September 4th - Newborn Jaundice
Jaundice is the most common condition seen in newborns. It occurs when high levels of bilirubin are exhibited in the blood. This causes yellowing of the skin. In extreme cases fatigue and poor feeding are seen. In mild cases treatment might not be necessary. The condition is simply monitored. If bilirubin levels are very high, phototherapy may be required to break down the bilirubin (as pictured). Rare complications include deafness, cerebral palsy and kernicterus (brain damage). Learn more at NIH.
Although there are many pregnancy complications that can occur, the following are some common complications to be aware of:
Intrauterine growth retardation (IUGR): IUGR refers to poor growth of a baby during pregnancy. If the baby weighs 90% less than babies of the same gestation, IUGR is diagnosed. Preeclampsia, multiples and placental problems increase the risk for this disorder. Fetal movement and growth is closely monitored if this condition occurs. Learn more at NIH.
Meconium Aspiration Syndrome (MAS): MAS occurs when a baby passes meconium while in the uterus. The baby may in turn breathe in the meconium which can cause respiratory complications. Antibiotics and ventilation are common treatments.
Preeclampsia: A condition that can occur during pregnancy in which a mother experience high blood pressure and protein in her urine after the 20th week of pregnancy. Swelling, nausea and vomiting are common symptoms. The only treatment for this condition is delivery. Learn more at NIH.
Placenta Previa (PP): PP is a condition in which the placenta grows in the lowest section of the womb and covers or partially covers the cervix. Bleeding is the major symptom of this disorder. Bed rest is a common treatment of PP. Learn more at NIH.
Group B Strep (GBS): GBS is a severe bacterial infection that can be transmitted from mother to baby during delivery. This is a life threatening disease that causes irregular heart rate, respiratory distress and unstable body temperature. Learn more at NIH.
Gestational Diabetes: This condition occurs when diabetes develops during pregnancy. This occurence can cause increased birth weight, low glucose levels and breathing difficulties in the neonate. Learn more at NIH.
Information retrieved from NIH
Shana experienced preterm labor due to Sepsis and PPROM caused from an Incompetent Cervix. Born at 3 months early, her daughter Shiloh experienced a 94 day NICU stay. Read more about Shana and Shiloh.
According to one study, in infants with <1500-g birth weight, the incidence of grade 3 to 4 IVH is 10% to 12%. Infants born prematurely are at increased risk for neural complications. The following are some common neural complications seen in neonates:
Intraventricular hemorrhage (IVH): IVH is bleeding into the fluid-filled areas (ventricles) inside the brain. Prematurity (and the degree of prematurity) is a risk factor for this condition. There are four grades of IVH. Grades 1-4 indicate severity of the bleed. Learn more at NIH.
Hydrocephalus: Hydrocephalus is a condition in which excess fluid accumulates in the brain. This causes widening of the ventricles and can put pressure on the brain. A common treatment for hydrocephalus is surgically placing a shunt system in the brain to rid the brain of excess fluid. Learn more at NIH.
Periventricular leukomalacia (PVL): PVL is a disorder in which there is a death of white brain matter caused by lack of oxygen or blood to the periventricular portion of the brain. There is no treatment to cure this condition. There are only treatments to alleviate symptoms. Learn more at NIH.
Information retrieved from AAP and NIH
According to the CDC, 4% of all newborns will receive assisted ventilation. About one of five of those requiring immediate ventilation went on to require assisted ventilation for more than 6 hours after delivery. Respiratory disorders can require or be caused by assisted ventilation.
The following are common Neonatal Respiratory Disorders:
Bronchopulmonary dysplasia (BPD): BPD is caused by prolonged periods of high levels of assisted ventilation. Congenital heart disease, prematurity and severe respiratory infection are risk factors for BPD. Infants with this disorder may be fed by NG tube and require extra calories. Diuretics, corticosteroids, bronchodilators and surfactant are common medicinal treatments.
Apnea: Apnea is caused by immaturity in the area of the brain that controls the drive to breathe or by illness. Intraventricular hemorrhage, intracranial hemorrhage, neonatal seizures, perinatal asphyxia,, Impairment of oxygenation from congestive heart failure and pulmonary edema (PDA, coarctation, etc.), or from shunting (cyanotic heart disease) are common risk factors.
Transient Tachypnea of the Newborn (TTN): TTN is found in full term babies and is caused by leftover fluid in the lungs. The baby affected will breathe rapidly and this will make it harder for the baby to keep the small air sacs of the lungs open. Pneumonia, blood infections and underdevelopment of the lungs is a risk factor. In treatment the baby will be given oxygen to keep stable.
Persistent Pulmonary Hypertension (PPHN): PPHN occurs when there is a failure of the normal circulatory transition that occurs after birth. Risk factors include meconium aspiration syndrome, pneumonia, infection, low blood sugar, birth asphyxia, amniotic fluid leak and low amniotic fluid. Treatments include ventilation, nitric oxide, and ECMO.
Pneumothorax: This disorder occurs when alveoli in the lung burst which leads to leaking air into the pleural space. RDS and meconium aspiration are causal factors. This condition is treated by placing a catheter into the baby's chest to remove the air.
Respiratory Distress Syndrome (RDS): RDS occurs when an infant's immature lungs do not produce enough surfactant. Ventilation and surfacant are common treatments.
Meconium Aspiration Syndrome (MAS): MAS occurs when a neonate passes meconium while in the uterus. The neonate may in turn breathe in the meconium which can cause respiratory complications. Antibiotics and ventilation are common treatments.
Information retrieved from NIH, Children's of University of Iowa and NYU Langone Medical Center
Although there are many treatments available for neonatal respiratory disorders including surfacant, ECMO, nitric oxide and antibiotics, the following are some common technologies used.
Continuous positive airway pressure (C-PAP) utilizes mild air pressure to keep an infant's airways open. This treatment is commonly used for respiratory distress syndrome or bronchopulmonary dysplasia.
An oxygen hood is provided to babies that can breath unassisted but require some additional warm, moist oxygen.
A ventilator delivers increased oxygen and can breath for the baby. This can allow a baby's lungs to recover if they are weak or sick.
Information retrieved from NIH
Asher, a micro-preemie, spent 88 days in the NICU. Respiratory issues were Asher’s major setback not only in the NICU but in life after the NICU.
Read more about Asher's journey.