Differentials Abdominal Pain
Neonatal Jaundice
Jaundice Ix
Indications
1. 1st 24 hours of life
2. Elevated conjugated Br
3. Rapidly rising
4. Not responsive to phototherapy
5. > 2weeks old
6. Ill appearing
Ix
FBC
Blood film
Haemolysis screen - retics, LDH, haptoglobin, Coombs
Ill appearing - septic screen, BSL, urine, ammonia
Risk Factors for hyperbilirubinaemia
- Premature < 37 weeks
- Isoimmune mediated haemolysis
- Sepsis
- Acidosis
- Cephalhaematoma
- Dehydration
- Genetics - Hereditary spherocytosis, G6PD
Vomiting DDx
Meckel’s Diverticulum
- Congenital abnormality of the small intestine in 2% of the population
- 2% symptomatic
- 2 inches long
- 2 feet from the ileocoecal valve
- 2 types of ectopic tissue: gastric or pancreatic
- 2:1 male preponderance
Cause = incomplete obliteration of omphalomesenteric duct
Presentations
* Obstruction
* Intussusception
* GI bleeding (ectopic gastric tissue)
* Anaemia 2 to GI bleeding
* Inflamation w/ fever, vomting, AP
Mx
Surgical resection
- diverticulum
- ileal segment if GI ulceration/bleeding
HSP Clinical Manifestations
HSP Considerations for admission
Consider admission
* Serious abdominal complications
* Severe debilitating pain
* Severe renal involvement
- HTN, proteinuria, impaired renal function
- Nephrotic or nephritic syndrome
* Neurological or pulmonary involvement
* Prednisolone treatment initiated
* Dvpt HTN, proteinuria or macroscopic haematuria
Dehydration Severity Assessment
Dehydration Asessment
High Risk Features
Take Hx re intake/ouptut/losses
Recent use of hyper/hypotonic fluids
Risks for severe dydration
* < 6 months
* GI Pathology
* CF
* Metabolic disorders
* Renal impairment / diuretic use
Dehydration => high risk for child
* Complex / cyanotic HD
* Slow wt gain
* Immunocompromised
* Post-organ Tx
* Nephrotxic medications
Rapid NG Rehydration
Indications: mod dehydration, expedite clinical improvement with aim to discharge home
NG insertion
ORS 10-25mls/kg/hr (4-10% deficit) for 4 hours
CI
Severe dehydration
Resp or CNS illness
Sig electrolyte abnormalities
< 6 months
Sig comorbidities
AP
Slow NG rehydration
Indications: mod dehydration when large fluid vol not desired
First 24hrs
5% deficit over 6 hrs, then full maintenance over 7-24 hrs
Next 24 hrs
Replace deficit if still indicated + maintenance volume
Midgut malrotation
NEC
Intusussception
GI bleeding
GI bleeding neonates vs adults
