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Neonatal disorders

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Neonatal health
Selected neonatal health conditions

Neonatal health
  • Prenatal care: Getting early and regular prenatal care is one of the most effective ways to ensure a healthy pregnancy. Prenatal care is very important and includes education and counseling about how to handle different aspects of pregnancy, such as nutrition and physical activity, what to expect from the birth itself, and basic skills needed to properly care for the infant.
  • Prenatal visits also give the woman and her family a chance to talk to a healthcare provider about any questions or concerns related to pregnancy, birth, or parenthood.
  • The objective of prenatal care is to monitor the health of the pregnant mother and fetus. It is important to visit the doctor as soon as a woman suspects she is pregnant. At each visit, a doctor examines the person and make sure that the baby and the mother are healthy. This examination includes: monitoring weight gain or loss, blood pressure, circumference of the abdomen, position of the fetus, and fetal heartbeat. Such variables are going to be closely followed during the course of the pregnancy.
  • A doctor may schedule monthly visits during the first two trimesters (from week one to week 28 of pregnancy), every two weeks from weeks 28-36 of pregnancy, and weekly after week 36 (until the day of delivery that could be between 38 to 40 weeks).
  • Food and nutrition during pregnancy: It is important for an expectant mother to eat a healthful diet. Unless she has a specific health problem (such as diabetes mellitus), common sense nutritional advice should be followed: balancing carbohydrates, fat, and proteins and eating a variety of foods, including dairy products and several fruits and vegetables daily. A pregnant woman should consult her obstetrician for specific advice. Some specific nutritional needs for pregnancy are listed below.
  • Energy needs increase in the pregnant woman only about 15%. However, pregnancy does not mean increasing the caloric intake. The individual should increase his/her intake of certain nutrients, including folate (folic acid), iron, and calcium. Pregnant women need to choose nutrient-dense foods to assure an adequate nutrient intake without increasing calories. For many women, this requires some change in their current eating habits. Grains, fruits and vegetables, protein (red meat), dairy (for calcium), healthful fats (such as omega-3 fatty acids), and plenty of water (6-8 glasses daily) are recommended.
  • Folic acid, also called folate or vitamin B9, is strongly recommended by healthcare professionals at the start of pregnancy and even before conception. Folic acid is needed for the closing of fetus' neural tube. In the developing fetus, the neural tube is the precursor to the central nervous system, which includes the brain and spinal cord. Folic acid thus helps prevent neural tube defects, including spina bifida and anencephaly. Folates are abundant in spinach (fresh, frozen, or canned) and are also found in green vegetables, salads, melon, and eggs. In the United States and Canada, most wheat products (such as flour or noodles) are supplemented with folic acid.
  • Calcium and iron are particularly needed by the rapidly growing fetus who needs these minerals more than the average individual. Pregnant women should eat the recommended daily allowance of dairy products (for calcium) and red meat (for iron) if they are not lactose intolerant or vegetarian. Women who do not eat dairy or meat can obtain calcium and iron from fortified soy milk and juice, soybeans, and certain leafy greens. Doctors may prescribe iron supplements if pregnant women develop anemia. Calcium is effective only if women also obtain enough vitamin D. Milk and dairy products are good sources of vitamin D. Salmon and fatty fishes are also good sources.
  • Fluoride helps to build strong teeth by changing the nature of calcium crystals. If water or salt does not contain fluoride, it is wise to take fluoride mini-pills at the end of pregnancy and during breastfeeding, but high doses are toxic. In many American cities, drinking water is supplemented with fluoride.
  • Oils from salmon, trout, tuna, herring, sardine, mackerel, and some chicken eggs contain omega-3 fatty acids that are needed to build neuron membranes. Thus, fatty fish intake during pregnancy may provide nutrition for proper brain and retina development of the fetus. However, large fish such as tuna and swordfish, may contain too much toxic mercury and one should balance risks with benefits; fish two or three times per week seems to bring enough good fat, but not too much mercury. Omega-3 fatty acids are also present in walnuts, flaxseed, and marine algae.
  • Dangerous bacteria or parasites may contaminate foods, particularly listeria and toxoplasma. To avoid those two hazards, hygiene rules should be strictly adhered to: carefully wash fruits and raw vegetables, overcook meats, avoid raw-milk cheeses (due to listeria), try to avoid contact with cat feces (due to toxoplasma), and clean the fridge often with diluted bleach (then rinse).
  • It is best to maintain a healthy weight and diet and to exercise regularly before, during, and after pregnancy. Pregnant women should talk to their doctors to determine what types of exercise and how much physical activity is safe during pregnancy. In general, healthcare professionals recommend that pregnant mothers avoid smoking, alcohol, and drug use before, during, and after pregnancy.

Selected neonatal health conditions
  • Sudden infant death syndrome (SIDS):
  • Sudden infant death syndrome (SIDS) is the sudden and unexplained death of an infant younger than one year of age. It is a frightening prospect because it can strike without warning, usually in a seemingly healthy infant.
  • SIDS is the leading cause of death among infants who are one month to one year old. According to the American SIDS Institute, about 2,500 infants die from this condition each year in the United States. Most SIDS deaths are associated with sleep (hence the common reference to "crib death"), and infants who die of SIDS show no signs of suffering.
  • When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined cause an at-risk infant to die of SIDS.
  • Most deaths due to SIDS occur between two and four months of age, and incidence increases during cold weather. African-American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than Caucasian infants. More boys than girls fall victim to SIDS. Other potential risk factors include: smoking, drinking, or drug use during pregnancy; poor prenatal care; prematurity or low birth-weight; mothers younger than 20; smoke exposure following birth; overheating from excessive sleepwear and bedding; and sleeping on the stomach.
  • Stomach sleeping: The most common risk factor for SIDS is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child's jaw, therefore narrowing the airway and hampering breathing.
  • Another theory is that stomach sleeping may increase an infant's risk of "rebreathing" his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby's mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS.
  • Also, infants who succumb to SIDS may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him or her at greater risk for SIDS.
  • Neonatal jaundice:
  • Neonatal jaundice is jaundice that begins within the first few days after birth. It is normal for bilirubin levels in the blood to become elevated in almost all infants during the first few days following birth, and jaundice occurs in more than half of newborns. For all but a few infants, the elevation and jaundice represents a normal physiological phenomenon and does not cause problems.
  • The cause of normal, physiological jaundice is well understood. During life in the uterus, the red blood cells of the fetus contain a type of hemoglobin (the oxygen carrying protein in the blood) that is different than the hemoglobin that is present after birth. When an infant is born, the infant's body begins to rapidly destroy the red blood cells containing the fetal-type hemoglobin and replaces them with red blood cells containing the adult-type hemoglobin. This destruction of red blood cells floods the liver with bilirubin derived from the fetal hemoglobin. The liver in a newborn infant is not mature, and its ability to process and eliminate bilirubin is limited. As a result of both the influx of large amounts of bilirubin and the immaturity of the liver, bilirubin accumulates in the blood. Within two or three weeks, the destruction of red blood cells ends, the liver matures, and the bilirubin levels return to normal.
  • There is another uncommon syndrome associated with neonatal jaundice, referred to as breast-milk or breastfeeding jaundice. In this syndrome, jaundice appears to be caused, or at least accentuated by, breastfeeding. Although the cause of this type of jaundice is unknown, it has been suggested that there is something in breast milk that reduces the ability of the infant's liver to process and eliminate bilirubin. With breast-milk jaundice, the bilirubin levels rise and reach peak levels in about two weeks, remain elevated for a week or so, and then decline to normal over several weeks or months. This timing of the elevation in bilirubin and jaundice is different than normal physiological jaundice described previously and allows the two causes of jaundice to be differentiated. The real importance of the more prolonged jaundice associate with breast-milk jaundice is that it raises the possibility that there is a more serious cause for the jaundice that needs to be sought, for example, biliary atresia (destruction of the bile ducts). Breast-milk jaundice alone usually does not cause problems for the infant.
  • Neonatal jaundice and breast-milk jaundice usually do not cause problems for the infant; however, there is a concern that high or prolonged elevations in levels of unconjugated bilirubin (the main type that is present in physiologic and breast-milk jaundice) will cause neurological damage to the infant. Therefore, when unconjugated bilirubin levels are high or prolonged, treatment usually is started to lower the levels of bilirubin.
  • Fortunately, because of modern management of pregnancy, this cause of jaundice is rare.
  • Other neonatal complications:
  • Pregnancy complications: Pregnancy takes about 40 weeks. If contractions cause the cervix to open earlier than normal, between the 20th and 37th week, labor may be premature. This may result in the birth of a premature baby. Babies born before the 37th week may have trouble breathing, eating, and keeping warm. The signs of premature labor include: uterine contractions every 10 minutes or faster; repeating or constant menstrual-like cramps in the lower abdomen; abdominal cramps with or without diarrhea; pelvic pressure that feels like the fetus is pushing down; increase or change in vaginal discharge; sudden gush of watery fluids from the vagina (water breaking); or a feeling like the fetus is "balling up."
  • In some pregnancies, known as high-risk pregnancies, the mother and/or fetus are at an increased risk of experiencing complications. A pregnancy may be classified as high risk for a number of reasons, including:
  • Mother's age: Women older than age 35 have an increased risk of having children with certain chromosomal abnormalities, such as Down's syndrome, as well as placental problems (such as placenta previa). Studies also suggest an increased risk of miscarriage and low birth weight in pregnant women in this age group. In addition, teen mothers are more likely to give birth prematurely than woman older than age 20.
  • Multiples: Women carrying two or more babies are at an increased risk for a number of complications, including premature labor and low birth weight.
  • Previous premature births: Women who have already delivered a premature baby are more likely to have pregnancy complications, including additional premature births.
  • STDs: A number of STDs can be transmitted to a baby before, during or after birth, resulting in medical complications. STDs include: herpes, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), genital warts (caused by human papilloma virus, or HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis.
  • Drugs: Women who were exposed to diethylstilbesterol (DES, a hormonal drug) when their mothers took the drug during pregnancy are at an increased risk for a number of complications, including ectopic pregnancy and preterm delivery.
  • Alcohol-related birth defects: Physical or cognitive deficits, which can range form mild to severe, that a child experiences as the result of alcohol consumption by its mother during pregnancy. This term includes, but is not limited to, fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE).
  • Fetal alcohol syndrome (FAS) refers to certain birth defects and serious, life-long mental and emotional impairments that may be suffered by a child as the result of heavy alcohol consumption by its mother during pregnancy. Symptoms of mental and emotional deficits may include significant learning and behavioral disorders (including attention deficits and hyperactivity), poor social judgment, diminished cause-and-effect thinking, and impulsive behaviors.
  • Fetal alcohol effect (FAE) is a disorder associated with cognitive and behavioral difficulties in children whose birth mothers drank alcohol during their pregnancy. Symptoms are similar to Fetal Alcohol Syndrome (FAS), but less severe or comprehensive.
  • Other conditions: Other health conditions that may occur in infants include: blue baby, a condition where the baby is born with a "blue" color due to congenital heart defects; childhood nephrotic syndrome, a condition where the kidney loses protein in the urine causing protein in the blood to drop and water to move into body tissues resulting swelling (edema); classic neonatal adrenoleukodystrophy (ALD) or a serious progressive, genetic disorder where the adrenal gland becomes wasted and ceases to function normally, which leads to progressively severe symptoms (occurs in boys); diarrhea; diaper rash; hemolytic disease of the newborn; infant botulism food poisoning; infantile colic; neonatal lupus, an autoimmune condition; neonatal myasthenia gravis, a lack of muscular control; neonatal ophthalmitis, inflammation of the eyes; neonatal respiratory distress syndrome, a syndrome caused in premature infants by developmental insufficiency of protein production and structural immaturity in the lungs; and neonatal tetanus, an often fatal infection with toxins from the bacterium Clostridium tetani.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
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