Blog - Dr. Allen Cherer | Neonatal Care & Pediatrics

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Top Podcasts for Pregnancy and Birth

On April 23, 2021

In Child Health Care, Neonatal Care, Newborn Screening, Newborns

Navigating pregnancy and infancy is complex and very taxing. There are many things you need to be aware of at all times. If you are a first-time mother, it can be even more difficult and stressful. There is no one-size-fits-all how-to manual on entering motherhood, but there are helpful resources that exist to help put minds at ease. One of the best resources for those who are busy and do not have time to read a book or attend a class is listening to a podcast. You can play them in the background, on the go, and when you’re multitasking. Let’s take a look at some of the best pregnancy and birth podcasts available, as featured in an article on Big City Moms.

The Birth Hour

This podcast is a saving grace for those who are interested in everything related to birth stories. There are many experiences told by special guest speakers who have all had to go through the process of giving birth; some examples include giving birth in an RV, delivering breech twins, natural births, water births, and c-sections. Their website provides a quiz on which birth setting might be the best for you. Listeners have described this podcast as extremely helpful, and some have said it opened their eyes up to birthing possibilities they did not consider at first.

Informed Pregnancy

Hosted by doula Dr. Elliot Berlin, this podcast contains large amounts of information that new moms should take into consideration. Berlin is a chiropractic doctor and childbirth educator, so it is safe to say that she definitely knows what she is talking about. One of the best episodes on the show is her interview with Ricki Lake. She delves into a wide range of topics such as birth plans, CPR safety tips, and vaccinations so that moms can keep themselves and their babies safe.

40 Weeks Pregnancy

This podcast might be the coolest on our list. You can listen to an episode of this show every week throughout your pregnancy, and it updates you on what to expect and how to deal with particular challenges you might be experiencing. Each week you can tune in to how your baby is likely developing and how to guide yourself through the journey.

Exploring Total Parenteral Nutrition in Newborns

By Dr. Allen Cherer

On March 25, 2021

In Child Health Care, Neonatal Care, Newborns, Research

Infants rely on their parents or caretakers to provide them with adequate nutrition needed for healthful physical and mental growth. Some babies aren’t able to receive nutrition via a bottle or a feeding tube due to developmental problems, disease or extreme prematurity. Parenteral nutrition may be necessary to help these infants get the calories and nutrients they need to thrive.

What is Total Parenteral Nutrition?

Parenteral nutrition was first given to babies more than 50 years ago. It has saved thousands of infants’ lives who are unable to take in enough calories and nutrients. The term parenteral refers to bypassing the digestive tract. Total parenteral nutrition means that all of the infants nutrition is delivered in this manner.

Nutrition in the form of carbohydrates, protein, fat, minerals, vitamins and electrolytes are given intravenously in total parenteral nutrition. This can be done by using an injection, but it typically requires that an IV be placed in the navel, hand, scalp or foot.

Emergency versus Ongoing Total Parenteral Nutrition

Preterm infants are often given parenteral nutrition immediately following their birth. This can give these babies the boost of nutrients they need to adjust to life outside of the womb. Total parenteral nutrition may continue to be given as the baby learns to use a bottle or breastfeed. When total parenteral nutrition is going to occur for a short time, medical professionals use smaller veins in a central location on the infant’s body to deliver the nutrients.

In some cases, an infant will need to receive total parenteral nutrition on an ongoing basis. This may be due to kidney or digestive tract problems. If ongoing parenteral nutrition is needed then a central line may be placed in the infant. This allows a larger amount of nutrients to quickly flow to the baby.

Success of Total Parenteral Nutrition in Newborns

Though there are some risks of continuing total parenteral nutrition in newborns, most do extremely well. Several studies have been done that compare the effect of milk feedings versus total parenteral nutrition in preterm infants with very low birthweights. Studies showed that these infants fared extremely well with total parenteral nutrition. The infants receiving total parenteral nurtiion were able to take in larger amounts of protein and carbohydrates versus the infants who were fed a milk diet.

Heart Murmur in Newborns: An Overview

By Dr. Allen Cherer

On March 25, 2021

In Child Health Care, Neonatal Care, Newborn Screening, Newborns, Research

The heart has the important job of distributing blood throughout the body. While you typically cannot hear the heart working, there are times when blood can be heard swirling in the heart. This is known as a heart murmur. It is very common for newborn babies to have heart murmurs, which can create a lot of fears for the parents. These are the most important things you need to know about heart murmurs in newborns.

How Is It Diagnosed?

The doctor will be able to diagnose a heart murmur by listening to your child’s chest with a stethoscope. They will likely have to check several spots on the chest to get an accurate diagnosis. It is easiest to diagnose this condition when the baby is not making any noise because the murmurs are very quiet. Once a heart murmur is found, the doctor will grade it based on the volume. A few imaging tests of the heart may also be done.

Is It Dangerous?

There are two distinct types of heart murmurs in newborns. Innocent heart murmurs are completely safe. Some babies are just born with a strong heart that makes a little noise when pumping blood. Most innocent heart murmurs eventually go away as your child gets older.

There is also a chance that the murmur is caused by a congenital heart defect. This occurs when there is a structural problem in your newborn’s heart. This is far less common than innocent heart murmurs. There is a chance that this heart defect will cause your child to experience a few other troubling symptoms. Catching the problem shortly after birth will make treatment much easier.

How Is It Treated?

Since they will not cause any issues, innocent heart murmurs require no treatment. You will not have to change anything about your child’s life when they have an innocent heart murmur. If the extra noises are caused by a heart defect, then you will need to get the issue treated by a medical professional. The form of treatment used will ultimately be determined by a variety of different factors including your child’s age and the severity of the issue. Medications and surgery are the most common forms of treatment for a dangerous murmur.

Understanding Tetralogy of Fallot

By Dr. Allen Cherer

On November 23, 2020

In Neonatal Care, Newborn Screening, Newborns, Research

A tetralogy is a cluster of four abnormalities or symptoms that exist at the same time. Tetralogy of Fallot is a condition where four separate genetic heart issues occur in the same person.

They are a hole between the lower chambers of the heart, or ventricular septal defect. Pulmonary valve stenosis, or a narrowed pathway between the heart and lungs, is another. An overriding aorta means that the aorta is positioned over the hole in the lower chambers. Finally, right ventricular hypertrophy means that the muscle that encases the lower right chamber becomes unusually thick. This is a serious issue because it makes it more likely the heart will become stiff and go into failure.

Usually, Tetralogy of Fallot is diagnosed in small babies. It’s a rare condition, but some of the symptoms are very distinctive. This cluster of symptoms causes oxygen-poor blood to circulate from the heart to the body. As a result, babies with it sometimes have a bluish appearance. This is also known as cyanosis.

Tetralogy of Fallot can vary in degree of severity. It often co-occurs with Down Syndrome or DiGeorge Syndrome. There are children who have other heart defects in addition to the ones in the tetralogy. Some people with less severe forms of this condition aren’t diagnosed until adulthood. Their symptoms can include fainting, clubbed fingers and toes and shortness of breath.

The treatment for Tetralogy of Fallot is surgery. There are two different ways medical teams approach this. Sometimes in babies, the first operation performed is only a temporary one. This can depend on how complicated the case is and what other problems may be present. Later on, a complete repair is completed. In cases with no complicating factors, the first operation may be the permanent, complete one.

Some people who have the surgery will need to see a cardiologist who has extensive experience with congenital defects throughout their lives. Sometimes, follow-up surgeries are required after the first repair procedure. These can include stent surgeries. The causes of Tetralogy of Fallot are mysterious. Sometimes, an infection like rubella can be to blame. At other times, it may be related to dietary deficiencies. There may also be a genetic component.

Irregular Breathing in Newborns: What You Should Know

By Dr. Allen Cherer

On October 27, 2020

In Neonatal Care, Newborn Screening, Newborns

New parents may be alarmed when their newborn has trouble breathing. Babies often breathe irregularly in the hours following their birth and in the first few days of life. Here is a brief overview of irregular breathing in newborns — and what warrants a visit to the pediatrician.

Normal Breathing in Newborns

Newborns typically breathe through their nose rather than their mouth and have smaller breathing pathways. These smaller pathways mean babies can’t take in as much as oxygen and breathe more rapidly. Babies usually take between 30 and 60 breaths per minute while they are awake and 20 breaths per minute during sleep. In comparison, an adult breathes between 12 and 20 times per minute.

It is normal for a baby to take several rapid breaths and then pause for several seconds. This is especially true in the newborn days when the respiration system is still developing. Most breathing irregularities typically resolve within the first few months of life.

Breathing Problems in Babies

Becoming familiar with a baby’s normal breathing pattern can make it easier for parents to distinguish any problems that occur. Some of these problems may include:

Barking cough and/or hoarse cries

Croup often hits in the middle of the night and terrifies parents. It is marked by a barking, seal-like cough, hoarse cries, breathing difficulties and/or a fever.

Whistling noises

Whistling sounds are often due to blockages in the nostrils. Babies breathe through their nostrils rather than their mouths. Any blockage in the nostrils due to allergies or a cold can make breathing difficult.

Wheezing

Wheezing can be a sign of a more serious condition in babies. When the airways become constricted due to asthma, pneumonia or respiratory syncytial virus (RSV), the baby isn’t able to draw enough oxygen during each breath.

Fast-paced Breathing

Fast-paced breathing is often accompanied by an elevated heart rate. Fluid in the airway from pneumonia or another infection could be the cause.

When to See a Doctor

Breathing problems are common during cold and flu season. An estimated 15 to 29 percent of all hospital admissions in babies are due to breathing problems. If parents notice any changes in their child’s breathing, they should notify a doctor immediately. Call 911 or go to the nearest emergency room if:

the baby stops breathing for more than 20 seconds
a blue color is noticed in the lips, toenails or fingernails
the muscles in the neck pull in during breathing

Taking care of a child when their breathing is irregular can be very stressful. Learning to watch for the signs and knowing when to alert the child’s pediatrician can help keep newborns safe and healthy as they grow.

Top Advice for Neonatal-Perinatal Fellows

By Dr. Allen Cherer

On September 18, 2020

In Neonatal Care, Newborn Screening, Newborns, Research

Becoming a Neonatal-Perinatal Fellow is no easy to task. After all the schooling to get to the point of becoming a fellow, the student has to land a fellowship in their preferred specialty. The tips shared below are from Dr. Patrick Myers who is a fellowship program director.

Medical and Real Life Experience
Something that fellowship directors are looking for on applications is a combination of real-life experience and medical experience. This is great for applicants who may not have taken a traditional path to get to their Neonatal-Perinatal Fellowship.

One example of a life experience that looks great on an application is a gap year where the applicant works as a chief or hospitalist. This allows the applicant to work face to face with patients in a clinical setting. Additionally, the applicant gains experience working as a member of a team in the hospital. Patrick goes as far as to say that this experience is a “gold mine” when it comes to applying for a fellowship.

Know your Path
The applicant needs to know what path they want to go down after the fellowship. If the applicant has a change of heart, it is two years that were spent headed in the wrong direction. For some applicants, this may mean taking an intentional gap year to gain experience in the field before applying for a fellowship. This is a win-win situation because the experience will enhance their application and they will feel confident in their path following the fellowship.

Important Skills
While skills will vary from person to person, there are a few skills that are consistently desired among applicants for neonatal-perinatal fellows. One important skill is problem-solving. Neonatal-Perinatal Fellows will be faced with a host of problems that need solving each day that they report to work. Additionally, the fellow will need to work with other specialties within the hospital. This means that communication skills are another must-have. Planning skills are also essential for a successful fellowship experience. These skills will be evident based on prior experience and performance in an interview setting. Additionally, these skills will be helpful in a career when the days of fellowship are in the distant past.

Tips for New Medical Residents

By Dr. Allen Cherer

On August 31, 2020

In Neonatal Care, Newborns, Research

After years of medical school, starting your residency can be both exciting and stressful. All of a sudden, you’re the one acting as a primary contact with patients and making decisions that will influence their lives. As you take this next step into the world of medicine, there are several tips that can help you adjust to residency.

Be a Sponge for Knowledge

An article on AMA advises new residents to aggressively seek out information. That may involve basic medical knowledge or knowledge specific to the patients on your caseload. Make it a goal to learn at least one new fact every day.

When in doubt about a situation, don’t bluff or avoid the question. Admit you don’t know and seek out an answer. Not only will this tactic help you learn, it will also earn you respect.

Pursue a Work/Life Balance

The website The DO encourages residents to actively pursue a balance between your work life and your personal life. Residency can be stressful – long hours, life-and-death decisions, financial pressures and lots of new material to master. Some residents put in long hours and may go for weeks without seeing their significant others.

This, though, is a risky way to live. You may fall pray to stress and the problems stress can cause such as insomnia, generalized anxiety and physical illness. Make sure to set aside time for the important people in your life as well as for the things you enjoy. For instance, you may choose to go to the gym three times a week, or you may set aside time to read a novel or even to take a nap.

If stress is starting to get the best of you, seek support from your loved ones and your colleagues. Many residency programs offer a confidential assistance program where you can talk with counselors about difficult issues.

Pay Attention to Financial Health

According to KevinMD.com, being under emotional pressure can lead to poor financial choices. You may be tempted to charge too much credit card debt, or you may lose track of your student loans. Another issue to consider is whether you want to get involved in your company’s 401(k) or 403(b) plans. When in doubt, check with a financial advisor.

Starting residency can be intimidating, but following a few simple steps can help you succeed.

Neonatal Septal Defects: An Overview

By Dr. Allen Cherer

On July 30, 2020

In Child Health Care, Neonatal Care, Newborns, Research, Uncategorized

Ventricular septal defects, or VSD, refers to an opening in the wall that separates the lower ventricles of the heart. The condition occurs naturally in neonates at a rate of one out of every 250 to 330 births. Normally, the hole closes before the infant is born, which prevents oxygenated blood from combining with unoxygenated blood.

Under normal circumstances, blood enters the right side of the heart and continues into the lungs to receive oxygen. The blood then travels to the left side of the heart and is pumped through the body. But, when VSD occurs, more blood enters the lungs than normal, which stresses the heart and the lungs.

If the hole is small, physicians might hear a murmur when listening to the heart using a stethoscope. Otherwise, the child exhibits no symptoms. The opening is not large enough to add stress. However, if the hole is large, the infant breathes faster and harder than normal secondary to the stress on the heart and lungs. They may also exhibit difficulties when suckling and gasp for breath. Symptoms may occur shortly after the birth of the child. Or, the signs may not appear until weeks later when the lungs become hypertensive. If the child does not receive medical intervention, the lungs and blood vessels may endure irreversible damage.

Small hole defects commonly close without intervention. However, if the defect is deemed to be large, surgical repair is required. The procedure used depends on the size of the defect. Some are easily corrected in a cath lab. If the hole is not extremely large, surgeons may simply sew the detector closed. Other options include surgically applying a fabric or tissue patch over the hole. The patch is later naturally covered by normal tissue that lines the heart.

Banding the pulmonary artery is another option, which reduces the amount of blood that flows into the lungs. The scheduled surgery takes place anytime from early infancy into later childhood depending on the severity of the condition and accompanying symptoms.

Once the defect is medically corrected, the infant or child may resume a normal life. A pediatric cardiologist may advise that the child undergo periodic evaluations to ensure the ongoing health and detect possible complications. In rare cases, a heart valve may develop a leak once the child is older, which also requires intervention.

COVID-19’s Potential Impact on Newborns

By Dr. Allen Cherer

On July 6, 2020

In Child Health Care, Neonatal Care, Newborn Screening, Newborns

COVID-19 produces victims of all ages. Concern grows for pregnant women and unborn children. Facilities around the world continue studying the microbe and reveal their findings thus far. Some studies suggest that infants born to mothers having the virus have a high risk of suffering ill effects.

From January 20 to February 5, nine women gave birth to 10 infants in five different hospitals in China’s Hubei province. Eight of the expectant mothers tested positive for COVID-19 before delivery. One mother tested negative. However, a fever and a CT scan of her chest revealed pneumonia that could not be contributed to any other underlying cause but the virus.

The women suffered a variety of prenatal complications that included intrauterine distress, ruptured members prior to the onset of labor, amniotic fluid abnormalities and placenta previa. Seven of the mothers delivered their babies via cesarean section. The other two women had normal vaginal deliveries.

The mothers were treated with Tamiflu or a combination of the antiviral plus interferon following delivery. After birth, all of the infants were tested for COVID-19 via oral swabs. All of the tests were negative. Four of the babies were full-term and six were premature. All of the infants exhibited unusual symptoms that included fevers, difficulty breathing, elevated heart rates, inability to feed, vomiting, gastric bleeding and bloating from liver malfunction. Seven of the infants exhibited abnormal chest X-rays. Two of the premature babies died nine days after birth.

A team of researchers from Northwestern University in Illinois recently discovered that the virus damages the placenta in expectant mothers. The study involved 16 pregnant women who tested positive for COVID-19. Following delivery, the placenta tissues were evaluated. The team discovered that the blood vessels within the placentas exhibited abnormal development or were otherwise damaged. However, all of the infants tested negative for the virus and were in reported good health.

Researchers from the University of California San Diego expanded the MotherToBaby program to gain a better understand the short- and long-term effects of the virus on expectant mothers and infants. Previously, the program was designed to evaluate medications and environmental factors that might affect pregnant women, newborns and breastfeeding.

The study will involve the examination of medical records and phone calls to women who volunteer for the research. The program also includes monitoring the neurological development of children to determine possible emotional, learning or memory issues.

COVID-19 and Breastfeeding: What to Know

By Dr. Allen Cherer

On June 2, 2020

In Neonatal Care, Newborns

This is an unprecedented time for all of us. There are many reasons to be stressed about the global pandemic, whether it’s a concern for the health and safety of loved ones, or a fear of job loss and lack of security. One demographic with their own set of fears is the breastfeeding mother or pregnant woman about to enter into motherhood. There is still a lot that we don’t know about a virus that has already killed hundreds of thousands of people, so it’s only natural to fear for a newly born baby’s health.

There are still a lot of unknowns when it comes to transmission of the COVID-19 virus. Fortunately, there are agencies that have established some guidelines to put a few minds at ease. The general consensus is that it is ok to move ahead with any preexisting plans to breastfeed, as long as common sense precautions are being made.

The general recommendations for breastfeeding still hold true, regardless of a global pandemic. Breastfeeding gives a baby better immunity and decreases the right of respiratory infections if they get sick, while this has not been directly established with COVID-19, the underlying studies about respiration are a promising sign. In addition to benefitting the baby, breastfeeding releases anti-stress hormones into the mother’s body, helping combat anxiety and improve overall wellness. Cortisol, the stress hormone, has been proven to affect people’s blood pressure, immune systems, and cardiovascular systems. In addition to these reasons, breast milk is available from the safety and privacy of your own home, limiting your exposure to the virus and other potentially infected members of the public.

To date, the virus has not been detected in breast milk, therefore organizations like the CDC, WHO, and the Academy of Breastfeeding Medicine have joined the list of entities that agree the benefits far outweigh the hypothetical risks. The major concern is that respiration from the mother might potentially infect a baby. Therefore, the advice is to thoroughly wash your hands before holding your baby and wearing a mask during a breastfeeding session.

If a mother has tested positive for COVID-19, the decision about whether to separate her from her baby is one that should only be made by an experienced health professional. Experts agree, however, that if another and baby are able to stay together, the continuation of breastfeeding is strongly encouraged.