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Understanding Tetralogy of Fallot

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.

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.

A Closer Look at Neonatal Polycythemia

By Dr. Allen Cherer

On June 1, 2020

In Neonatal Care, Newborns

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.

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.