Pharmac Study day.

Normal or Not: Neonate in the first six weeks.

Thanks to Pharmac and to Marion hunter for a well organised day with very interesting speakers.
Sharon Gardiner research fellow from the Christchurch School of Medicine provided an interesting and thought provoking discussion about drug therapy during lactation. Blew away some of the myths about witholding necessary therapy from breastfeeding women or insisting that they stop feeding in order to have therapy. Although all drugs reach breast milk very few reach toxic levels in the neonate. Sharon gave us a good insight into pharmacokintetics and the neonate and gave us a contact druginfo@cdhb.govt.nz who are happy to answer questions about drug therapy during pregnancy and lactation. Will only respond to questions from health professionals and need to have as full a picture of the scenario as possible. They are looking for funding to write a book specific to this topic which will be a useful handbook for midwives. This was particularly interesting for me as it is the Christchurch school which produced the resource in my previous posting.
Diana Purvis a neonatal dermatologist from Starship children's hospital outlined the common and not so common skin rashes that might be seen with neonates. Reassuring that most of these are normal and not a cause for concern. However there are rare conditions which do need to be recognised and early referral to specialist care is necessary. Infections such as bullous impetigo, herpes, pemphligas and scalded skin syndrome can be highly infectious and need referral and treatment. Subcutaneous fat necrosis of the newborn is more common infants who have experienced cold stress and asphyxia. Treatment is a low calcium diet. Neonatal lupus is caused by transplacental passage of antibodies (Rh or anti-La) usually resolves but there is a risk of the infant developing lupus later in life.
Cheryl Benn from Massey chaired a session on normal and abnormal weight loss in the neonate and stressed that 10% or greater weight loss needs to be investigated, and a clear plan of care should be established and followed. Interesting discussion about the variety of "normal" patterns for newborn feeding and sleeping and the need to be flexible to the babies needs. Also the need to adjust care to the needs or the particular woman and her baby.
It was a very interesting but whirlwind session from Dr Lindsay Mildenhall covering growth, jaundice, congenital heart disease, group B streptococcus and hips. A lot was covered and it would perhaps have been good to have more time for this session. He showed us a really neat baby stool chart from the Pediatrics journal which would be great to have in our wellchild books. I wonder why it is not there? Biliary atresia is rare but needs to be picked up early, grey stools are indicative as is bile coloured vomit, must refer asap. Lindsay also stressed the importance of recording the neonatal rectal temperature as this is the most accurate, axilliary and aural being very inaccurate in the neonate. I need to investigate this further as we moved away from rectal temps because of concerns about trauma and we teach students not to do this now. He also commented on the difference between clicks and clunks in hip checks, clicks are common and benign, clunks are not and are the indicator for developmental hip dysplasia (used to be congenital hip dyplasia). These are not always present from birth, thus the change in title and why we recheck.
Overall a really good day. I did not really learn anything totally new to me, however brought things I did know to the surface and made me think about these things in clear way. It was good sensible no nonsense advice.