Tag: newborns

Exploring Current Neonatology Trends

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.

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.

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.

A Closer Look at Neonatal Alagille Syndrome

By Dr. Allen Cherer

On May 14, 2019

In Newborn Screening, Newborns, Research

Roughly 1 out of 70,000 newborns is born with neonatal Alagille syndrome. This condition is often present at birth, though it can take several years for the symptoms to become present. Here are some important facts that parents need to know about neonatal Alagille syndrome.

What Is Neonatal Alagille Syndrome?

Neonatal Alagille Syndrome is a type of genetic disorder that children can inherit from their parents. People with neonatal Alagille syndrome have a mutated or missing copy of a gene labeled Jagged1 on chromosome 20. Problems with this gene are associated with a wide range of liver, heart, and eye problems. Due to a variety of skeletal abnormalities, people with neonatal Alagille syndrome tend to have a very characteristic appearance. Alagille syndrome is also referred to as Alagille-Watson syndrome, syndromic bile duct paucity, or arteriohepatic dysplasia.

What Are the Neonatal Alagille Syndrome Symptoms?

Not all people with neonatal Alagille syndrome have the same symptoms present. The condition can just cause minor issues like some changes to facial features, or it can cause severe heart and liver disease. Some of the most common symptoms include:

Deep-set eyes
Straight nose
Triangular face shape with pointed chin
Jaundice
Heart murmurs
Cardiac anomaly
Short height
Butterfly shaped vertebrae
Kidney abnormalities
Eye abnormalities

Parents should keep in mind that some symptoms, like kidney abnormalities, can take a while to notice. Signs that these organs are not functioning properly can include chronic itchiness, fatigue, pale skin, fluid retention, weakness, or abnormally pale feces.

How Is Neonatal Alagille Syndrome Treated?

Treatment for neonatal alagille syndrome typically relies on what symptoms the patient is presenting. Many children have mild enough Alagille syndrome that they just need to eat a healthy diet and get plenty of rest to help with issues like delayed puberty or failure to thrive. Certain medications can help with things like improving bile function, stabilizing kidney function, and helping the heart run properly. However, in more serious situations, surgery may be necessary. Surgeries can help to correct skeletal issues, replace malfunctioning kidneys and livers, or treat cardiac abnormalities.

Echogenic Bowel: An Overview

By Dr. Allen Cherer

On May 14, 2019

In Neonatal Care, Newborn Screening, Newborns, Research

Though it is not an incredibly common diagnosis, there are still thousands of fetuses diagnosed with an echogenic bowel each year. Roughly 1.8 percent of all fetuses have echogenic bowel, and their parents often wonder what exactly this term means. Understanding all the details about echogenic bowel will help parents discover how to handle this condition.

What Is Echogenic Bowel?

This term is simply used to refer to a fetal bowel that is abnormally bright when viewed on an ultrasound. Ultrasounds are always in shades of black, grey, and white, with denser tissue being bright white and fluid being black. Usually, the bowels of the fetus tend to be a dark grey on an ultrasound because they are softened tissue, but if a fetus has echogenic bowel, their bowels may look as bright as thick bones like the pelvic bone.

What Does It Mean to Have Echogenic Bowel?

When parents first hear this word, they often start to wonder if it is a serious problem. The reality is that it is not always a sign of a health condition. 0.5 percent of all perfectly healthy fetuses have an echogenic bowel, and it can just occur due to various fluctuations in growth. However, echogenic bowel can be a cause for concern because it is more common in babies born with Down syndrome or cystic fibrosis. It can also be a sign that the fetus is suffering from an intestinal obstruction or an infection like cytomegalovirus or toxoplasmosis.

How Is Echogenic Bowel Treated?

The method for addressing echogenic bowel typically depends on the severity. Low grade echogenic bowels which are less dense than bone are normally harmless, so doctors tend to take a “wait and see” approach. They normally recommend taking a more detailed ultrasound in a few weeks to check up on the growth of the fetus. However, for more severely echogenic bowels, doctors may recommend a maternal serum screening, blood tests, or an amniocentesis to determine if the fetus has Down syndrome, infections, or cystic fibrosis. To make sure that the pregnancy continues safely, doctors will usually do regular fetal monitoring to make sure the fetus is growing properly following a display of echogenic bowel.

Persistent Myths in Neonatology

By Dr. Allen Cherer

On March 18, 2019

In Neonatal Care, Newborn Screening, Newborns, Research

Neonatology is a medical specialty that deals with the care of newborns. It’s a subspecialty of pediatrics. In recent years, neonatologists have taken steps to demystify infant care. Part of that means confronting myths about caring for babies that have existed for generations.

Typically, these myths are spread by well-meaning friends and families. They want to help new parents and truly believe they’re passing on sound advice. However, much of this advice is badly out of date. Evidence-based medicine supported by double-blind trials has disproved much of it.

Nutrition and diet are common areas where myths abound. There are several nutrition myths about preemies and full-term babies. Nutrition myths can be focused on what babies eat, how they are fed and how their meals are prepared.

An example of a nutrition myth is that infant formula must be sterilized before feedings. This hasn’t been a recommended practice since the 1950s. In developed countries with clean water, preparing bottles with clean tap water is sufficient. Bottles and nipples should, of course, be washed with soap and water. But boiling is not necessary.

Other myths that persist are often centered on fevers. Parents misunderstand which fevers are serious. They can also attribute fevers to milestones like teething. Studies since the 1990s have shown that there’s actually no link between fever and teething. Even on days when new teeth erupt, an average temperature should not be above 100 degrees. This is a slight elevation, but not a dangerous fever.

Parents typically see fevers of about 102 as serious, high fevers. This is rarely the case. While calling a pediatrician can be prudent in these cases, typically the fever itself is not serious. Causes of fever can also be misunderstood, even by medical professionals. Sometimes, doctors attribute fever in newborns to dehydration. While this may be the case, it’s also important to rule out causes like infection before settling on that diagnosis.

It’s important to continue to talk about these neonatology myths. They are often handed down from previous generations in families. While they represent advice that was cutting-edge in the past, they can create more work for parents in the present. Medical professionals should also ensure that they are keeping up with literature, so that they can avoid pitfalls in treating newborn babies.

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.