Blog - Dr. Allen Cherer | Neonatal Care & Pediatrics

A Closer Look at Neonatal Polycythemia

On June 1, 2020

Polycythemia occurs when bone marrow is manufacturing too many red blood cells, thereby increasing the volume percentage of red blood cells in the blood. It can also be caused by a low plasma count in relation to blood cells, causing an imbalance. These excess cells, in turn, thicken the blood, which slows down the overall blood flow leading to more serious issues, such as blood clots. Polycythemia is essentially the opposite of anemia, which is when there are too few blood cells being produced.

Neonatal is a term used to describe babies within the first 28 days of life. Neonatal polycythemia is diagnosed when a baby’s blood is composed of more than 65% red blood cells. This is a common problem with newborns, but that number is expected to decrease within a few hours if everything is normal.

Some babies who are at a higher risk include those who are born small for their gestational age, babies who are post-term, infants of mothers with diabetes, twin-to-twin blood transfer in utero, low oxygen levels in fetal blood, and babies born with chromosomal abnormalities.

It can be hard to diagnose this condition when babies are first born, because, aside from a high blood viscosity, babies might be asymptomatic before showing any metabolic changes due to this disorder. Samples should be taken from a largely free-flowing blood vessel in order to get an accurate hematocrit result. Signs that blood is affected include poor blood flow returning to a site after pressure is applied (peripheral perfusion), and blood having a ruddy, dusky appearance. There are also other clinical symptoms that include lethargy, irritability, tremors, seizures, lack of interest in feeding, hypoglycemia, rapid breathing (tachypnea), and bluish/grayish skin coloration (cyanosis).

There are several other conditions that share similar symptoms with neonatal polycythemia, which is why it is vital to rule them out before attempting any course of treatment. Some conditions that are similar include hypoglycemia, neological dysfunction, renal failure, or respiratory issues. Once a firm diagnosis is confirmed, there is a recommended course of action.

Not all babies require treatment, but if there are signs of metabolic distress, the first priority is to lower the hematocrit by performing a partial exchange transfusion (PET). Either a saline solution may be used or a 5% protein solution. Saline is the preferred material because it won’t risk infection and has a better price point. It is strongly advised to avoid fresh frozen plasma because studies have shown a correlation between its use and necrotizing enterocolitis.

Top Pregnancy Myths: 2020

By Dr. Allen Cherer

On April 17, 2020

In Neonatal Care, Newborns, Research

Some of the information expectant mothers receive is often based on myths or old wives’ tales. Dispelling the myths may bring comfort and reassurance in addition to ensuring the health of the expectant mother and growing infant.

You’re Eating for Two

For decades, women were encouraged to substantially increase their dietary intake in order to ensure they were consuming enough nutrients for the growing infant. However, overeating leads to obesity, which leaves the mother and baby at risk. Being overweight increases the chances of developing gestational diabetes or hypertension. The excess weight also stresses the cardiovascular system. Health care providers suggest that increasing daily calorie intake by a mere 200 to 300 calories is more than sufficient to ensure a healthy pregnancy.

Belly Size and Shape Reveals Gender

Physicians rebuke the belief that external appearance correlates with the baby’s gender. Some women carry the baby high while others carry it lower. However, the difference is often equated with genetics and physical characteristics and not infant gender.

Moisturizing Prevents Stretch Marks

Cocoa butter has long been touted as being one of the solutions to prevent stretch marks. While moisturizing preparations are good for the skin, they do not prevent the physiological effects that a growing infant causes on external skin. Women develop varying degrees of marks depending on genetics and the extent that the abdomen needs to stretch to accommodate the infant.

Stay Away from Cats

There is no reason why expectant mothers cannot have and care for a feline companion. The danger lies in changing the litter box. Feline waste products commonly contain a parasite that has the potential for causing toxoplasmosis. While the mother may or may not experience flu-like symptoms, the illness has the potential of becoming serious in infants. Best to leave litter box duties to someone else. The disease can also be contracted by eating undercooked meat or unwashed fruits and vegetables.

Coronavirus and Pregnancy: What to Know

By Dr. Allen Cherer

On March 24, 2020

In Child Health Care, Neonatal Care, Newborns, Research

Historically, viral illnesses become more serious in the very young, the elderly and in individuals having a weakened immune system. Given that victims of all ages have become infected with the coronavirus, many are understandably concerned about the effect the illness may have on expectant mothers.

Pregnancy and Covid-19

The World Health Organization reports that in a study of 147 pregnant women, eight percent developed more severe forms of the illness. One percent required critical care.

A study of nine afflicted women who gave birth indicated that none of the infants tested positive for the virus. But, the women all became infected during the last trimester of pregnancy. It remains yet unknown how the virus might affect a fetus during the early months of development.

Another study involved 10 newborn infants who developed serious forms of the illness. According to a physician from the Northwestern University Feinberg School of Medicine, the amniotic fluid, breast milk, and cord blood were tested. But, all of the fluid was negative for Covid-19. So, physicians do not believe that the illness passes from the mother to the developing infant. Theories revolving how the babies became infected include that the women may not have undergone testing and found to be afflicted before delivery. The babies may have come in contact with their infected mothers shortly after birth.

An obstetrician affiliated with the American College of Obstetricians and Gynecologists advises that pregnant women should undergo testing at their initial appointment and separated from patients who tested negative. Pregnant women are advised to use the same precautions recommended for the general public.

About Covid-19

After exposure, individuals may develop symptoms in two days to two weeks. The majority of afflicted individuals suffer symptoms that are equated with the common flu. The experience may include fever, generalized fatigue and upper respiratory symptoms. Others suffer muscle aches and diarrhea. The World Health Organization reports that the virus causes serious illness in one out of every six patients. More severe cases exhibit difficulty breathing and shortness of breath. Individuals experiencing more serious symptoms are advised to seek medical attention.

Scientists recently revealed that the virus has two strains, one of which is more aggressive than the other. Health care providers also report that it is possible for individuals to suffer a relapse, which is often more serious.

Transmission occurs through airborne droplets or coming in contact with infected animals, surfaces or fecal matter.

Exploring Current Neonatology Trends

By Dr. Allen Cherer

On February 24, 2020

In Neonatal Care, Newborn Screening, Newborns

As technology has aided in advanced medical care over the last few decades, neonatology treatments and care options have improved and grown in number. Maternal mortality prevention is the goal of neonatology, and these trends are helping caregivers achieve their goals.

Here are a few prevailing neonatology trends to keep an eye on in 2020.

More Resources for Practicing Neonatologists

There are more available than ever for practicing neonatologists, primarily because of the growing need for more highly capable practitioners. The increasing number of mothers who are addicted to drugs or alcohol, increasingly poor nutrition, diabetes and high blood pressure are some driving factors of this trend. Neonatologists and medical professionals with similar disciplines can connect with the Section on Neonatal-Perinatal Medicine (SONPM) website, which is an affiliate of the American Academy of Pediatrics.

Preventing Neonatal Sepsis

Neonatal sepsis is another condition that affects millions of children every year. This is a bacterial bloodstream infection (BSI) that is potentially life-threatening to babies, especially those of low birth-weight. This can happen quite unexpectedly and for many reasons, including pneumonia, meningitis and gastroenteritis. This makes the detection of neonatal sepsis before it fully takes hold of the child imperative. Treatments can be applied speedily to rid the bloodstream of the infection when it’s detected early.

Improving Communication with Parents

When your newborn child is in the intensive care unit (ICU), it can be the most trying experience of your life. To reduce the stress and anxiety that can come from not knowing, neonatologists are trying to be more transparent and open to communicating with the parents. In cases of premature infants, this can mean encouraging skin-to-skin contact between the parents and the baby. Research has even shown the babies’ vital signs tend to suddenly improve when they are being held by their parents. The relief the parents feel to know their child is in good care is an added benefit.

With the help of specialized supplements for newborn babies, malnutrition is no longer a problem. However, optimizing the use of breastmilk is a tradition that most neonatologists are trained to believe in. Breastfeeding is encouraged, but when this can’t happen, donor milk is promoted as an option before other methods for nutrition aid are considered.

Neonatal Necrotizing Enterocolitis: What is It and How is it Managed?

By Dr. Allen Cherer

On January 31, 2020

In Neonatal Care, Newborn Screening, Newborns, Research

Necrotizing enterocolitis, or NEC, is a serious intestinal affliction that affects one in every 2,000 to 4,000 infants. The disease process more commonly occurs in premature babies born before the 32nd week of gestation. But, the disorder has been found in babies born at full term who also have heart anomalies or other health conditions. NEC develops when the large or small intestine becomes inflamed or injured by naturally occurring bacteria. The affected site may eventually weaken, which enables the bacteria to pass through and cause a life-threatening systemic infection.

NEC Causes

Researchers have not determined a specific cause for the disease development. However, there is a theory that a number of factors contribute to the problem.

Abnormally high level of intestinal bacteria
The presence of invasive bacteria or viral colonies that instigate an infection
Insufficient blood flow and oxygen to the intestine
Intestinal lining injury
Baby formula
Underdeveloped intestines

Necrotizing Enterocolitis Signs and Symptoms

Infants develop symptoms within the first month after birth. As the disorder progresses, the infant’s abdomen swells, becomes red and tender. The child may become constipated or pass dark, bloody diarrhea. The infant may vomit green bile. The baby’s body temperature, heart rate, blood pressure, and respiratory rate decrease. The infant becomes lethargic.

NEC Treatment

Once diagnosed, feedings are temporarily discontinued. The infant receives fluids and nutrition via IV supplements. A surgeon inserts a gastric or a nasogastric tube into the stomach, which enables air and fluid to escape. The presence of infection, or to prevent infection, requires antibiotic treatment. The baby undergoes frequent abdominal exams and X-rays to monitor progress. The child’s stools are monitored for stool changes. Blood tests determine anemia or infection. In severe instances, the child may require surgery.

If the child’s condition worsens or does not respond to treatment, surgery may be necessary to repair any perforation or to remove dead tissue. In the event that a large area of the intestine suffers damage, the surgeon may reroute the remaining tissue to an opening in the stomach, which is known as a stoma.

When the medical team deems that the infant’s condition is improving, they typically recommend that the child receive breast milk. Breast milk boosts immunity, is easier to digest and promotes the growth of healthy bacteria in the gastrointestinal tract.

Becoming a Neonatal Professional: The Basics

By Dr. Allen Cherer

On December 30, 2019

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

Neonatal professionals are skilled and trained to properly care for newborn infants, specifically within their first twenty-eight days of life. Neonatal nurses specialize in caring for healthy newborns, while neonatal nurse practitioners specialize in caring for infants that may need special care and attention. These infants may include those in the Neonatal Intensive Care Unit (NICU), emergency rooms, delivery rooms or specialty clinics. During the first twenty-eight days of life, infants are at high risk of infections and possibly developing abnormalities. It is the extensive training and education that neonatal professionals are required to have that prepares them for this line of work.

One of the first steps in becoming a neonatal professional is to earn a high school diploma or GED, this is a key requirement to begin a registered nursing program. A registered nursing program will set the foundation of a career as a neonatal professional. Nursing students may obtain an associate degree or a bachelor’s degree in nursing, this could take 2-4 years. Typically, the curriculum for these degrees focuses on anatomy and physiology, lifespan development, microbiology, community health nursing, and principles of ethics among other studies.

After the successful completion of a registered nursing program, registered nurses (RNs) need to pursue a suitable master’s program. This can be a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) program. Generally, an MSN program may require the completion of approximately 550 clinical hours and a DNP program may require the completion of 1,000 clinical hours. MSN programs are usually completed in two years, while DNP programs can take between 3-4 years for completion. During this time nurses experience working in neonatal settings with infants and their families.

With years of studying, training, experience and successfully completing an accredited master’s program, it is important to obtain proper licensing and certification. There are multiple ways to obtain national certification and state licensing. The American Nursing Credentialing Council offers a pediatric nursing certification, while most neonatal credentials are administered by the National Certification Corporation (NCC). Proper certification and licensing for practicing may vary from state to state. These certification requirements typically include a three-year revision. Maintaining certification also includes a “continuing competency specialty assessment”, which will determine the number of continuing education hours needed. Becoming a neonatal professional is a process and can take years of hard work and dedication but is also very rewarding.

Neonatal Intensive Care Burnout: An Overview of a Growing Issue

By Dr. Allen Cherer

On December 30, 2019

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

Nurses who work in the Neonatal Intensive Care Unit (NICU) have a unique and demanding responsibility. Caring for the tiniest, most vulnerable patients new to life requires a genuine heart, individual attention, and authentic nurturing.

A NICU Podcast interview sheds light on the day-to-day challenges NICU nurses face. In addition to providing round the clock service to life-clinging babies, NICU nurses are also the support to and for parents, who, in their own way, are emotionally fragile and sensitive. To these parents, the critical state of their child calls for heightened attention and empathy. The nurses’ position is both guardian and savior, and this can take a toll on nurses who themselves are only human.

On top of normal stresses that come with the job is a growing demand to implement sophisticated technology. On the one hand, technology is bettering our lives every day, making it easier to complete tasks faster and more smoothly. However, research shows this increase in digitization is taking a toll on medical staff. Nurses are now required to maintain reports and data in ways their jobs did not involve before. This learning curve calls for specialized training, which is yet another level of duties for nurses to cover.

As essential as the NICU nurse’s position is in the livelihood of their most precious patients, many times, their efforts and care go unnoticed. Physicians‘ status gets much attention, but the backbone of care and service falls on the nurse staff.

Research among NICU nurses found burnout rates among nurses in NICU are much higher than physicians. In fact, burnout was prevalent for non-physician, day-time, and veteran nurses of more than five years.

The effects of burnout are significant. Emotional suffering, physical exhaustion, depression, weight gain or loss, and reduction in job performance are just a few. Burnout affects work-life balance, socialization, relationships, and one’s perspective on life.

According to the World Health Organization (WHO), burnout is now recognized as a chronic health condition. Unfortunately, many NICU nurses are falling victim to this condition as a result of their working environment.

NICU staff carry the burden of high standards, critically positioned babies, and anxious parents. On top of all this, an enthusiastic spirit that wants to be available, do their best at providing care, and occasional loss of an infant makes for extremely stressful conditions. Burnout is not a myth, but a reality, and one that needs immediate attention — sooner than later.

A Closer Look at Neonatal Jaundice

By Dr. Allen Cherer

On November 27, 2019

In Child Health Care, Hiking, Neonatal Care, Newborns

Neonatal jaundice is caused by unconjugated bilirubin in a newborn’s body. It’s presently the most common condition that requires medical attention or hospital readmission for newborns. This condition can have dire consequences, so early detection and treatment is crucial.

Symptoms Of Neonatal Jaundice

It’s common practice for hospitals to check newborns for jaundice before release,however parents should be aware of what to look for. Some symptoms of jaundice in infants include:

Yellow sclera (white part of the eyes)
Yellow skin, especially the abdomen and limbs
Baby is hard to awaken or lethargic
Baby is not gaining weight

If these symptoms appear after a child has been sent home from the hospital, it may be advisable to bring them back in for medical treatment.

Causes Of Neonatal Jaundice

Jaundice in infants can often be caused by the liver being underdeveloped. This leads to an inability for the liver to properly break down the bilirubin in their bodies. Besides immature livers, some other causes of this condition include:

Blood infection (sepsis)
Viral or bacterial infection
Malfunction of the liver
Deficient enzymes
Internal bleeding
Abnormal red blood cells

If symptoms of jaundice appear, the child will need to be checked for underlying causes to form a treatment plan.

Factors That Increase Risk Of Neonatal Jaundice

There are some factors that make jaundice more likely in infants. These factors include:

Bruising during birth
Mother and child’s blood types are different
Birth before 38 weeks
Breastfeeding difficulties

If a child has these risk factors, their parents and medical team will need to monitor them.

Treatment Of Neonatal Jaundice

To avoid acute or chronic complications, jaundice needs early treatment. Some ways it can be treated include:

Light therapy
Intravenous immunoglobulin
Exchange transfusion

These methods focus on diluting pathogenic antibodies in the child’s blood that cause jaundice or, in the case of light therapy, help the child’s body to more easily break down and excrete the excess bilirubin.

A Closer Look at Neonatal Macrosomia

By Dr. Allen Cherer

On October 29, 2019

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

Neonatal macrosomia refers to babies weighing more than eight pounds and 13 ounces at birth. Approximately nine percent of infants are born with the condition. The larger the baby, the greater the risks to the mother and the infant. There are a variety of causes and risk factorsYour text to link… that lead to overweight newborns. Some causes are preventable.

Causes and Risks

Diabetes-Expectant mothers may have been diagnosed with diabetes before becoming pregnant. Others develop gestational diabetes during pregnancy. Blood sugars must be monitored and controlled otherwise, the infant develops with a larger amount of body fat.
Previous history-Women who have given birth to overly large infants in the past have a greater risk of having large babies in the future.
Obesity-There is a greater chance of having a baby with neonatal macrosomia if the mother is obese. Gaining too much weight during pregnancy also increases the risk.
Male infants-Neonatal macrosomia occurs more often in boy babies.

Overdue pregnancies-Pregnancies that extend two or more weeks beyond the estimated due date increase the chance that the infant will be overly large.
Mother’s age-Pregnant women over the age of 35 are more likely to have abnormally large babies.

Maternal Complications

Difficult labor-When an infant is too large, there is a likelihood that the baby becomes stuck in the birth canal, which may necessitate a C-section delivery.
Internal injuries-During the birthing process, the mother may suffer laceration or tearing of the vaginal tissues and perineal muscles.
Hemorrhaging-Internal injuries combined with the uterus’ inability to contract properly may lead to severe bleeding.
Uterine damage-Women who previously gave birth via C-section or had gynecological surgery have an increased risk of suffering from a uterine rupture.

Infant Complications

Hypoglycemia-Babies born with neonatal macrosomia have an increased risk of suffering from abnormally low blood sugars.
Obesity-Overly large infants are at a greater risk of becoming obese during childhood.
Metabolic syndrome-Neonatal macrosomia infants are likely to have metabolic syndrome. The condition is associated with hypertension, hyperglycemia, elevated cholesterol and excess body fat.

Prevention

Women must maintain a healthy weight before during and after pregnancy. While pregnant women should not gain ore than 35 pounds. Women diagnosed with diabetes must have their blood sugar continually monitored and controlled.

Diagnosing and Addressing Neonatal Apnea

By Dr. Allen Cherer

On October 3, 2019

In Neonatal Care, Newborns

Apnea is a term defined as the cessation of breathing for longer than 10 to 15 seconds. While this can happen at any age, it typically affects infants aged two to four weeks until six months.

It is particularly seen in premature infants born around 28 weeks due to their underdeveloped respiratory systems. It happens when the brain and spinal cord do not mature, obstructing breathing

When apnea develops, it can have many causes. The most common links found in neonatal apnea are an infection, neurological, cardiovascular, pulmonary, metabolic, temperature regulation and maternal drug use.

Types of Apnea

There are three main types of apnea. These are central, obstructive and mixed apnea.

Central apnea is when there is no signal of breathing transmitted to the respiratory muscles, causing the system to not respond due to immature development.

Obstructive apnea is when there is a brief pause of airflow in the pharynx where the muscles are too weak to help the infant breathe properly.

Mixed apnea is a combination of the two.

Treating Neonatal Apnea

To manage apnea in infants born before 34 weeks gestation, it is important for professionals in the neonatal intensive care unit to monitor breathing and development. Underlying causes will also have to be determined and close monitoring is imperative. Health professionals will check to see if there is a link to bradycardia and hypoxia.

Bradycardia is a heart rate that is too slow for normal functionality. Hypoxia is when there is an oxygen distribution deprivation. These two conditions are often linked to cases of apnea in infancy.

Management varies between infants and will depend on a series of factors. Medicines will be administered depending on the severity and cause of the issue.

Untreated apnea can cause unwanted effects to the overall wellbeing of the child. These effects can be a failure to thrive or decrease in intellect. Certain types of apnea can also result in death.

Having a wide group of trained health professionals can assist in the monitoring and betterment of neonates. Once proper diagnosis and treatment are implemented, the infant can be treated accordingly until the risks decline and their health improves.