Category: Research Page 1 of 3

Exploring Total Parenteral Nutrition in Newborns

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.

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.

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.

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.