Tag: babies

Exploring Neonatal Sepsis

On August 7, 2019

In Neonatal Care, Newborn Screening, Newborns, Research

Neonatal Sepsis is a blood infection that infants may develop before reaching 90 days of age. Babies can also develop early-onset and late-onset sepsis.

Causes?

A bacteria named Eschericia coli (E coli) and Listeria can cause infants to develop sepsis. A specific streptococcus strain (Group B streptococcus or GBS) can also make an infant ill. If the baby’s mother contracts herpes simplex virus (HSV), this can also lead to neonatal sepsis.

An early-onset case usually develops 24 to 48 hours after the baby’s birth, usually by being exposed during birth.

Contributors to early-onset sepsis:

Preterm delivery
GBS colonization during mother’s pregnancy
Placental tissues and amniotic fluid become infected (chorioamniontitis)
Early rupture of membranes (more than 18 hours)

Late-onset sepsis risks:

Extended hospitalization for infant
Keeping a catheter in baby’s blood vessel for an extended time

Symptoms?

Breathing problems
Changes in body temperature
Decreased bowel movements or diarrhea
Reduced movements
Low blood sugar
Reduced suckling
Heart rate is fast or slow
Seizures
Vomiting
Swollen abdomen
Jaundice (yellow skin and whites of eyes)

Diagnostic Tests?

Pediatricians perform the following diagnostic tests:

C-reactive protein
Blood culture
Complete blood count (CBC)
Lumbar puncture
Urine, skin or stool cultures to search for herpes virus
Chest X-ray (if baby has difficulty breathing)
Urine cultures

Treatments?

Even if the newborn is symptom-free, they will receive intravenous antibiotics. Babies younger than 4 weeks with fever or other symptoms receive IV antibiotics immediately.

The baby stays on antibiotics for three weeks if bacteria is in the spinal fluid or blood. This is shorter if no bacteria is present.

Acyclovir (antiviral medication) is given for HSV-caused infections.

If the baby has already gone home, it will be re-admitted to the hospital for treatment.

Outlook?

The infant may recover completely and show no evidence of any other problems. Neonatal sepsis can lead to infant death. The sooner treatment starts, the better the prognosis.

Potential Complications?

Disability after illness
Death

Prevention?

Pregnant mothers should receive preventive antibiotics if they have these illnesses:

Group B strep colonization
Chorioamnionitis
Has already had a baby with bacterial sepsis
This condition is preventable. Babies should be delivered 12 to 24 hours after water breaks.

Other Names?

Other names include:

Neonatal septicemia
Sepsis – infant
Sepsis neonatorium

Neonatology: an overview

By Dr. Allen Cherer

On February 14, 2019

In Neonatal Care, Newborn Screening, Newborns, Research

Neonatology is a type of pediatrics, focusing specifically on medical care for newborns. The primary patients of neonatology are newborn infants who were born ill or became ill shortly after birth.

Here is a quick overview of this medical concentration, for those unfamiliar.

Origins of Neonatology

Neonatology is a very recent concentration of pediatrics. High infant mortality rates existed as early as the late 1800s. The first premature infant incubator station was created in Chicago by Joseph DeLee. The first NICU (newborn intensive care unit) was established in New Haven, Connecticut. Neonatology was officially recognized as an official subspecialty of pediatrics in 1975 by the American Board of Pediatrics.

Modern Neonatologists

Modern neonatology physicians are not here to help with minor problems; a normal pediatrician will be able to assist with most medical issues in infants. A neonatologist is trained to deal with high-risk situations. Premature babies, birth defects, and other serious issues are handled by neonatologists.

Neonatologists are serious doctors, and it takes serious time to become qualified. In addition to a standard college education, a doctor must have 4 years of medical school, 3 years of residency in pediatrics, 3 more years of residency in newborn intensive care, and they must be certified by the American Board of Pediatrics.

In addition to neonatologists, there are neonatal nurse practitioners. These nurses are specialized in neonatal care, and they will be assisting the physician along the way. They are able to diagnose some issues, prescribe medication, and some can even perform medical procedures themselves.

A neonatologist may assist with the diagnoses of breathing disorders, certain infections, and birth defects. They will also be the primary strategist in treatment options for an infant. They will formulate nutrition plans to make sure an infant will have maximum growth. A neonatologist will work closely with other medical staff, pediatricians, and nursing staff to assist with any serious illnesses in newborns.

Neonatologists are Best for Newborns

Minor problems for adults could mean possible death for an infant. That’s why specialists are needed for infants. There are also many common postpartum issues that a neonatologists can assist with. Many of these are routine for them; however, rare diseases and disorders can be diagnosed by a neonatologist as well.

Neonatal jaundice, neonatal cancer, inborn errors of metabolism, neonatal diabetes mellitus, neonatal herpes simplex, and neonatal seizure are a few of the more common problems a neonatologist will assist with.

The Prevention of Cystic Fibrosis in Newborns

By Dr. Allen Cherer

On February 14, 2019

In Neonatal Care, Newborn Screening, Newborns, Research

Cystic fibrosis is one of the most common conditions caused by genetics. One baby out of every 3,500 live births will have cystic fibrosis. Cystic fibrosis affects the respiratory and digestive systems. Normally, the mucus that lines organs in the body is thin and slick with a consistency slightly thicker than water. Babies who are born with cystic fibrosis have mucus that is sticky and thick. If the mucus builds up, it makes breathing difficult. Additionally, the thick mucus can prevent nutrients from being absorbed properly, which may lead to poor growth.

Causes of Cystic Fibrosis

Cystic fibrosis is a genetic condition and must be inherited from a parent. A gene mutation causes cystic fibrosis. When it is passed on to a child, the baby will be born with the condition. There is no way to prevent cystic fibrosis from occurring in newborns.

Diagnosis of Cystic Fibrosis

In the United States, newborns are regularly screened for cystic fibrosis. A small amount of blood is taken from the newborn and examined for high levels of a chemical called immunoreactive trypsinogen (IRT). If IRT levels are higher than normal, a secondary test will be run in order to rule out other conditions that can also present with high IRT levels.

The second test is known as a “sweat test.” Newborns with cystic fibrosis have more salt in their sweat than normal. Medication will be administered to the baby that causes sweat to form. This sweat will then be tested for sodium levels. If sodium levels are high, cystic fibrosis is typically diagnosed. Additional tests, such as genetic tests, may also be performed to confirm the diagnosis.

Treatment of Cystic Fibrosis in Newborns

When diagnosed early, cystic fibrosis has a higher success rate of treatment. Prescription medications can help prevent infections from occurring, reduce lung damage and decrease inflammation. Physical therapy will help loosen the thick mucus and make it easier for babies to breathe. A special diet will help increase food absorption and help newborns with the condition grow and thrive.

Cystic fibrosis is a life-threatening condition that requires continual care. Though there is no way to prevent cystic fibrosis in newborns, medical advancements can help babies diagnosed with the condition live longer and healthier lives than ever before.

DNA Sequencing Could Change How We Look at Genetic Neonatal Diseases

By Dr. Allen Cherer

On January 16, 2019

In Neonatal Care, Research

DNA sequencing is one of the most promising new technologies in terms of identifying the risk of disease, but it might not quite be ready for market. But regardless of concerns that DNA sequencing isn’t yet a safe screening method for newborn infants, chances are very strong that it will become a regular toolkit in preventative medicine sooner rather than later.

Routine blood tests are already part of standard procedure for infants born in the United States, and these tests can provide some substantive insight into potential future risks. But while a routine blood test can help identify dozens of different genetic conditions, that’s just scratching the surface of what can be accomplished with DNA sequencing. A study published in the American Journal of Human Genetics conducted DNA sequencing on 159 babies and found that 9% displayed anomalies that could predict genetic diseases that could appear in childhood. These include congenital heart disease and hearing loss.

But how much of an effect this testing could have on the health of infants is still an open question. Even co-author Alan Beggs questions how much substantive and actionable intelligence will arise from these genetic markers, at least for now. Nine percent is a low number, and many of these issues can be uncovered with the existing blood testing. Then there’s the fact that many of these genetic markers are not that well understood yet, and it can be difficult to understand how high of a risk such a genetic marker would actually pose.

Finally, there are a number of ethical and practical questions to consider. It can be hard to unpack issues of consent when dealing with the very genetic makeup of a child, and the rules behind the sharing of personal data, even as a means to better understand the map of human DNA, is still something like the Wild West. Finally, there are questions of how accessible this technology is and the costs associated for both medical providers and patients.

The running consensus now seems to be that DNA sequencing may be a beneficial choice in specific instances where parents are concerned about severe genetic disorders, but it’s not quite ready for primetime. As the technology and research continues to develop, it will likely become standard practice as a complement rather than a replacement for standard and accepted blood tests.