Tag Archives: newborns

October 2018 newsletter

This month brings a handout entitled “Towards a healthy lifestyle…” which is a collaboration between dietitians, physiotherapists, psychiatrists and paediatricians at Homerton Hospital.  We have found many families are keen to do something about their child’s weight but don’t know where to start.  Hopefully this friendly article aiming for families to be “healthy enough” is a good place to start.

Also a bit on faltering growth, on-line safety, BRUE and the investigations that do not need to be done.  Tachycardia is (of course) mentioned again.  Do leave comments below.

May 2018 newsletter published

Cyclical vomiting this month as the message from the front line, BESS as a learning point for those monitoring the size of an infant’s head, milia also for the babies and the perennial problem of whether or not montelukast works to control episodic wheeze.  Do leave comments below:

March 2018 PDF in time for Easter

NICE on faltering growth this month, paediatric stroke, a reminder of the new epilepsy classification and a contribution from the safeguarding team on what constitutes a “legal high”?  Do leave comments below:

November 2017 PDF

Children’s cancer information this month – prevalence and red flags, a link to the excellent immunisation resource – Oxford vaccine group – for all those questions about individual immunisations that you can’t always answer,  NICE’s recent UTI update and infant dyschezia.  Do leave comments below.

July 2017 PDF

Proteinuria this month, babies’ poo, bedwetting and a bit more on paediatric hypertension.  Please do leave comments below.

February 2017

The burns triage tool this month plus a bit on urinalysis (pH) and the start of our decoding the FBC series.  Also a reminder about the MAP guideline for management of CMPA in primary care, a link to some good courses on this topic and to a document I have put together on milks to use in the UK for CMPA.

Paediatric Haematology: Decoding the full blood count (Hb and RBC)

With thanks to Dr Alexandra Briscoe and Professor Irene Roberts for their collaborative work.

The red cell count and haemoglobin (see February 2017 newsletter for normal ranges)

The red cell count is the actual number of red cells per mL of blood, and the haemoglobin (Hb) is the concentration of the Hb protein itself- the oxygen carrying protein.

A raised red cell count due to increased production of red cells is seen in children with chronic hypoxia, such as congenital heart disease and, in neonates, manifests as neonatal polycythaemia, usually due to chronic in utero hypoxia.

During the last 2 months of pregnancy erythropoiesis occurs at a rate of 3-5 x that of adults, consequentially the healthy newborn has a relative polycythaemia compared to infants and children-  manifest as a raised Hb, red cell count and haematocrit.

The Hb falls over the first 2-3 months of life in response to several factors- with the onset of respiration at birth- oxygenation increases, erythropoieitin production and erythropoiesis is decreased via negative feedback. Neonatal red blood cells have a shorter half-life of 90 days compared to 120 days for red cells in healthy children and adults. In addition over this time period, neonates undergo  rapid growth and weight increase with a subsequent increase in circulatory volume- leading to relative haemodilution. This physiological anaemia requires no intervention in otherwise healthy term infants and will rarely fall below 90g/L.

In contrast, infants born extremely prematurely at <28 weeks of completed gestation, will frequently require red cell transfusion. This is due to anaemia of prematurity. The cause is multifactorial, including low erythropoietin, shortened red cell lifespan, nutritional deficiency and iatrogenic blood letting, however the nadir in Hb occurs earlier (4-8 weeks compared to 8-12 weeks in term babies) and is more severe. Premature red blood cells have a life span of 35-50 days, and infants have a circulating blood volume of 90- 105 mls/kg, which could be as little as 45mls in a 24 week 500g infant. In addition, these infants do not receive maternal iron transfer via the placenta. Preterm infants also have a slow erythropoietin response to hypoxia and anaemia- this is because the site of production of erythropoietin is the liver rather than the kidney as per term infants. There is also evidence of increased metabolism of EPO in the preterm infant. (Strauss, 2010). Despite multiple studies into the use of exogenous erythropoietin for preterm infants, current guidelines recommend red cell transfusion for the management of anaemia of prematurity.

Reference:

Ronald G. Strauss, Anaemia of prematurity: Pathophysiology and treatment, Blood Reviews, Volume 24, Issue 6, November 2010, Pages 221-225, ISSN 0268-960X, http://dx.doi.org/10.1016/j.blre.2010.08.001.
(http://www.sciencedirect.com/science/article/pii/S0268960X10000408)

			

July 2016 PDF added

Malaria this month, sexual exploitation, sepsis, prolonged jaundice and DDH.  Do leave comments below:

June 2016 published

Curly toes this month to herald the start of a new series on paediatric orthopaedics, sexual bullying, jaundice in the neonatal period and periorbital cellulitis.  Do leave comments below…

Welcome to January 2016

January 2016 newsletter continues on the theme of asthma and covers internet safety, IDA and early weight loss in breastfed babies.  Do leave comments below: