Approximately 1 in 4000 newborn infants has a severe deficiency of thyroid function, while even more have mild or partial degrees. If untreated for several months after birth, severe congenital hypothyroidism can lead to growth failure and permanent mental retardation. Treatment consists of a daily dose of thyroid hormone (thyroxine) by mouth. Because the treatment is simple, effective, and inexpensive, nearly all of the developed world practices newborn screening to detect and treat congenital hypothyroidism in the first weeks of life.
Congenital adrenal hyperplasia (CAH) refers to any of several autosomalrecessivediseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands (steroidogenesis). CAH is one of the possible underlying synthesis problems in Addison’s disease.Most of these conditions involve excessive or deficient production of sex steroids and can alter development of primary or secondary sex characteristics in some affected infants, children, or adults. The symptoms of CAH vary depending upon the form of CAH and the gender of the patient. Symptoms can include:Due to inadequate mineralocorticoids:vomiting due to salt-wasting leading to dehydration and deathDue to excess mineralocorticoids:hypertension (11beta[OH] deficiency)Due to excess androgens:ambiguous genitalia, in some females, such that it can be initially difficult to determine sexearly pubic hair and rapid growth in childhoodprecocious puberty or failure of puberty to occur (sexual infantilism: absent or delayed puberty)excessive facial hair, virilization, and/or menstrual irregularity in adolescenceinfertility due to anovulationenlarged clitoris and shallow vagina
Galactosemia (British Galactosaemia) is a rare geneticmetabolicdisorder that affects an individual's ability to metabolize the sugar galactose properly. Galactosemia is not related to and should not be confused with lactose intolerance. Galactosemia follows an autosomal recessive mode of inheritance that confers a deficiency in an enzyme responsible for adequate galactose degradation.Goppert first described the disease in 1917, with its cause as a defect in galactose metabolism being identified by a group led by Herman Kalckar in 1956.Its incidence is about 1 per 60,000 births. It is much rarer in Japan. Galactosemia is also very common within the Irish Traveller population. This is attributed to inbreeding within a relatively small gene pool.Lactose in food (such as dairy products) is broken down by the enzyme lactase into glucose and galactose. In individuals with galactosemia, the enzymes needed for further metabolism of galactose are severely diminished or missing entirely, leading to toxic levels of galactose 1-phosphate in various tissues, as in the case of classic galactosemia, resulting in hepatomegaly (an enlarged liver), cirrhosis, renal failure, cataracts, brain damage, and ovarian failure. Without treatment, mortality in infants with galactosemia is about 75%.Galactosemia is inherited in an autosomal recessive manner, meaning a child must inherit one defective gene from each parent to show the disease. Heterozygotes are carriers, because they inherit one normal gene and one defective gene. Carriers have been known to show milder symptoms of galactosemia.The only treatment for classic galactosemia is eliminating lactose and galactose from the diet. Even with an early diagnosis and a restricted diet, however, some individuals with galactosemia experience long-term complications such as speech difficulties, learning disabilities, neurological impairment (e.g. tremors, etc), symptoms have not been associated with Duarte galactosemia, and many individuals with Duarte galactosemia do not need to restrict their diet at all. Infants with classic galactosemia cannot be breast-fed due to lactose in human breast milk and are usually fed a soy-based formula.Galactosemia is sometimes confused with lactose intolerance, but galactosemia is a more serious condition. Lactose intolerant individuals have an acquired or inherited shortage of the enzyme lactase, and experience abdominal pains after ingesting dairy products, but no long-term effects. In contrast, a galactosemic individual who consumes galactose can cause permanent damage to their bodies.Long term complication of galactosemia includes:Speech deficitsAtaxiaDysmetriaDiminished bone densityPremature ovarian failureCataract
Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is a hereditary condition in which red blood cells break down when the body is exposed to certain drugs or the stress of infection.G6PD deficiency occurs when a person is missing or doesn't have enough of an enzyme called glucose-6-phosphate dehydrogenase, which helps red blood cells work properly.Too little G6PD leads to the destruction of red blood cells. This process is called hemolysis. When this process is actively occurring, it is called a hemolytic episode. The episodes are usually brief, because the body continues to produce new red blood cells, which have normal activity.Red blood cell destruction can be triggered by infections, severe stress, certain foods (such as fava beans), and certain drugs, including:Antimalarial drugsAspirinNitrofurantoinNonsteroidal anti-inflammatory drugs (NSAIDs)QuinidineQuinineSulfa drugsOther chemicals, such as those in mothballs, can also trigger an episode.In the United States, G6PD deficiency is more common among blacks than whites. Men are more likely to have this disorder than women.You are more likely to develop this condition if you:Are African AmericanAre of Middle Eastern decent, particularly Kurdish or Sephardic JewishAre maleHave a family history of the deficiencyA form of this disorder is common in whites of Mediterranean descent. This form is also associated with acute episodes of hemolysis. Episodes are longer and more severe than in the other types of the disorder.SymptomsPersons with this condition do not display any signs of the disease until their red blood cells are exposed to certain chemicals in food or medicine, or to stress.Symptoms are more common in men and may include:Dark urineEnlarged spleenFatiguePallorRapid heart rateShortness of breathYellow skin color (jaundice)
The neonatal period is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extrauterine existence. The high neonatal morbidity and mortality rates attest to the fragility of life during this period; in the United States, of all deaths occurring in the 1st yr, two thirds are in the neonatal period. The annual rate of deaths during the 1st yr is unequaled until the 7th decade.An infant's transition from intrauterine to extrauterine life requires many biochemical and physiologic changes. No longer dependent on maternal circulation via the placenta, the newborn's respiratory system must function for exchange of oxygen and carbon dioxide. Newborn infants are also dependent on gastrointestinal tract function for absorbing food, renal function for excreting waste and maintaining chemical homeostasis, hepatic function for neutralizing and excreting toxic substances, and function of the immunologic system for protecting against infection. The neonatal cardiovascular and endocrine systems also adapt for self-sufficient functioning. Many of a newborn infant's special problems are related to poor adaptation because of asphyxia, premature birth, life-threatening congenital anomalies, or the adverse effects of delivery.
Going home with a new baby is exciting, but it can be scary, too. Newborns have many needs, like frequent feedings and diaper changes. Babies can have health issues that are different from older children and adults, like diaper rash and cradle cap. Your baby will go through many changes during the first year of life. You may feel uneasy at first. Ask your health care provider for help if you need it.
Baby bath basics: A parent's guideWonder how to do a baby bath? Here's a step-by-step guide to help you master the basics. By Mayo Clinic staff Bathing a slippery newborn can be a nerve-racking experience. Your baby may not like it much, either. With a little practice, however, you'll both start to feel more comfortable at bath time. Start by learning baby bath basics. How often does my newborn need a bath?There's no need to give your newborn a bath every day. In fact, bathing your baby more than several times a week can dry out his or her skin. If you're quick with clean diapers and burp cloths, you're already cleaning the parts that really need attention — the face, neck and diaper area. Is it better to bathe my baby in the morning or at night?That's up to you. Choose a time when you're not rushed or likely to be interrupted. Some parents opt for morning baths, when their babies are alert and ready to enjoy the experience. Others prefer to make baby baths part of a calming bedtime ritual. Is a sponge bath good enough?A baby bath doesn't necessarily need to be done in a tub of water. The American Academy of Pediatrics recommends sponge baths until the umbilical cord stump falls off — which might take up to three weeks. If you'd like to give your baby a sponge bath, you'll need: A warm place with a flat surface. A bathroom or kitchen counter, changing table or firm bed will work. Even a blanket or towel on the floor is OK if it's warm enough.A soft blanket, towel or changing pad. Spread it out for your baby to lie on.A free hand. Always keep one hand on your baby. On a changing table, use the safety strap as well.A sink or shallow plastic basin to hold the water. Run warm water into the basin or sink. Check the water temperature with your hand to make sure it's not too hot.Essential supplies. Gather a washcloth, a towel — preferably with a built-in hood — cotton balls, mild baby shampoo, mild moisturizing soap, baby wipes, a clean diaper and a change of clothes.When you're ready to begin the sponge bath, undress your baby and wrap him or her in a towel. Lay your baby on his or her back on the blanket, towel or pad you've prepared. Wet the washcloth, wring out excess water and wipe your baby's face. There's no need to use soap. Use a damp cotton ball or clean cotton cloth to wipe each eyelid, from the inside to the outside corner. When you're ready to clean your baby's body, plain water is usually OK. If your baby is smelly or dirty, use a mild moisturizing soap. Pay special attention to creases under the arms, behind the ears, around the neck and in the diaper area. Also wash between your baby's fingers and toes. To keep your baby warm, expose only the parts you're washing. What type of baby tub is best?Many parents choose free-standing plastic tubs specifically designed for newborns. Others opt for plastic basins or inflatable tubs that fit inside the bathtub. Lined with a towel or rubber mat, the kitchen or bathroom sink might be another option. Remember, though, safety is the most important consideration — not necessarily the type of tub. Gather the same supplies you'd use for a sponge bath and a cup of rinsing water ahead of time so that you can keep one hand on the baby at all times. Never leave your baby alone in the water. How much water should I put in the tub?You'll need only 2 to 3 inches (about 5 to 8 centimeters) of warm water for a baby bath. To keep your baby warm, pour warm water over his or her body throughout the bath. Baby bath basics: A parent's guideWhat about water temperature?Warm water is best. To prevent scalding, set the thermostat on your water heater to below 120 F (49 C). Always check the water temperature with your hand before bathing your baby. Be sure the room is comfortably warm, too. A wet baby can be easily chilled. What's the best way to hold my newborn in the tub?A secure hold will help your baby feel comfortable — and stay safe — in the tub. Use one of your hands to support your baby's head and the other to hold and guide your baby's body into the water, feet first. Support your baby's head and torso with your arm and hand. Wrap your arm under your baby's back, grasping your baby firmly under the armpit. When you clean your baby's back and buttocks, lean him or her forward on your arm. Continue to grasp your baby under the armpit. What should I wash first?Most parents start with the baby's face and move on to dirtier parts of the body. Wash inside skin folds, and rinse the genitals carefully. Should I wash my newborn's hair?Wash your newborn's hair if it seems dirty or your baby develops cradle cap — a common condition characterized by scaly patches on the scalp. Supporting your baby's head and shoulders with your free hand, gently massage a drop of mild baby shampoo into your baby's scalp. Rinse the shampoo with a damp washcloth or directly under the faucet, cupping one hand across your baby's forehead to keep suds out of his or her eyes. If your baby has cradle cap, loosen the scales with a soft-bristled baby brush or toothbrush before rinsing off the shampoo. Do I need a special type of soap?There's no need to use special soap for a baby bath. In fact, plain water is fine for newborns. When needed, use a mild moisturizing soap. Avoid bubble bath and scented soaps. Will lotion after a baby bath help prevent rashes?Most newborns don't need lotion after a bath. The best way to prevent rashes is to dry inside your baby's folds of skin after each bath. If you choose to use lotion, pick one that's hypoallergen
There are a few of the things you can expect regarding the basic needs of your new baby:- Lots of feedings. In the first month, newborn babies breast or bottle feed an average of 8 to 12 times throughout the day and night. Babies who formula feed tend to eat a little more, as formula keeps them fuller longer. You’ll start to get a feel for when your baby is hungry very quickly.- Lots of sleeping. Most moms will tell you that in the first few months, it seems like all their baby does is sleep and eat. Newborns will usually sleep at least 16 hours a day, and sometimes more. Make sure you provide a safe sleeping area for your baby, and always put your infant on his back to minimize the chance of SIDS.- Lots of cleaning up. In the first few months, you’ll go through lots of diapers. Keep enough diapers, wipes, and diaper rash ointment on hand. You will also need to bathe your newborn baby. In the beginning, a sponge bath with a washcloth and warm water is fine. Once you start to bathe your baby, make sure you always test the temperature to make sure it’s lukewarm and not too hot. Use a soap specifically designed for babies and their sensitive skin, as other cleansers or bar soaps can dry a baby’s skin.Taking care of a newborn baby takes practice, but once you know the baby’s basic needs, you’ll catch on very quickly.
Elevations in temperature (38–39°C or 100–103°F) are occasionally noted on the 2nd–3rd day of life in infants whose clinical course has been otherwise satisfactory. This disturbance is especially likely to occur in breast-fed infants whose intake of fluid has been particularly low or in infants who are overdressed or are exposed to high environmental temperatures, either in an incubator, in a bassinette near a radiator, or in the sun.The infant may lose weight. A consistent relationship may not be seen between the fever and the extent of weight loss or inadequacy of fluid intake. Urinary output and the frequency of voiding diminish. The fontanel may be depressed. The infant takes fluids avidly, but the apparent vigor of the infant contrasts with the usual appearance of “being sick” from an infection.
The rise in temperature may be associated with an increase in serum levels of protein and sodium and with an increase in hematocrit. The possibility of local or systemic infection should be evaluated. Administering oral or parenteral fluids or lowering the environmental temperature leads to prompt reduction of the fever and alleviation of symptoms. Oral hydration should be with additional nursing or formula and not with pure water, due to the risk of hyponatremia.
The myoclonic twitches are usually caused by sudden muscle contractions; they also can result from brief lapses of contraction. Contractions are called positive myoclonus; relaxations are called negative myoclonus. The most common time for people to encounter them is while falling asleep (hypnic jerk), but myoclonic jerks are also a sign of a number of neurological disorders. Hiccups are also a kind of myoclonic jerk specifically affecting the diaphragm. Also when a spasm is caused by another person it is known as a "provoked spasm". Shuddering attacks with babies also fall in this category.
Edema may produce a superficial appearance of good nutrition. Pitting after applied pressure may or may not be noted, but the skin of the fingers and toes lacks the normal fine wrinkles when filled with fluid. Edema of the eyelids commonly results from irritation caused by the administration of silver nitrate. Generalized edema may occur with prematurity, hypoproteinemia secondary to severe erythroblastosisfetalis, nonimmunehydrops, congenital nephrosis, Hurler syndrome, or unknown cause. Localized edema suggests a congenital malformation of the lymphatic system; when confined to one or more extremities of a female infant, it may be the initial sign of Turner syndrome
Metabolic bone disease is a common complication in very low birthweight preterm infants. The smallest sickest infants are at greatest risk. Progressive osteopenia with demineralized bones and occasionally pathologic fractures may develop. The major cause is inadequate intake of calcium to meet the requirements for growth. Poor intake of phosphorus and vitamin D are additional risk factors. Contributing factors include prolonged parenteral nutrition, vitamin D and calcium malabsorption, intake of unsupplemented human milk, immobilization, and urinary calcium losses from chronic diuretic use. The serum alkaline phosphatase level is used to monitor metabolic bone disease and can be over 1,000 U/L in severe cases. Fortified human milk and formulas designed for preterm infants provide improved intake of calcium, phosphorus, and vitamin D; promote bone mineralization; and may prevent metabolic bone disease. Many extremely low birthweight infants will require additional oral supplements of calcium, phosphorus, and vitamin D. Treatment of fractures requires immobilization and administration of calcium and, if needed, phosphorus (for hypophosphatemia) and vitamin D (not more than 1,000 IU/day unless severe cholestasis or vitamin D resistance is present). See also Chapters 48 and 571 .
Transient neonatal pustularmelanosis (also known as "Transient neonatal pustulosis", and "Lentiginesneonatorum") is a cutaneous condition that presents at birth with 1- to 3-mm flaccid, superficial fragile pustules, some of which may have already resolved in utero, leaving pigmented macules.:856-7
generalized 1-2 mm pustules Comments:A healthy newborn boy was evaluated for generalized 1-2 mm pustules. The child appeared well. Bacterial culture of one of the pustules was negative, and a Gram stain revealed neutrophils without organisms. Transient neonatal pustularmelanosis (or rather pustulosis in this light pigmented child) is a benign self-limited eruption which resolved quickly without treatmen
The vast majority of newborns enter the world healthy. But sometimes, infants develop conditions that require medical tests and treatment.Newborns are particularly susceptible to certain diseases, much more so than older children and adults. Their new immune systems aren't adequately developed to fight the bacteria, viruses, and parasites that cause these infections.As a result, when newborns get sick, they may need to spend time in the hospital — or even the neonatal intensive care unit (NICU) — to recover. Although it can be frightening to see your baby hospitalized, a hospital stay is often the best way back to good health for a sick newborn.
ListeriosisListeriosis is an infection that is caused by the bacteria-Listeriamonocytogenes. It is a serious infection and affects pregnant women and newborns. Listeriosis affects about 2,500 people every year and pregnant women are 20 times more likely to become infected with the condition. If you have AIDS, you are approximately 300 times more likely to become infected with listeriosis. However, the infection can be prevented. If you develop listeriosis, you might feel some mild symptoms that are similar to that of a cold. However, you might also begin to experience a fever, muscle aches, stiff neck, confusion, headaches, and nausea or diarrhea. Sometimes convulsions and loss of balance may also be present. If you get listeriosis while you are pregnant, there is an icreased chance of miscarriage, stillbirth, premature delivery and your baby may be infected as well. Newborns are usually the ones that will suffer the most from the condition. The bacteria that causes listeriosis can be found in soil, water, vegetables, uncooked meats, dairy products, soft cheeses and juices. When foods and drinks are pasteurized and cooked, the bacteria are killed. However, hot dogs and lunch meats can still carry the bacteria after they have been cooked. It is important to follow general sanitary rules and keep a clean food preparation area while cooking to avoid becoming infected with listeriosis. Wash your hands properly before, during and after meal preparation.Clean all foods before eating or cooking them.Cook foods thoroughly before consuming.Never eat unpasteurized foods or juices.Never drink unpasteurized milk.Wash vegetables thoroughly before eating or cooking.Eat ready-to-eat foods as soon as possible.Do not eat hot dogs or lunch meats unless they are heated until they are STEAMING HOT.Wash all surfaces and hands after handling hot dogs, lunch meats and deli meats.Do not eat refrigerated, smoked seafood.Do not eat refrigerated meat spreads. Canned spreads are generally okay.Avoid Soft CheesesBrieCamembertBlueFetaQueso BlancoQueso FrescoOther Mexican-style cheesesIf you think that you have the symptoms of listeriosis, contact your healthcare provider immediately. A blood or spinal test can show if you have the infection. If you have tested positive for the infection, your doctor will give you antibiotics to try to prevent an infection in your growing baby. What is the treatment for listeriosis?During pregnancy, antibiotics are given to treat listeriosis in the mother. In most cases, the antibiotics also prevent infection of the fetus or newborn. Antibiotics are also given to babies who are born with listeriosis.
To diagnose or rule out sepsis, doctors draw blood and sometimes examine cerebrospinal fluid and other body fluids to look for bacteria or other pathogens. They typically look for sepsis and meningitis in the same work-up. Once a positive diagnosis is made, the child will receive a course of antibiotics during a stay in the hospital.
Congenital InfectionsWhat are they?Many infections that affect newborns are transmitted from mother to infant, either during pregnancy or delivery. Because the baby is born with them, they're known as congenital infections. They are most often caused by viruses and parasites.Congenital infections include: HIV (which causes AIDS); rubella (German measles); chickenpox; syphilis; herpes; toxoplasmosis; and cytomegalovirus (CMV), the most common congenital infection and the leading cause of congenital hearing loss. Several of these infections, such as GBS infection and listeriosis, can be acquired either from the mother or later from the newborn's environment.It's more likely that babies will be born with an infection if their mothers become infected for the first time with a particular germ while pregnant. However, transmission to the baby doesn't always occur, so many babies born to mothers with these infections don't have the infection themselves. Other newborns may not initially show signs of disease, but may later exhibit its effects.The risk these infections pose to an infant often depends on when the mother is exposed to the germ. With many infections, such as rubella and toxoplasmosis, the risk is greatest in the first trimester. If the mother becomes infected then, it can cause serious problems such as heart disease, brain damage, deafness, visual impairment, or even miscarriage. Infection later in the pregnancy may lead to less severe effects on the fetus but can still cause problems with the infant's growth or development.Some early signs of a possible congenital infection include: a large or small head, small body size, seizures, problems with the eyes, skin rashes, jaundice, enlarged abdominal organs, and a heart murmur.How are they diagnosed and treated?If a congenital infection is suspected, a doctor will run blood tests and cultures of blood and other fluids from the infant, and sometimes the mother, to try to make a diagnosis. Treatment often includes the antiviral or antibiotic medications that are used to treat the diseases in older patients, as well as intense supportive care while the baby's in the hospital. Congenital infections also call for close medical follow-up to watch for any effects of the disease that may develop as the infant grows.
the most common congenital infection and the leading cause of congenital hearing loss. Several of these infections, such as GBS infection and listeriosis, can be acquired either from the mother or later from the newborn's environment.
omplications of Neonatal InfectionsNeonatal infections that aren't treated promptly or that spread can have serious consequences. Because babies' bodies and organs are undergoing rapid development, any interruption in that process can lead to complications, including growth, developmental, neurological, cardiac, respiratory, and sensory problems. In some severe cases, neonatal infections can even be fatal.With their fragile new immune systems, babies aren't well equipped to deal with infection. Premature or otherwise immunocompromised babies are at an even greater risk of developing a critical disease from a bacterium or virus that might cause a simple illness in an older child. An early diagnosis, swift treatment, and close monitoring and care give a baby the best chance of overcoming the infection.Can Neonatal Infections Be Prevented?If a pregnant woman is diagnosed with one of these infections, or if she is considered at risk of infection, preventive measures can lower the probability that she will pass it to her baby. Because many infections can be treated with medicine given to the mother while she's pregnant, maternal testing is extremely useful.In many cases, a quick blood or fluid test can determine if a pregnant woman should receive treatment. For a woman with listeriosis, a course of antibiotics usually prevents transmission of the bacterium to the fetus. Women who are HIV positive are advised to take antiretroviral medication during pregnancy to lower the risk that their babies will contract HIV infection.Other neonatal infections are best prevented through steps that keep expectant mothers from developing the infection in the first place.Women can help protect themselves and their unborn babies by:making sure they've been immunized against rubella and chickenpox infection before trying to become pregnantthoroughly washing and cooking food, regularly washing hands (particularly before and after preparing food, after using the toilet, and after coming into contact with bodily fluids and waste), and avoiding all contact with cat and other animal feces to lower the risk of contracting bacteria and parasites that lead to infections such as listeriosis and toxoplasmosispracticing safe sex to avoid sexually transmitted diseases (STDs) that can lead to congenital infectionsSome preventive measures are routine parts of pregnancy and delivery. Many doctors recommend that an expectant mother have a simple swab test late in pregnancy to check whether she's carrying GBS. If she is, she will receive intravenous (IV) antibiotics during delivery to lower the risk of transmitting the bacteria to her baby. Doctors also routinely put antibiotic drops or ointment in newborns' eyes to prevent conjunctivitis caused by gonorrhea bacteria.Reviewed by: Michael L. Spear, MDDate reviewed: April 2009
NEW BORN CARE AND INFECTIONS
Mothers Class<br />New born care and Newborn Infections<br />Vivian C. Barrera<br />Department of Family and Community Medicine<br />Perpetual Succour Hospital<br />
Caring for a newborn is one of<br />the greatest challenges a parent<br />or caregiver faces. A new baby<br />is completely dependent on loved ones<br />to care for him or her<br />
NEWBORN SCREENING<br />RA 9288 orNewborn Screening program of 2004<br />
CONGENITAL ADRENAL HYPERPLASIA<br />excessive or deficient production of sex steroids <br />
GALACTOSEMIA<br />Rare genetic metabolic disorder<br />incidence is about 1 per 60,000 births<br />Without treatment, mortality in infants is about 75%.<br />
PHENYLKETONURIA<br /> occurs in 1 in 10,000 to 15,000 newborns.<br /> Most cases of PKU are detected shortly after birth by newborn screening<br /> treatment is started promptly<br />
G6PD DEFICIENCY<br />Persons with this condition do not display any signs of the disease until their red blood cells are exposed to certain chemicals in food or medicine, or to stress<br />Red cells break down when exposed to certain drugs or stress of infection<br />
Antimalarial drugs<br />Aspirin<br />Nitrofurantoin<br />Nonsteroidal anti-inflammatory drugs (NSAIDs)<br />Quinidine<br />Quinine<br />Sulfa drugs<br />Other chemicals, such as those in mothballs, can also trigger an episode.<br />)<br />Are African American<br />Are of Middle Eastern decent, particularly Kurdish or Sephardic Jewish<br />Are male<br />Have a family history of the deficiency<br />A form of this disorder is common in whites of Mediterranean descent<br />Dark urine<br />Enlarged spleen<br />Fatigue<br />Pallor<br />Rapid heart rate<br />Shortness of breath<br />Yellow skin color(jaundice<br />
Neonatal Period ( 0 - 1st mos )<br />Vulnerable time<br />Completing vulnerable changes<br />High morbidity and mortality rates<br />U.S. Deaths in 1sy year of life: 2/3 in neonatal period<br />No longer dependent on maternal circulation <br />
Parental role in Maternal-Infant Attachment<br /> Requires dedication because a newborn's needs are urgent, continuous, and often unclear<br />
Mother is freaking out for?<br />Is it something worth freaking out?<br />
Newborn’s Basic Needs<br />Lots of feeding<br />Lots of sleep<br />clothing<br />Lots of Cleaning Up<br />
FEVER IN NEONATES<br />Fever is a prominent symptom of many different disease processes<br />
Neonates and young infants may manifest fever as the only sign of significant underlying infection. <br />A rectal temperature of 38ºC(100.4ºF) generally is regarded as fever in the neonate 0 to 28 days of age. <br />FEVER IN NEONATES<br />
HYPERTHERMIA IN THE NEWBORN TRANSITORY FEVER OF THE NEWBORN, DEHYDRATION FEVER<br />Temp: 38-39<br />2nd -3rd day of life<br /> Risks factors:<br />Breast fed infant whose intake is low<br />Overdressed<br />Exposure to high temperatures<br />Manifestations<br />Infants may lose weight<br />Diminish urine output<br />Depressed fontanel<br />Infant takes fluid avidly<br />
HYPERTHERMIA IN THE NEWBORN TRANSITORY FEVER OF THE NEWBORN, DEHYDRATION FEVER<br />Should be evaluated for local or systemic infection<br />Treatment“:<br />Addtional nursing formula NOT pure water<br />
Check TEMP<br />Loosen up clothings<br />Cool environment<br />WHAT TO DO?<br />Call a friend <br />
Presence of fever should be evaluated <br />laboratory evaluation<br />CBC, Blood Culture, UA , CSF <br />CXR and Stool Cx<br />Admission<br />Visit an M.D.<br />
General Appearance<br />Myoclonus<br />Is brief, involuntary twitching of a muscle or a group of muscles. <br />It describes a medical sign and, generally, is not a diagnosis of a disease. <br />Brief twitches are perfectly normal us<br />
EDEMA<br />Produce superficial appearcance of good nutrition<br />(+) Pitting<br />Generalized<br />Prematurity<br />Hypoproteinemia<br />Non immune hydrops<br />Congenital nephrosis<br />Hurlers syndrome<br />Unknown cause<br />1 or more extremities: initial sign of turners syndrome<br />
HYPOCALCEMIA (TETANY)<br />Common complication of VLBW pre term infants<br />Can lead to fracture<br />Major cause :<br /> inadequate intake of calcium to meet the requirement for growth<br />Prolonged parenteral nutrition<br />Vit D and calcium mal absorption<br />Intake of unsupplemented human milk<br />Urinary calcium losses from chronic diuretic use.<br />
called a milk spot or an oil seed<br />is a keratin-filled cyst that can appear just under the epidermis or on the roof of the mouth<br />commonly associated with newborn babies<br />found around the nose, eyes, and genitalia<br />In children milia often disappear within 2 to 4 weeks.<br />Milia<br />
Erythema toxicum<br />Common Harmless Rash<br />Appears within 1-2days after birth <br /> goes away on its own within a week<br />Not contagious,<br />does not require any medical treatment <br />
<ul><li>tiny bumps that are firm, yellowish or white, and surrounded by a ring of redness. </li></ul>Sometimes these bumps are filled with a fluid that looks like (but isn't) pus.<br />Sometimes there are no bumps at all — only a splotchy redness<br />
The rash usually appears on the baby's face, chest, arms, and legs<br /> It may be concentrated on only one area of the body<br /> it may cover much of the child's skin,<br /> although it usually does not affect the palms or soles of the feet<br />
TRANSIENT NEONATAL PUSTULAR MELANOSIS<br />BENIGN idiopathic skin condition mainly seen in newborns <br /><ul><li>has distinctive features characterized by vesicles, superficial pustules, and pigmented macules</li></li></ul><li>present at birth.<br />occur on the chin, neck, forehead, chest, buttocks, back, and, less often, on the palms and soles<br />The vesicles and pustules rupture easily and resolve within 48 hours.<br />The brown macules may persist for several months<br />NO SPECIFIC THERAPY is indicated for transient neonatal pustularmelanosis<br />
Main cause not known<br />But it could be due to the increased sensitivity of the infant's sebaceous glands to maternal hormones during pregnancy<br />Peaks at around 2 months<br />Rarely needs treatment. <br />
Signs to Look for<br />Many infections cause similar symptoms. Call your child's doctor or seek emergency medical care if your new baby shows any of these possible signs of infection:<br />poor feeding<br />breathing difficulty<br />listlessness<br />decreased or elevated temperature<br />unusual skin rash or change in skin color<br />persistent crying<br />unusual irritability<br />
Group B Streptococcal Disease<br /> A common type of bacterium that can cause a variety of infections in newborns. <br />Some of the most common are sepsis, pneumonia, and meningitis. <br />Babies usually get the bacteria from their mothers during birth — many pregnant women carry these bacteria in the rectum or vagina, where they can easily pass to the newborn if the mother hasn’t been treated with antibiotics.<br />
Group B streptococcal Disease<br />Babies with GBS often show symptoms of infection within the first week of life, although some develop symptoms weeks or months later.<br /> Depending on the infection (pneumonia or sepsis, for example), the symptoms might include trouble breathing or feeding, a high temperature, listlessness, or unusual crankiness<br />
Listeriosis<br />Serious infection affecting pregnant women and newborns<br />Can lead to diseases such as pneumonia, sepsis, and meningitis in newborns.<br /> Most people encounter the bacteria by eating contaminated food <br />Bacteria are found in soil and water and can end up on fruits and vegetables, as well as in foods that come from animals, such as meat and dairy products<br />.<br />
Listeriosis<br />Food that isn't properly cleaned, pasteurized, or cooked may give someone listeriosis<br />Babies can acquire bacteria from their mothers if the mother contracts listeriosis while pregnant.<br /> In severe cases, listeriosis may lead to premature delivery or even stillbirth.<br /> Babies born with listeriosis may show signs of infection similar to those of GBS<br />
It is important to follow general sanitary rules and keep a clean food preparation area while cooking to avoid becoming infected with listeriosis.<br />
Do not eat hot dogs or lunch meats unless they are heated until they are STEAMING HOT.<br />Wash all surfaces and hands after handling hot dogs, lunch meats and deli meats.<br />Do not eat refrigerated, smoked seafood.<br />Do not eat refrigerated meat spreads. Canned spreads are generally okay.<br />
SEPSIS<br />Is a serious infection that involves the spread of germs throughout the body's blood and tissues. <br />It can be caused by viruses, fungi, parasites, or bacteria. <br />Some of these infectious agents are acquired during birth, while others are picked up from the environment.<br /> As with meningitis, the symptoms of sepsis are not specific and vary from child to child. <br />
How is it diagnosed and treated?<br />To diagnose or rule out sepsis<br />Blood test<br />Examine cerebrospinal fluid and other body fluids to look for bacteria or other pathogens. <br />They typically look for sepsis and meningitis in the same work-up. <br />Once a positive diagnosis is made,<br /> the child will receive a course of antibiotics during a stay in the hospital.<br />
CONJUNCTIVITIS(PINK EYE)<br />Some newborns develop an inflammation of the eye's covering membranes<br />appears as redness and swelling in the eye, <br />usually accompanied by a discharge. <br />Both bacterial and viral infections can cause conjunctivitis in newborns.<br />
HOW IS IT DIAGNOSED AND TREATED?<br />The infection can be very contagious, so the doctor may also suggest that other children in the family limit contact with the baby.<br /> If a more serious type of conjunctivitis is suspected, hospitalization may be necessary<br />
CANDIASIS<br />An overgrowth of the common yeast candida, found on everyone's body, leads to the fungal infection candidiasis. <br />In newborns, it usually shows up as diaper rash, but babies can also develop oral thrush in the mouth and throat. <br />It causes cracks in the corners of the mouth and white patches on the tongue, palate, lips, and insides of the cheeks.<br /> Newborns who get thrush have often picked up the fungus from the mother's vagina during delivery or during breastfeeding.<br />
It's more likely that babies will be born with an infection if their mothers become infected for the first time with a particular germ while pregnant. However, transmission to the baby doesn't always occur, so many babies born to mothers with these infections don't have the infection themselves. Other newborns may not initially show signs of disease, but may later exhibit its effects.<br />
Congenital infections include<br />The risk these infections pose to an infant often depends on when the mother is exposed to the germ<br />
Complications<br />Large or small head<br />Small body size<br />Seizures<br />Problems with the eyes<br />Skin rashes<br />Jaundice<br />Enlarged abdominal organs<br />A heart murmur.<br />heart disease<br />brain damage<br />Deafness<br />visual impairment<br />Miscarriage<br />Infection later in the pregnancy may lead to less severe effects on the fetus but can still cause problems with the infant's growth or development<br />