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Respiratory Distress in Newborns

On March 18, 2019

In Neonatal Care, Newborn Screening, Newborns, Research

Respiratory distress syndrome, or RDS, is a common lung complaint for infants. This is especially true in premature babies, born before 37 weeks. The more premature the baby, the greater the chance the child will develop RDS.

RDS is caused by a shortage of pulmonary surfactant. Surfactant is a liquid that helps keep air sacs in the lungs, known as alveoli, open. Alveoli are critical. They are the site of the exchange of oxygen and carbon dioxide. They make it possible for the blood to be oxygenated fully. Since surfactant makes this possible, it’s a very important substance indeed.

There are several risk factors for RDS. In addition to prematurity, babies with RDS are more likely to be white, male, and multiples. Mothers with diabetes are more likely to give birth to RDS babies. Babies delivered by c-section are also more likely to develop this problem.

Parents of babies with some of these risk factors should be aware of the symptoms of respiratory distress syndrome. Babies with RDS breathe fast. They may grunt, making an ugh sound with each breath. Their nostrils will flare every time they breathe. Finally, they can have retractions, where the skin pulls under the rib cage or in between ribs with each breath. Their skin may not be as pink as that of a typical baby.

Luckily, there is treatment for RDS these days. Delivery of oxygen by nasal cannula is one treatment. A CPAP, or continuous positive airway pressure, machine can be used to push air into an infant’s lungs. This will keep the alveoli open. Severe cases of RDS can require a ventilator.

Ventilators are a serious measure. They require intubation, or a tube being placed down the infant’s windpipe. Ventilators are only used in babies who can’t breathe well without assistance.

In addition to helping deliver more oxygen, the issue of a lack of surfactant can also be addressed. Surfactant can be delivered directly to the lungs, also via intubation. Medications to calm the infant are also used, especially when intubation is required.

RDS can sometimes also be associated with infections. In those cases, antibiotics may be given to the infant. Not every baby requires all of these treatments. In some cases, babies get worse before getting better. RDS is, in general, very treatable.

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.

Neonatology: a Brief History

By Dr. Allen Cherer

On January 16, 2019

In Neonatal Care, Newborn Screening, Newborns

Physicians and scientists began recognizing that premature or ill newborns required specialized care in the 1700s. However, it would be another century before a physician would take the first steps toward improving neonatal health. In the coming years, advancements in science and technology steadily enhanced the chances that preterm infants survived.

19th Century

French obstetrician Etienne Stephane Tarnier recognized that premature infants were unable to maintain their body temperature. The physician invented the first incubator using a wooden box with a glass lid. The heat was provided by a hot water bottle. As a result, infant mortality decreased by 28 percent.

Pierre-Constant Budin trained under Dr. Tarnier and became a pioneer in neonatal nutrition during the late 1800s. Dr. Budin was aware of the risks of feeding newborns cow’s milk due to pathogens. He encouraged his new mothers to breastfeed. He was also responsible for introducing tube feeding for preemies who were unable to feed naturally.

By the early 1900s, Martin Couney, one of Dr. Budin’s students, improved upon Tarnier’s incubator design. However, the medical community was not accepting and the devices were not used in hospitals. In order to gain attention for the need, Dr. Couney began treating infants free of charge and demonstrated his invention at expositions and fairs.

20th Century

For the most part, premature or ailing infants were not provided medical care. It was not until after World War II that the medical community recognized the need to offer specialized care. During this era, hospitals began developing “Special Care Baby Units” that eventually evolved into NICUs. Along with providing sufficient warmth, the units ensured that the infants received oxygen. There was also increasing awareness of an infant’s susceptibility to infection, which led to stringent hand washing.

Formulas for premature infants were introduced during this time. The formulas contained increased levels of calcium, phosphorus, sodium and protein. However, the high protein levels soon created a number of problems. As such, whey proteins were used.

Beginning in the 1960s, laboratory tests and values were established to monitor infant health. Physicians created a way to evaluate blood gases, bilirubin levels and liver function along with checking electrolytes, blood sugar and oxygen levels.

Advancements in knowledge and technology meant that infants born after 23 weeks of gestation had a survival rate of 33 percent. Infants born after 24 weeks had a survival rate of 66 percent. The survival rates continue growing each year.

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.