The document discusses various neonatal problems including: anaemia, apnoea, bradycardia, chronic lung disease, diaphragmatic hernia, exomphalos, feeding problems, gastro-oesophageal reflux, gastroschisis, Hirschsprung's disease, hypoglycemia, hyperglycemia, hypotension, inguinal hernia, intraventricular haemorrhage, malrotation, meconium aspiration syndrome, necrotizing enterocolitis, patent ductus arteriosus, pneumothorax, poor weight gain, persistent pulmonary hypertension of the newborn, respiratory distress syndrome, retinopathy of prematurity, seizures, identifying sepsis, tachycardia

1. Neonatal problems

2. • Anaemia: Anaemia is when the body does not have
enough red blood cells. Red blood cells are
responsible for carry oxygen around your baby's body.
If your baby is Anaemic he/she may appear pale, be
short of breath, and have increased oxygen
requirements. A blood test can be taken to determine
what the baby's red blood cell count is.
• Apnoea: Apnoea is the term commonly used for
stopping breathing for 20 seconds or longer and is
directly related to prematurity. The more premature
your baby is, the more likely apnoea will occur. This is
because the receptors in the brain that control
breathing are immature. Your baby will be
continuously monitored for apnoea episodes and if
apnoea does occur your baby will be gently
stimulated to encourage regular breathing again

3. • Bradycardia: Bradycardia is an abnormal slowing
of the heart, often arising from other problems
like low oxygen levels in the blood or from apnoea
(breathing that stops longer than 10 seconds).
• Chronic lung disease (CLD):Often the combination
of the premature baby's immature lungs and the
treatments to help him breathe (including
machines and oxygen) can cause scarring of the
delicate lung tissue. Babies who still need oxygen
at 36 weeks gestation are considered to have CLD.
– CLD is sometimes treated with steroids

4. • Diaphragmatic hernia: Diaphragmatic hernia
occurs early in development when the diaphragm
which separates the lungs and the abdominal
contents fails to form properly.
• The problem is usually diagnosed before the baby
is born. Babies who have a diaphragmatic hernia
will have some contents of the abdomen in place
of where the lungs should be, affecting the
development of the lungs. As the lungs are not
used while the baby is in the womb this does not
cause any problems. However when the baby is
born he will have difficulty breathing.

5. • Exomphalos: Exomphalos occurs when the gut fails to
return into the abdominal cavity during development.
It is usually picked up on antenatal scans, and
requires surgical treatment.
• Feeding problems: Feeding problems are very
common in the newborn. If your baby has been born
prematurely or has had surgery then oral feeds will
be started very slowly.
– This is because the gut may be immature or sluggish
following surgery.
– Tolerance of feeds will be assessed regularly to ensure that
your baby is digesting the milk, avoiding problems such as
vomiting.
– If your baby is not tolerating the small amounts of milk,
vomiting or showing signs of being unwell the feeds will
not be increased and they may even be stopped

6. • Gastro-oesophageal reflux: Gastro-oesophageal
reflux occurs when the stomach frequently
regurgitates its contents upwards towards the mouth.
– If your baby has been born prematurely, has had
abdominal surgery or has had problems establishing feeds
then he/she is likely to be at an increased risk of
developing reflux.
– Vomiting milk during or immediately after a feed is
suggestive of reflux, and is usually treated by tilting your
baby's bed to a more upright position and feeding more
slowly.
– Occasionally medication is used to reduce gastric acid and
help reduce reflux.
• Gastroschisis: Gastroschisis is a condition where the
abdominal contents are outside due to a defect in the
abdominal wall.

7. • Hirschsprung's Disease: Hirschsprung's Disease is a
congenital condition which can cause extreme constipation,
pain, and intestinal blockage.
• Anemia, bloody stools and diarrhea may also be noted
with the condition.
• Hirschsprung's Disease manifests as a lack of appropriate
nerve cells in the large intestine or colon. When the body
cannot sense that the colon is full with waste products, the
intestine can back up.
• In infants this may be seen as infrequency of bowel
movements, which may be accompanied by painful spasms.
Because of larger bowel movements, the sensitive skin
around the anus can tear, causing blood in the stool.
• The definitive diagnosis of Hirschsprung’s Disease rests on
histology of a rectal biopsy.
• The normal treatment for an infant with Hirschsprung's
Disease is called a pull through surgery

8. • Hypoglycemia: Hypoglycaemia occurs when your
baby's blood sugar level falls. If your baby has
been born prematurely or small then he/she is at
increased risk of developing hypoglycaemia due
to decreased fat stores.
• Your baby is also at increased risk of
hypoglycaemia if he/she has an infection, gets
cold following delivery or if Mum is diabetic.
• Your baby's blood glucose level will be monitored
regularly throughout his/her stay on the NICU.
• Hypoglycaemia can easily be treated depending
on the cause.

9. • Hyperglycaemia: Hyperglycaemia occurs when your
baby's blood sugar is persistently high. If your baby
has been born prematurely then he/she is at an
increased risk of developing hyperglycaemia due to
the immaturity of the organs that routinely control
blood glucose levels.
– Infants that become stressed, whether due to surgery or a
routine medical procedure, are also at risk of developing
hyperglycaemia due to the release of stress related
hormones.
• Hypotension: Hypotension is the term used when
your baby's blood pressure is low and is measured in
two ways: using a blood pressure cuff or inserting an
arterial line, usually into the umbilical cord.

10. • Inguinal hernia: The inguinal canal is a tube that
passes through a natural hole in the muscles of the
groin. In babies, especially those born prematurely,
occasionally part of the gut can get stuck in the tube.
This can result in a swelling/bulge in the groin. The
hernia may be on one or both sides.
• Intraventricular Haemorrhage (IVH): If your baby has
been born prematurely, especially more than 3
months early, they are particularly vulnerable.
– Shortly after birth there is a risk of bleeding into the fluid
filled spaces in the centre of the brain (the ventricles); this
is known as an intraventricular haemorrhage.
– If the bleeding is large there is a risk that it can damage
part of the brain itself. The blood can also fill the ventricles
and block the normal flow of fluid around the brain.
– This blockage can lead to a problem called hydrocephalus.

11. • Malrotation: When the gut develops it has to fold up
in the abdomen in a certain way. If it folds up the
wrong way this is known as malrotation and can
cause obstruction of the bowel (volvulus).
• Meconium Aspiration Syndrome (MAS): Meconium
aspiration occurs when a baby (usually born at term)
inhales a mixture of meconium and amniotic fluid.
The inhaled meconium can affect the baby's
breathing in a number of ways, including chemical
irritation to the lung tissue, airway obstruction by a
meconium plug, infection, and the inactivation of
surfactant by the meconium.
• Newborns with meconium aspiration may require
admission to NICU and support with their breathing,
which can range from extra oxygen via a nasal
cannula to full ventilatory support.

12. • Necrotizing enterocolitis (NEC): Necrotising
enterocolitis (NEC) is a disease of the intestine
(bowel); which causes infection and inflammation
of the bowel tissues.
• Treatment for necrotising enterocolitis is usually
by resting the gut and giving intravenous
antibiotics. However it may be necessary to
operate to remove a portion of the bowel. The
remaining ends of the bowel are either joined
back together or brought up to the skin to form a
stoma.

13. • Patent Ductus Arteriosus (PDA): A common
problem for very premature babies is that a small
connection between the vessels supplying the
lungs and the vessels supplying the body with
blood remains open.
• When your baby was still developing in the
womb, he or she had a short blood vessel called
the ductus arteriosus (DA) linking two of the big
blood vessels of the heart, the aorta (which
provides blood to the rest of the body) and the
pulmonary artery (which sends blood to the
lungs). While your baby is in the womb the ductus
arteriosus allows blood to bypass the lungs.

14. • Pneumothorax: A pneumothorax is when a lung collapses
because of a leak of air between the lung and the chest
wall.
– It may occur spontaneously in term infants or may be seen in
babies with breathing difficulties. If your baby has a large
pneumothorax a tube called a chest drain will need to be
inserted under local anaesthetic into your baby's chest, to
remove the extra air.
• Poor weight gain: Any infant born, whether prematurely or
full term, will lose weight within the first 2-3 days of life
and this is completely normal.
– Preterm infants and term infants requiring intensive care
however, may lose weight for longer periods, or fail to gain
weight at an adequate level, for a variety of reasons.
– Although we encourage your baby to receive breast milk at
every opportunity, it may be necessary to give nutrition
intravenously (TPN) if your baby is very premature or sick.
Babies are weighed on a daily basis on NICU and dieticians are
regularly involved in care to ensure that your baby is receiving
the optimal nutrition to gain weight.

15. • PPHN (Persistent Pulmonary Hypertension of the
Newborn): In the womb the lungs receive very little blood.
At birth this has to change rapidly to ensure that the baby is
able to receive the oxygen from the lungs. PPHN occurs
when a baby fails to adapt and blood flow to the lungs
remains reduced.
• Respiratory Distress Syndrome (RDS): Although there are
many causes of breathing difficulties in premature babies,
the most common is called respiratory distress syndrome
(RDS).
– It occurs because the infant's immature lungs are not able to
produce enough surfactant. This is a chemical produced in the
lungs which prevent the lings from collapsing down when we
breathe out.
– Steroids given to mothers before the baby is born help
promote surfactant production. Premature babies are often
given replacement surfactant directly into the lungs when they
are born and they may need additional oxygen and help from a
ventilator with breathing.

16. • Retinopathy of prematurity: Retinopathy of
prematurity (ROP) is the name of a disease that
frequently affects the eyes of very small premature
babies.
– The blood vessels at the back of the eye develops
abnormally and if untreated can lead to retinal
detachment and blindness
• Seizures: Seizures (also known as fits) are movements
caused by abnormal electrical activity in the brain
• Identifying Sepsis: Sepsis in newborns is not always
easy to identify since newborn babies often do not
show symptoms in the same way older babies and
children may show symptoms to infection.
– Babies with sepsis may be lethargic, have a low or high
temperature, not tolerate feeds, and can have problems
with apnoea or difficulty breathing and appear jaundiced
(yellow skin).

17. • Tachycardia: Tachycardia occurs when your baby's
heart rate is elevated, usually above 200 beats per
minute
• Tracheo-oesophageal fistula (TOF) and
oesophageal atresia (OA): TOF and OA are rare
conditions which occur early in the baby’s
development.
– They can occur individually or together and can
sometimes be suspected on the antenatal ultrasound
scan.
– TOF occurs when the trachea (windpipe) and the
oesophagus (the food pipe) remain attached.

18. • Transient Tachypnoea of the Newborn (TTN): In
the womb the baby’s lungs are filled with liquid.
– This liquid is normally removed before the baby is
born and during birth. However, in some cases the
lungs still have fluid in them, particularly those born
by elective caesarean section.
– The fluid in the lungs can cause breathing difficulties in
the newborn, known as transient tachypnoea
• Volvulus: Volvulus is a surgical problem where the
bowel loops on itself and causes obstruction.
– It is usually associated with other problems,
particularly malrotation.

19. • Sepsis
• Jaundice
• Hydrocephalus