And here are the answers to the Neonatal Crossword Round
1. Syphilis
A congenital infection presenting with a maculopapular rash that can desquamate and have characteristic x-ray long bone changes.
Congenital syphilis is not uncommon in developing countries. Pathognomic signs for congenital syphilis include a generalised maculopapular rash that can desquamate, rhinorrhoea and involvement of the long bones. Long bone x-rays will show translucent metaphyseal bands, osteochondritis, osteitis and metaphysitis and periostitis. Have a look at Trisha’s post on neonatal rashes you shouldn’t ignore for some more serious neonatal rashes.
2. Hyperbilirubinaemia
Prolonged and can be split.
Prolonged hyperbilirubinaemia (>14 days in term and >21 days in prems) needs further investigation. Look for clinical clues like hepatomegaly and encephalopathy. For a brilliant acronym on clinical signs, causes and investigations for pathological jaundice read Shalome’s neonatal jaundice post.
3. Trisomy
13, 18, 21
Trisomy 13, 18 and 21 are examples of chromosomal structural abnormalities and these children present with syndromes of recognisable patterns of morphological abnormality. Genetic testing benefits include confirmation and implications for treatment, prognosis and recurrence. Have a look at this post for a few more examples of genetic syndromes.
4. Ultrasound
A 20 day old baby presents with worsening respiratory distress since birth. Which investigation will differentiate between a diaphragmatic hernia and phrenic nerve palsy?
Phrenic nerve palsies can occur after birth trauma and commonly after thoracic surgery causing hemi-diaphragmatic paralysis. Both phrenic nerve palsies and congenital diaphragmatic herniae can look similar on chest x-ray so ultrasound can be really useful to differentiate between them. Plication is the most common surgical treatment. Read more on whether there is a connection between phrenic nerve and Erb’s palsies on Abbey’s a pair of palsies post.Â
5. Ortolani
This test is positive when a posterior dislocation of the hip is reducible with this manoeuvre.
Infants can have asymmetric skin creases but not all have asymmetric skin creases with risk factors for Developmental Dysplasia of the Hip (DDH). Read more on the clinical exam and use of imaging for diagnosing in Andy’s post on diagnosing DDH.
6. BRUE
An acronym used to explain an event in an infant which could be due to a totally benign or alternatively very serious condition.
This new definition: a Brief, and now Resolved, Unexplained Event stratifies patients. Low-risk BRUE’s do not need admission but do require certain investigations. Read more on who fulfils criteria as a low-risk BRUE and what to do for them in Tessa and Damian’s Fancy a BRUE and Tessa’s BRUE is the new black posts.
7. Pylorus
Babies become alkalotic when this becomes obstructed.
Only 1 in 7 cases of pyloric stenosis will have the classic triad of forceful and projectile vomiting, visible peristalsis and the palpable ‘olive’. Babies usually present at around 6 weeks of age and are usually hungry and dehydrated. Read more on typical gas findings and management in Erin’s pyloric stenosis post.
8. Hypoglycaemia
Monitored for in high-risk babies but no one can agree on a universal definition.
Some risk factors for hypoglycaemia include prematurity, small for gestational age babies, infants of diabetic mothers and even hereditary defects in carbohydrate or amino acid metabolism. It is always best to screen those at risk, avoid hypoglycaemia in hospital and check your hospital protocol for the correct threshold for intervention in hypoglycaemia. Want to read more about low sugar level thresholds? Read How low can you go? by Becky, Jasmine and Alasdair.
9. Umbilicus
Can be in or out. Has 3 vessels.
2 Arteries. 1 Vein. Did you know the umbilical vessels can be catheterised up to 7-10 days after delivery? If the cord is dry, apply saline-soaked gauze around the cord for at least one hour prior to the procedure. Read more on topics involving the umbilicus in Andy’s navel gazing post.
10. Gastroschisis
A congenital cause of short gut.
Other common causes of short bowel syndrome or short gut include those children who have undergone procedures for necrotising enterocolitis and volvulus. The amount and anatomy of the remaining gut determines the outcome of enteral and parenteral nutrition. Read more on the complications and management of short bowel syndrome in this post by Li-Zsa.
11. Desaturating
“Sophie is ………… and her murmur has disappeared. I think she’s having a hypercyanotic spell.”
Cyanotic heart conditions generally have some derangement with either their pulmonary or systemic blood flow. Baseline saturations or status of Tetralogy of Fallot depends primarily on the degree of pulmonary stenosis (or pulmonary outflow obstruction). Read further on how to manage a tet spell in Tessa’s congenital heart disease in PEM post.
12. Meconium
Passage of this is delayed in Hirschprung’s.
When faced with a delayed passage of meconium also think about cystic fibrosis, meconium plug syndrome and make sure there are no anorectal malformations. Want to know about infant stools? Read Andy’s poop patrol post.
13. Ammonia
A blood test that should always be sent when a baby is lethargic (and in fact when any child has a decreased conscious level of unknown cause but is often forgotten).
Always suspect metabolic disease when things don’t quite fit together. History is key, together with signs and start with tests including glucose, ammonia, lactate, gas, LFT’s, FBC, plasma amino acids and acylcarnitine’s and urine organic acids. Read more on inherited metabolic disorders in Katie’s spotting the zebras post.
14. Prostin
Get this out the cupboard when a baby comes in blue or shocked.
Congenital cyanotic right heart obstructions such as TOF’s, transposition of the great arteries with ventricular septal defect and pulmonary stenosis generally present after the resuscitaire. Listen to this great DFTB podcast to learn more about congenital heart disease.
And the hidden word?
BUBBLES (of course)
