing proper
evaluation of the baby…….
Vomiting:
• Amniotic fluid gastritis: Present of Day1, non-bilious, no
abdominal distension, responds to stomach wash with nornal
saline

• GER :

– Often a normal phenomenon, regurgitation of feeds, non

projectile, non bilious, active and alert baby, feeding normal
and appropriate weight gain
– Avoid bottle feeding
– Nurse in right lateral position after adequate burping

• Bilious vomiting or persistent vomiting : Refer

Constipation:

• Frequency can be as long as 3 to 7 days

• No abdominal distension or vomiting
• Look for Hirsch rung's and hypothyroidism
• Local inspection for fissures if stool is hard or blood
stained
• May need enema in some cases.
• Laxatives should be avoided
Hiccups & sneezing:

Hiccups are due to spasmodic contractions of the

diaphragm.
They usually occur immediately after feed due to
distension of the stomach, which then irritates the diaphragm
muscle above.
Burping the baby will facilitate the exit of air from the
stomach

Sneezing occur due to irritation of nostril by secretion.

Usually not considered as URTI.
Superficial infection:

• Skin pustules

• Conjunctivitis

• Umbilical sepsis

• Thrush
Neonatal Pustular Lesions
Herquiline Phenomena

 Striking reddening of one

side of the body and
blanching of the other half
with a sharp line of
demarcation in between.
 Each episode may last from
seconds to minutes
occasionally longer and the
episodes may recur.
 Such episodes occur most
often during the first few
days of life.
 A vascular manifestation of
the autonomic dsfunction
in the newborn.
Salmon Patch
Port Wine Stains
Skin and mucus membrane:

• Cephalhematoma/sub-galeal: Evaluate for pallor and jaundice

(day 3 and day 4)

• Sub-conjunctival H’mage: No treatment

• Eye discharge
– No treatment if no redness or swelling and non purulent

• Obstructed nasolacrimal duct

– Massage from angle of eye to the nose
– Probing after 12 months
Excessive crying:
•Newborns may be excessively troublesome
especially in the night.
•In continuation to their intrauterine behaviour
the babies may be used to sleeping during the day
and playing in the night.
•It may take 4-6 weeks for the baby to establish a
routine of sleeping in the night. A lot of patience,
common sense goes into handling a crying baby.
Evening colic:

It is attributed to an immature gastrointestinal

system. However the exact cause is not known.
The babies tend to have sudden crying spells with
flexion of thighs and flushing of face.
It normally occurs around the same time everyday and
lasts for few minutes to few hours.
The excessive crying leads to further swallowing of air
and leading to vicious cycle of colic-crying-colic.
It is more common in first born wiry active babies
born to anxious parents and grandparents.
Putting the child in prone position, holding the baby
against skin, cuddling, patting, rocking, taking him for a
drive etc may help. The condition spontaneously resolves in
a couple months.
Excessive sleepiness:

Some babies may keep their eyes closed in the first 48

hours after delivery.
During first few days of life many infants go to sleep
after just a few sucks.
They should be aroused during feeding by tickling on
the soles or behind the ear but it should not be carried to the
point of discomfort.

Lack of interest in feeds and lethargy in a child who was

previously active and feeding well is a cause for concern and
should be immediately brought to the paediatrician's notice.
Persistent lethargy may also need investigation.
Disorder due to trans-placental passage of
hormones:
• Mastitis neonatorum: 3rd or 4th day.
No local massage, squeezing

• Vaginal bleeding: 3rd to 5th day. Last

for 2-4 days.

• Mucoid vaginal secretion: should not

be mistaken for purulent discharge
Cephalhematoma:

It is the collection of the

blood under the bone periosteum
due to the rupture of emissary vein
during labor.

Never present at birth.

Fluctuant swelling.

It does not cross the suture

lines and spontaneously resolves in
few days to few weeks.
Cradle cap:

It is the seborrheic cap with

crusty rash seen on the crown of the
head in infants.

Ketoconazole shampoo can alleviate this

condition. In resistant cases a mild
steroid may be prescribed.
Umbilical granuloma:

It is a small fleshy pale

nodule at the base of the
umbilicus with persistent
discharge.
It does not allow the
umbilical stump to dry and heal.

It is managed by
cauterization with silver nitrate,
copper sulphate or common salt.
Local sepsis may be managed
with local antibiotics.
Sore buttocks, nappy rashes:

Use of nylon or plastic water

tight nappies can cause redness,
excoriation and indurations of the
nappy area, and may be associated
with pain and irritability.
The nappy area should be kept
clean and dry and exposed to air.
Soiling should be immediately
cleaned and kept dry.
A soothing cream can be used.
Sometimes if fungal infection is
present an antifungal ointment can be
used.
Erythema toxicum:

• Small white occasionally vesiculo-pastular papules on an

erythematous base
• Develop 1-3 days after birth
• Benign rash
• Persists for as long as 1 wk
• Contain eosinophils
• Face - > trunk - > extremities
Peeling of Skin:

Most common in post

term babies

Cutis Marmorata:

Red or blue marbled

cutaneous vascular pattern
over the extremities in
infants exposed to low
environmental temperature
Milia:
Yellow white spots- D/T
retention of sebum

Stork- bites:
• Discrete pinkish white sparse
capillary hemangioma
• Nape of the neck, upper eyelid,
forehead, root of the nose.

Epstain pearl:
White spot one or either
side of the median raphe.
Oral Thrush
Acne neonatorum:
Acne lesions on the
forehead, cheeks and nose may be
seen at birth or soon after birth in
term babies.
They are due to the trans-
placental transfer of maternal
hormones (androgens) to the
foetus.
They normally resolve by
themselves.
Congenital Teeth:
• 1:4000
• No treatment unless loose or
interfere with feeding

Tongue Tie:
Fibrous franulum under the tongue
producing a notch at the tip of the
tongue due to traction.

Sucking callosities:
Button like cornified plaque over
the center of upper lip at birth.
Mongolian Spots
These dark blue-grey
lesions are most commonly
seen in darker-skinned
infants.
The sacrum is the
most commonly affected
area.
Fade over several years but
may not completely
disappear.
No evaluation is
needed.
•Congenital hydrocele: Disappear within first 3 months

•Physiological phimosis: Normal up to 2 yr

•CTEV: Need treatment from birth

Cleft lip and Cleft palate:

• Feeding by Palade or bottle

• Correction of cleft lip by 10
weeks and cleft palate by 10
months
• As early as possible
• Prognosis good but risk of
recurrent ear infections
Cryptorchidism:

Assess for scrotum,

hypospadiasis, palpable
mass
• Unilateral : most descent
by 1 year
• Medical treatment and
surgical options after 1year
only
• Hypospadiasis or bilateral
Congenital Hydrocele
Umbilical hernia:
Out pouching of the
umbilicus especially when
straining or crying may be seen in
some babies.
As the baby grows the tone
in the abdominal muscles
increases and the umbilical hernia
resolves spontaneously.
 Occurs in as many as 1 in 6
children.
 They are due to incomplete
closure of the ring of muscle
around the umbilical ring
through which the umbilical
vessels enter the fetus.
 They are more common in
preterm infants, in children
with Down Syndrome, and
children with hypothyroidism.
 Most umbilical hernias close
spontaneously within 3-5
years.
 If the hernia is still present at
the age of 3, referral to a
paediatric surgeon is
indicated.
Common surgical Problems
Problem Intervention Remarks

Indirect inguinal hernia Needs repair as and when Can get obstructed if left
diagnosed alone
Operate before discharge in
case of preterm

Umbilical hernia Surgical indications are- Occurs in 20% of

1. Large hernias newborns; closes
2. One which has not spontaneously in 12 months
closed for 3 years but may take up to 3 years
3. Incarceration

Umbilical granuloma Apply a very small pinch of Silver nitrate application

table/cooking salt over the not advisable as there is a
umbilical granuloma. risk of burns to the
Cover the area with a gauze surrounding skin.
dressing and hold it in In case of continuous
place for 10-30 minutes. discharge from umbilicus
Clean the site using a clean rule out infection and
gauze soaked in warm patent vitello-intestinal
water. Repeat the duct.
procedure twice a day for
at least 3 days
Labial Adhesions (Vulval Syncechiae)
THANK YOU