Common Newborn Problems
Allergic colitis
Many of these babies will also have intolerance to soy protein and usually need to be on an elemental formula, such as Nutramagen or Alimentum.
Breast fed babies can also develop allergic colitis, usually secondary to maternal milk drinking. Eliminating milk and other dairy products from the mother's diet is usually necessary, but you can continue to breast feed.
Babies with allergic colitis should be seen by their doctor, especially if they have poor weight gain, vomiting, or abdominal pain.
Infants with allergic colitis will be normal except for having small bright red streaks of blood in their stool. It is usually caused by protein intolerance.
Birthmarks
Birthmarks are common in children and can include:
Stork Bites
Stork bites (also called angel's kisses or salmon patches) are common birthmarks in children and usually begin as a flat, pink or red area on the skin on the back of the neck, forehead, eyelids, or around the nose. Stork bites usually fade as your child gets older, but faint remnants may persist.
Mongolian Spots
Mongolian spots are dark flat bluish-black areas on the lower back or buttocks. These birthmarks will darken at first and then fade with by the time he is six to seven years old.
Cafe au lait spots
Cafe au lait spots are flat light brown oval shaped patches of skin that can occur anywhere on the body. They do not fade and may even increase in number as your child gets older, especially around adolescence. If your child has more than 6 cafe au lait spots that are larger than half a centimeter in diameter, you should discuss it with your pediatrician, as this can be associated with some medical problems.
Strawberry hemangioma
Another common type of birthmark that affects ten percent of babies is the strawberry hemangioma. These are soft, firm, raised red areas that can occur anywhere on the body. They may be present at birth as a small red spot or they may appear later in the first month of life.
They usually grow rapidly during the first six to twelve months, remain unchanged until your child is about eighteen months old and then slowly become smaller and fade by the time your child is five to ten years old. Fifty percent of hemangiomas will fade by the time your child is five years old and seventy-five percent will fade by the time he is seven years old. Hemangiomas will usually become pale in the center and turn a more purple and then grayish color just before starting to get smaller.
Unless a strawberry is in an area that can interfere with your babies normal development (for example by blocking his vision or causing difficulty breathing or hearing), no treatment is necessary. If it begins bleeding, you should apply firm pressure as you would for any other area of the skin that was bleeding. About 5% of hemangiomas become ulcerated, especially if they are in an area that is under pressure or touched a lot. Other complications, including congestive heart failure from very large lesions and Kasabach-Merritt syndrome are rare.
You may consider treatment if it is not showing any improvement by the time your child is four years old. Treatments for hemangiomas include the use of high doses of steroids (either orally or injected into the lesion) to stop their growth (keep in mind that steroids only keep them from growing, they don't make the hemangioma any smaller), interferon alphs, laser therapy and surgical removal. But remember that most hemangiomas do not require treatment.
Port wine stains
Port wine stains are deep red or purple flat areas on the skin of the face or extremities. They are present at birth and grow at the same rate as the child. They usually occur on one side of the body only and do not fade with time. However, they can usually be treated with laser therapy to help them fade. Port wine stains that are on the face, especially around the eye can be associated with Sturge-Weber Syndrome, in which children can also have seizures and mental retardation.
Colic in Newborns
Colic is a common problem, affecting 10-25% of all newborns. It is defined as recurrent inconsolable crying in a healthy and well-fed infant. It usually begins at about two to three weeks of age, is at its worst at six weeks of age and then gradually improves and finally resolves on its own by three to four months. The most common symptoms of colic are the sudden onset of screaming and crying that can last for more than two to three hours at a time. Babies with colic will often seem as if they are in pain and are difficult to console. While crying they will usually pass a lot of gas, draw up their legs and their abdomen may seem hard or distended.
Most babies with colic have one or two episodes of this type of crying each day. In between these episodes they usually act fine.
Causes of colic
It is not known what causes colic, but it is not usually thought to be from abdominal pain, formula allergies, the iron in infant formula or gas. It is known that normal babies have a fussy period toward the end of the day that begins when they are two to three weeks old and that this may be their way of ‘blowing off steam' or dealing with the normal stimulus of their day. It may be that babies with colic are more sensitive to this normal everyday stimulation. It is also known that babies with colic do not have more difficult temperaments and are not more hypersensitive as they grow older.
Causes of crying
There are medical problems that can cause crying in newborns, but in general, infants with these problems usually cry through out the day.
If crying always seems to occur during feedings or right after a feeding and your child is spitting up a lot, then he may have reflux esophagitis.
A formula or milk allergy may be suspected if the crying always occurs 30-60 minutes after a feeding and your child also has vomiting and diarrhea and does not seem to be gaining weight well. In this case a 1-2 week trial of a soy formula or an elemental formula (such as Nutramagen) can be used.
If you are breastfeeding and your baby seems to always cry after you eat or drink certain foods, then it would be reasonable to try and stay away from those foods. A one to two week trial off of dairy products and/or caffeine may also help.
Managing colic
Unless your baby has reflux or a formula allergy, there are no medicines to make colic go away. Some tips to help deal with colic until it clears up on its own include:
- Reassure yourself and other family members that this is a benign problem that always clears up on its own without any long term effects.
- Some things that you may try to comfort your baby include:
- swaddling
- cuddling
- rhythmic rocking
- going for a walk or ride
- warm baths
- singing
- rhythmic sounds
- massages
- using a pacifier, windup swing or vibrating chair.
None of these measures work for all children, but you can try one or two at a time until you find what works for your baby.
If nothing works, it is okay to just put your baby down and let him cry for short periods. Always remember that it wasn't anything that you did or didn't do that caused your baby to have colic and as a last resort try to take a break by having a family member or friend help care for your baby.
Important Reminders
- Be patient. This is a frustrating problem without good treatment options, but it always improves as your child gets older.
- It can be frustrating taking care of a crying baby, so get help if you are having trouble coping with your infant's crying. Remember that you should never shake your baby, which can cause shaken baby syndrome. Get help if you think you might harm your baby.
- Avoid frequent changes of your babies formula, unless instructed to do so and do not use a low iron formula.
- Call the office if your child has a rectal temperature over 100.4, has persistent vomiting, if she does not seem to be gaining weight, or if the crying is not improving or does not go away by the time she is 3-4 months old.
Constipation
Constipation in a newborn can be a sign that your baby isn't getting enough to eat. If your new baby is not having frequent bowel movements, be sure to discuss with your Pediatrician your baby's feeding schedule, amount of wet diapers and if he seems to be gaining weight.
After your baby is born, he will pass meconium for a few days, which is a dark green or black substance. Regular bowel movements, which begin being lighter than meconium, usually start by about the third day of life. At this time, bowel movements also become more frequent, especially for breastfeeding mothers. If your baby isn't having regular bowel movements by the fourth or fifth day of life, or if he is still passing meconium, then that may be a sign that he isn't getting enough to eat.
Constipation is defined as the passage of hard, pellet-like stools that cause pain or bleeding (groaning or straining is normal) and not so much by how often your baby has a bowel movement. Keep in mind that some breast fed babies only have one bowel movement each week or two after they are 3-4 weeks old. Breastfed babies are very rarely constipated if you are exclusively breastfeeding.
Initial treatment for constipation is by giving 2-4 ounces of water or diluted prune juice once or twice a day or by changing to a soy based formula if you are using formula.
Cradle Cap
Babies with cradle cap will have greasy yellow or salmon colored scaly areas with redness on their scalp. Your baby may also have redness behind his ears or on the creases of his neck (seborrheic dermatitis). Unlike eczema and other forms of red scaly skin, these conditions are not itchy and shouldn't cause your baby any discomfort. It will improve on its own, but cradle cap can be treated by frequent use of an antiseborrheic shampoo, such as Selsun Blue, and then using a soft brush to remove the scales. Gentle scrubbing may be required to help remove the scale.
Persistent cases may require treatment with a low potency topical steroid cream. You can also try massaging baby oil into the scalp and then gently scrubbing with a soft brush to remove the scales.
Diaper Rashes
Diaper rashes are usually caused by irritation of the skin by urine and/or stool. Irritant diaper rashes usually spare the creases or skin folds of the diaper area and should improve in 2-3 days with an OTC diaper rash cream. If it is not clearing up or is bright red and surrounded by red dots, your baby may have a secondary yeast infection (Candida) and will need an antifungal cream in addition to the regular diaper creams for treatment to help clear it up.
Seborrheic dermatitis can also involve the diaper area, and usually causes redness in the creases of the skin with sparing of other skin surfaces in the diaper area. Children with diaper rashes caused by seborrheic dermatitis will usually have involvement of other areas of the body, such as the scalp (cradle cap), behind the ears, or in other skin folds (axilla).
Diaper rashes can be prevented by minimizing wetness in the diaper area. You can do this by frequent diaper changes, using superabsorbent diapers, applying a barrier ointment after each diaper change, increasing air exposure by keeping the diaper off as much as possible. Also avoid excessively cleaning or scrubbing the skin in the diaper area. Instead, use a mild soap or skin cleanser only after bowel movements and rinse with just warm water at other times.
Severe diaper rashes may need to be treated with a mild 1/2% hydrocortizone cream twice a day for two or three days in addition to the above recommendations. Avoid using stronger steroid creams in the diaper area.
Warning: Don't use Lotrisone, a combination of clotrimazole (an antifungal) and a very strong steroid to treat your infant's diaper rash. The steroid is too strong and can lead to serious side effects, including skin atrophy and growth retardation.
Eye Problems
Eye problems in newborns can include matting, or a green discharge, which is usually caused by irritation from the eye ointment that was placed after he was born or by a blocked tear duct. It can also be caused by an infection (conjunctivitis), especially if the white part of the eye is red, and you should notify your doctor if the mother had a sexually transmitted disease (such as gonorrhea or chlamydia) or if the discharge does not quickly clear up.
Blocked tear ducts (dacryostenosis) are very common and usually clear up on their own by the time your baby is a year old. It can cause some matting of the eye, and persistent tearing. Until then, you should wipe away any discharge with a warm cloth. You can also gently massage the side of the upper part of your baby's nose to try and open up the duct. If your baby has a lot of discharge that needs to be wiped away more than a few times a day, then he may need an antibiotic and you should see your doctor.
Subconjunctival hemorrhages occur because of pressure during the birth process. It causes a red streaking of the white part of the eye and it will go away in a few weeks.
Fever
A rectal temperature above 100.4 in a newborn infant less than two to three months old is considered a fever and a medical emergency and you should call your doctor
Hip Dysplasia
Developmental dysplasia of the hip is caused by the hip joint being loose and allowing the hips to dislocate. It is very common and if treated early with a Pavlik harness, the hips will stabilize. In severe cases, surgery may be required for treatment. Your doctor will check your newborn's hips in the nursery and during his well child visits during the first year of life.
Hydrocele
A hydrocele is the painless accumulation of fluid inside your child's testicles. It is very common in newborns and the fluid is usually reabsorbed by the time your child is a year old. If your child has a swollen testicle he should be evaluated by his doctor, who can diagnose a hydrocele by shining a light through the scrotum. Hydroceles need to be repaired in older children or if they do not go away by the time your child is about a year old.
If the amount of fluid in your child's testicle varies, and is worse at the end of the day and improves after lying down, then your child has a communicating hydrocele. This means that there is a hernia and open connection into the abdomen. This type of hydrocele also needs to treatment with a surgical repair.
Hypospadias
Hypospadias is a common anomaly of the external genitalia in newborns, occurring in about 1 out of every 150 to 250 live births. It is defined as a congenital defect of the penis, in which the urethral meatus (opening of the urethra) is incompletely developed. This can cause the opening of the urethra to be located anywhere on the ventral (bottom) surface of the penis. In mild cases it may be at the base of the glands (the head of the penis) or just a little bit off center, but it more severe cases it may be anywhere along the bottom shaft of the penis or on the scrotum.
Hypospadias, in addition to the cosmetic effects, can cause a child's urinary stream to be deformed because the meatus is not centered. This can range from a mildly downward deflected stream and difficulty urinating while standing up for children with a mild hypospadias to more serious difficulties if the meatus is on the shaft of the penis or on the scrotum. It may also cause sexual dysfunction if there is any curvature to the penis and it is not corrected.
While hypospadias may be genetically inherited, and is more common in children in which his father and a sibling also have hypospadias, it is usually an isolated abnormality, although it may be associated with undescended testicles and/or inguinal hernias in some children. The incidence of hypospadias does seem to be increasing.
Hypospadias is usually easy to notice in a newborn because it is commonly associated with a hooded foreskin, making the opening of the urethra easy to see. Children with a hooded foreskin have a foreskin that is developed normally on the top and sides of the tip of the penis, but with an absent foreskin on the bottom. In about 5% of cases of hypospadias, the foreskin is completely formed and normal appearing and will cover up the hypospadias. In these cases, unless the child is being circumcised, the hypospadias will probably not be discovered until much later in life when his foreskin begins to naturally retract.
A hypospadias may also be associated with a chordee, or a ventral (downward) curvature of the penis.
Hypospadias is usually classified by the location of the meatus either before chordee release (Smith's classification) or after chordee release (Schaeffer and Erbes classification), because in many cases, release of the chordee may alter the position of the meatus lower. Classifications include first degree or glandular hypospadias, where the meatus is at the level of the glands, second degree, where the meatus is at the level of the penile shaft, either coronal (the base of the glands), sub coronal (below the base of the glands) or midpenile (in the middle of the shaft), or a third degree, which includes a meatus opening on the scrotum or below, either a pen scrotal, scrotal or perineal hypospadias.
First degree or glandular hypospadias are the most common, occurring in 60% of children with hypospadias. Second degree hypospadias is less common (25%) and third degree are the least common (15%). Children with a third degree hypospadias may need further evaluation, including a voiding cystourethrogram (VCUG) to look for associated abnormalities.
Children with a hypospadias should not be circumcised, and in cases with a complete foreskin, where the hypospadias is not discovered until the circumcision is begun, then the circumcision should not be completed until your child is evaluated by a Pediatric Urologist. The reason for not performing a circumcision and removing the foreskin in children with a hypospadias, is that the foreskin will probably be used as part of the repair during surgery to correct the hypospadias.
While very mild cases of hypospadias in which the opening of the meatus is just a little bit off center may not need to be repaired, more severe cases, especially if the meatus is on the shaft of the penis or scrotum, will need to be surgically repaired.
The surgical repair is usually performed early, when your child is between six months and 12 months of age. Surgery will help to release a chordee and bring the meatus up to the tip of the glands, so that your child can have a normal urinary stream. Except for severe cases, most repairs are in a one stage procedure. More severe cases may need two stages to completely repair the hypospadias, and may also involve the use of suprapubic tubes or urinary drip stents as a urinary diversion.
Most children with hypospadias should see a Pediatric Urologist shortly after they are born for an evaluation and to discuss the need for treatment. It is also important to defer a circumcision until this evaluation is complete. For more severe cases of hypospadias, especially if there are undescended testes and a concern for ambiguous genitalia, the evaluation should occur as soon as possible and while he is still in the nursery.
Jaundice
Jaundice, or yellowing skin, occurs in almost half of all babies. It is usually treated by frequent feedings and the use of bilirubin lights in severe cases. Your doctor will be able to tell if treatments is necessary by examining your baby or doing a blood test.
If your baby is yellow on his face and upper part of his chest, then you may place him in front of a window for ten to fifteen minutes 3-4 times each day. The sunlight (and ultraviolet light if it is cloudy) helps to convert the bilirubin that makes his skin yellow into another substance that can pass in the urine.
In some cases of blood type incompatibility, your baby may become severely jaundiced and require more aggressive treatment.
Premature Babies
A normal pregnancy lasts nine months, or about 38 to 42 weeks. Newborns are considered to be premature if they are born before they are 37 weeks old. Although there are many risk factors that can help to predict which pregnancies are at risk for premature delivery, in most cases, no cause is found.
Among the risk factors that may increase your chances of having a premature baby include:
- Having delivered a previous premature baby, which puts you at a 20-40% of having another premature baby.
- Multiple gestation pregnancies, such as twins, triplets, etc. The risk increases with each additional fetus.
- Placental abruptions and placenta previa are two causes of bleeding that can lead to a premature delivery.
- Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid.
- Infections during pregnancy, especially if they spread to the uterus or placenta.
- Diabetes.
- High blood pressure.
- Preeclampsia, which causes maternal high blood pressure, proteinuria (spilling protein in your urine), and swelling.
- Maternal smoking or use of illicit drugs.
- Maternal malnutrition, especially if it leads to poor weight gain during pregnancy.
- Fibroids, an abnormally shaped uterus and cervical incompetence.
- Becoming pregnant while being treated for infertility, having a previous abortion in the 2nd trimester, and not having prenatal care.
- Problems with the fetus can also lead to a premature delivery, including infections, poor growth and certain birth defects.
If you think you have risk factors for having a premature baby, be sure to discuss them with your obstetrician. You may have to be seen by a perinatologist, who is a doctor that specializes in high risk pregnancies.
If you believe that you are having preterm labor, then you should call your doctor. Among the symptoms of preterm labor include frequent uterine contractions, pain, and increased vaginal discharge, especially if bloody (it may be your mucus plug) or a lot of clear fluid (which can be your water breaking).
It may not be possible to stop your premature labor
If you are in preterm labor, then you will likely be seen in the hospital, where you will be likely started on bed rest and given fluids as an evaluation is done to check on the status of the baby and mother. In some situations labor can be stopped with bed rest and intravenous fluids. In other cases, medications, usually magnesium sulfate or terbutaline may be used. Other treatments may include a cerclage for a weak or incompetent cervix, antibiotics for infections, and fluids for dehydration. It may not be possible to stop your premature labor however.
Sometimes your doctor will decide that your baby needs to be delivered prematurely, especially if he has poor growth or if he is in distress. If your baby is less than 34 weeks, then, if possible, you may receive steroids to help his lungs develop more quickly before he is delivered.
Your Premature Baby
If your baby is going to be born prematurely, then you may try and talk with your Pediatrician and/or a neonatologist before the delivery if there is time. If possible, either your Pediatrician or a neonatologist will attend the delivery to take care of the early resuscitation of your new baby. Once stabilized, depending on your baby's gestational age and his medical condition, he will likely be transferred to a Neonatal Intensive Care Unit (NICU). This is usually a simple matter if you are in a larger hospital that has its own NICU, but it may involve transfer to another hospital that has a NICU and services
i.e. born after 24 to 25 weeks of gestation are mature enough to survive, although they will need a prolonged period of intensive care.to care for your premature baby.
How early is too early? In general, babies born after 24 to 25 weeks of gestation are mature enough to survive, although they will need a prolonged period of intensive care. Babies born at less than 23 weeks of gestation are usually not mature enough to survive. However, in addition to age, other factors play a role (usually because babies with these characteristics are more mature) and increase the chances that a premature baby will do well, including being female and African American. A premature babies size also can influence how well he will do, with larger babies doing better than smaller babies.
Once your premature baby is born, your neonatologist will help to prepare you for what will come next. It is outside the scope of this article to discuss statistics on survival and outcomes for premature babies. All preemies are individuals, and in addition to his gestational age and size, many other factors are involved in how well he will do, especially how mature his organs are and whether he has other medical problems, such as infections, birth defects, etc. For even the smallest preemies, it is important to keep in mind that almost two thirds of those that survive will either be normal or have only mild or moderate medical problems.
The more mature your baby is at birth, the more likely that it is that he will not have any problems, so that babies born at 26-29 weeks have a much better chance of surviving and growing up either normal or with mild or moderate problems. Babies born at 30-33 weeks usually do even better, and have a very high rate of survival. After 34 weeks, babies are usually only mildly immature and usually do very well.
Except for older infants over 30-33 weeks, many premature babies need to be on a ventilator to help them breath normally. In addition, one of the problems that your premature baby may have on his first few days of life is Respiratory Distress Syndrome (RDS) because of his immature lungs. Babies with RDS are usually on a ventilator and will probably also receive a medication called surfactant to help their lungs.
In addition to being on a ventilator and/or receiving oxygen, it is likely that your premature baby will also be on antibiotics, because infections are a common reason for premature births. Also, since he likely won't be able to eat for awhile, he will be on intravenous fluids, either through an IV or umbilical central line. Other equipment that you may notice include a special bed with a radiant warmer to help him maintain his body temperature and which may include a cellophane wrapping to minimize the loss of heat and fluids through their thin skin. He will probably also be on a cardio respiratory monitor with a pulse oximeter to measure the oxygen in his blood, and he may have a feeding tube if he is old enough to eat.
Other problems that your premature baby may have and which are more common in premature babies under 30-33 weeks and uncommon after 34 weeks of gestation are:
- Persistent ductus arteriosus (PDA), which is a blood vessel near the heart that normally closes after birth, but which can stay open, especially in premature babies. Many times, a PDA needs to be closed, either with medications or if that doesn't work, then with surgery.
- intraventricular hemorrhage (IVH), which is bleeding in the brain and which can be discovered during routine head ultrasounds. Most bleeding occurs in the first few days of life, and except for larger bleeds (grades 3 or 4), many do not cause any long term problems.
- periventricular leukomalacia (PVL), which is a sign brain damage.
- infections, because they also have immature immune systems
- Necrotizing enterocolitis (NEC), which is an inflammation of the intestines that usually doesn't occur until after feedings have been begun. Treatments, depending on how severe it is, can include antibiotics, intravenous nutrition and sometimes surgery.
- Retinopathy of prematurity (ROP), which are abnormal blood vessels in the eyes of premature babies and which will be followed by an ophthalmologist.
- Apnea and bradycardia (A & Bs) or apnea of prematurity, which occurs when their immature respiratory and nervous system cause them to stop breathing for short periods of time and for their heart rate to drop. This may be treated with stimulation, medications, CPAP, oxygen and/or by being on a ventilator, depending on how often and how long the periods of apnea are.
- Anemia or low blood counts, which sometimes require blood transfusions.
- Bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD) is diagnosed in babies who still need oxygen after they are four weeks old and/or at 36 weeks gestation. They may need long term treatment with oxygen and medications, including diuretics, bronchodilators and/or steroids and will probably need more calories than infants without BPD.
- Premature babies are also at increased risk for inguinal hernias and hydroceles.
When can he start eating? It depends on his gestational age and medical condition. Once feeds are begun, unless he is over 32-34 weeks, then he probably won't be able to nurse of drink from a bottle. Instead, he will likely be fed by gavage feedings, with a tube in his mouth or nose that goes down to his stomach. Even though many premature babies can't nurse at the breast, that doesn't mean you can't breastfeed. You can pump and have aren't ready to be discharged until some time around your original due date and once he is eating and gaining weight, and breathing well on his own (although he may need oxygen).the NICU store your expressed breast milk for when your baby is ready to eat.
When can he go home from the hospital? This also depends on your babies gestational age and overall medical condition. In general, most infants aren't ready to be discharged until some time around your original due date. So for a baby born at 26 weeks, that can mean three months in the hospital. In general, your baby will need to be gaining weight, breathing well on his own (although he may need oxygen), and eating to be able to leave the NICU. Among the doctors that may continue to see your child after he is discharged from the NICU include your Pediatrician, an ophthalmologist, and possible a pulmonologist and/or a developmental pediatrician.
What problems will he have? In addition to having the problems described above, premature babies, especially those under 30-32 weeks are at risk for having mild to moderate medical problems, including bronchopulmonary dysplasia (BPD), learning disabilities, problems with their hearing and vision, and/or mild cerebral palsy. Some will have more serious medical conditions, including blindness, deafness, severe cerebral palsy, and mental retardation. Keep in mind though, that many premature babies grow up without any problems at all.
Prenatal Hydronephrosis
Having 'fluid on the kidneys' before birth is referred to as prenatal hydronephrosis. It is the most common abnormality found on prenatal ultrasound and is found in almost 1.4% of fetuses.
Causes of prenatal hydronephrosis can include a ureteropelvic junction (UPJ) obstruction (most common), vesicoureteral reflux, megaureter, or posterior urethral valves (found in males who may also have a dilated bladder on prental ultrasound).
More reassuring though, is that 50% of babies who had prenatal hydronephrosis have no evidence of hydronephrosis after being born.
An important part of the evaluation of a baby with prenatal hydronephrosis is if there is a normal amount of amniotic fluid. If there isn't, and you have decreased fluid, then that could be a sign that the babies kidneys aren't working properly and that might be an indication to deliver at a tertiary care center.
After delivery, your child will likely have a renal ultrasound and voiding cystourethrogram (VCUG) at some point on an outpatient basis. They are generally done at least 2-3 days after birth, but may then be done anytime during the first 4-6 weeks of life, unless the dilation is severe. The postnatal renal ultrasound will again look for hydronephrosis, while the VCUG will check for reflux. Until the tests are done, your baby will likely be placed on antibiotics (usually Amoxicillin) to prevent urinary tract infections.
Depending on the initial test results, further testing might also be needed, including a renal scan.
The postnatal evaluation of children with prenatal hydronephrosis is actually a little controversial. Some doctors recommend just doing a postnatal ultrasound, and nothing further if it is normal and a VCUG only if hydroneprhosis is still present. Other doctors think that all of these children should have a VCUG, even if the initial postnatal ultrasound is normal, since these children could still have reflux.
I generally place otherwise well newborns with prenatally diagnosed hydronephrosis on Amoxicillin and do both a renal sonogram and a VCUG as an outpatient. If the tests are abnormal, then I generally refer those patients to a Pediatric Urologist.
If you would feel more comfortable, you could also arrange an evaluation with a Pediatric Urologist either before or after the baby is born.
Prenatal Hydronephrosis Internet Links:
Pyloric Stenosis
A condition that is caused by a thickening of the muscle or valve that empties the stomach. This valve can be so enlarged that it does not allow the stomach to empty. Babies with pyloric stenosis will usually begin to have projectile vomiting after each feeding when they are two to six weeks old. The vomiting will not improve with formula changes or by giving Pedialyte and your child will quickly lose weight and become dehydrated without treatment. Your doctor may do a sonogram if he suspects that your baby has this condition. The only treatment is surgery (pyloromyotomy) to open the enlarged pylorus with a small incision.
It is more common in boys and does seem to run in certain families.
Rashes in Newborns
Rashes are a very common problem in newborns and include neonatal acne, drooling rashes, and flaky skin. Most of these rashes will usually clear up on their own without treatment.
- Acrocyanosis: a bluish discoloration of a newborns hands and feet. This is normal when your baby is cold or crying if the rest of your baby's skin is pink.
- Epstein’s pearls: small white cysts or bumps on the roof of your newborn's mouth that will go away without treatment.
- Erythema toxicum: a common rash that begins in the first few days after birth and is characterized by small blotchy red areas with a raised yellow or white center. There may be quite a few lesions, especially on the trunk and they will continue to pop up during the first week to ten days of life and will then go away without treatment in the next 5-7 days.
- Forceps marks: or bruises will heal on their own.
- Miliaria (heat rash or prickly heat): there are two forms of miliaria, miliaria crystallina, which consists of small clear fluid filled vesicles that rupture and leave behind some scale, and miliaria rubra, which have similar clear fluid filled vesicles, but they are surrounded by red areas. Miliaria is most common on the head, neck, upper chest and in skin folds and is due to blockage of the sweat ducts in the skin. It will resolve on its own, but can be prevented by reducing heat and humidity and not dressing your newborn in tight clothing.
- Milia: small white or yellow pinpoint sized spots on your newborn's nose and chin. They are caused by small sebaceous retention cysts and will clear up in a few weeks without treatment.
- Neonatal acne: this is a rash that looks like acne in older children and it is thought to be caused by hormonal stimulation. It usually begins between two to four weeks of age and resolves on its own over the next few months. Severe cases may need to be treated with 2.5% benzoyl peroxide or other keratolytic creams.
- Sebaceous gland hyperplasia: multiple tiny yellow or flesh colored papules on the nose and cheeks of newborns. It is thought to be from maternal hormonal stimulation of the sweat glands and will resolve on its own in the first month of life.
- Seborrheic dermatitis: causes greasy scales and patchy redness on the scalp (cradle cap), face, behind the ears and in skin folds. Most children clear up without treatment in three to four weeks, but more severe or persistent forms can be treated with and antiseborrheic shampoo or a topical steroid cream.
- Transient neonatal pustular melanosis: causes tiny 1-2mm pustules to occur on the face, neck, extremities, palms and soles. These pustules are present at birth and can have some scale around them, but they are not red or inflamed. The pustules rupture in the first few days of life and leave behind flat dark areas that resemble freckles. These areas will fade in three weeks to three months without treatment.
- More serious conditions might be considered for children with red scaly skin and a very severe or prolonged course or other symptoms, such as failure to thrive (weight loss or poor weight gain), alopecia (hair loss), chronic diarrhea and involvement of other organs of the body. These conditions include congenital syphilis, congenital candidiasis, icthyosis, immune system disorders, ectodermal dysplasia, and nutritional or metabolic disorders.
Sibling Rivalry
Having a new baby can be very disruptive to families, especially to first born children and toddlers. It is very common and even normal for siblings to feel jealously towards a new baby. Siblings may also become more demanding, disruptive, or aggressive and may regress in many of their behaviors, including not wanting to use the potty anymore, using baby talk or having frequent temper tantrums. Younger siblings will feel that they are no longer the center of attention and will be jealous of the attention that is paid to the new baby.
Spina Bifida
Spina bifida is a type of congenital malformation of the central nervous system. In its mildest form, spina bifida occulta, there is a malformation of the vertebral arches of the spinal cord without other problems. Spina bifida occulta occurs in 5% of the population and does not cause any symptoms or problems and no treatment is required. Some children with this disorder also have a patch of hair or skin discoloration on the skin of the lower back with the defect occurs.
Children with spina bifida, or myelomeningocele also have a malformation of the vertebral arches of the spinal cord and they have abnormalities of the spinal cord, in which the spinal cord and nerve roots protrude out. The malformation is most commonly found in the lumbosacral area of the lower back, but it can occur anywhere along the spinal cord.
Spina bifida occurs in about 1 per 1000 live births in the United States, and although the cause is not known, it does seem to run in certain families. The risk of having a child with spina bifida after having a previous child with this disorder is almost 3-4%. It is also known that the use of folic acid by pregnant women, especially if started before conception, decreases the risk of having a baby with spina bifida.
It is possible to detect spina bifida and other neural tube defects prenatally by testing pregnant mom's for alpha-fetoprotein. This substance is elevated in the serum and amniotic fluid of mothers who are having a baby with spina bifida. If the alpha-fetoprotein level is elevated, then it is usually repeated and an ultrasound is done to look for any abnormalities.
The symptoms of spina bifida can include bowel and bladder problems, trouble with the muscles and nerves of the lower extremity, leading to babies being unable to move their legs or unable to respond to touch or pain. Other problems can include hydrocephalus, with or without an Arnold Chiari II malformation of the brain, club feet, frequent urinary tract infections, scoliosis, constipation, and seizures. The extent to which a baby will have these problems depends on where the malformation occurs. If the defect is in the low sacral area, then a child may have bowel and bladder problems, but he may not have any problems moving his legs and walking. A defect in the mid lumbar area may cause problems with paralysis of the legs, loss of feeling, and bladder and bowel problems.
Treatment of spina bifida is usually carried out by a multidisciplinary team, including a neurosurgeon, urologist, physical and occupational therapists, and other professionals as needed, possibly including an orthopedic surgeon, ophthalmologist, plastic surgeon, orthotist and a pediatrician or family physician to coordinate things. Treatment will include an operation to close the defect, and evaluation for hydrocephalus with a sonogram and/or CT scan of the head, evaluation of bladder function, and evaluation of motor and sensory function.
Spina bifida is a complex birth defect with many different presentations and outcomes. You should not read this article and try and predict what problems your infant may have. If your child has been diagnosed prenatally with this disorder, then you should try and arrange a prenatal consult with a pediatric neurosurgeon to discuss things. If diagnosed at birth, then you should still seek advice from a specialist that cares for babies with spina bifida.
Spitting Up
Many babies spit up after eating due to overfeeding or because the valve that closes the upper part of the stomach is immature. It is usually not a concern as long as your baby is gaining weight and it is not causing him to cough or choke. Some steps to take to improve this problem are feeding smaller amounts, more frequent burping during feeds, avoiding pressure on his belly vigorous activity after eating. It improves with age without treatment.
Stuffy Nose and Sneezing
Having a stuffy nose or occasionally sneezing is very common in newborns and is usually caused by irritation from dry air, smoke, or dust. Try to eliminate common irritants. You can also try using a humidifier or salt water nose drops as treatment.
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome (SIDS) is the diagnosis given for the sudden death of an infant under one year of age that remains unexplained after a complete investigation, which includes an autopsy, examination of the death scene, and review of the symptoms or illnesses the infant had prior to dying and any other pertinent medical history. Because most cases of SIDS occur when a baby is sleeping in a crib, SIDS is also commonly known as crib death.
SIDS is the leading cause of death in infants between 1 month and 1 year of age. Most SIDS deaths occur when a baby is between 1 and 4 months of age. African American children are two to three times more likely than white babies to die of SIDS, and Native American babies are about three times more susceptible. Also, more boys are SIDS victims than girls.
What are the risk factors for SIDS?
A number of factors seem to put a baby at higher risk of dying from SIDS. Babies who sleep on their stomachs are more likely to die of SIDS than those who sleep on their backs. Mothers who smoke during pregnancy are three times more likely to have a SIDS baby, and exposure to passive smoke from smoking by mothers, fathers, and others in the household doubles a baby's risk of SIDS. Other risk factors include mothers who are less than 20 years old at the time of their first pregnancy, babies born to mothers who had no or late prenatal care, and premature or low birth weight babies.
What Causes SIDS?
Mounting evidence suggests that some SIDS babies are born with brain abnormalities that make them vulnerable to sudden death during infancy. Studies of SIDS victims reveal that many SIDS infants have abnormalities in the "arcuate nucleus," a portion of the brain that is likely to be involved in controlling breathing and waking during sleep. Babies born with defects in other portions of the brain or body may also be more prone to a sudden death. These abnormalities may stem from prenatal exposure to a toxic substance, or lack of a vital compound in the prenatal environment, such as sufficient oxygen. Cigarette smoking during pregnancy, for example, can reduce the amount of oxygen the fetus receives.
Scientists believe that the abnormalities that are present at birth may not be sufficient to cause death. Other possibly important events occur after birth such as lack of oxygen, excessive carbon dioxide intake, overheating or an infection. For example, many babies experience a lack of oxygen and excessive carbon dioxide levels when they have respiratory infections that hamper breathing, or they rebreathe exhaled air trapped in underlying bedding when they sleep on their stomachs. Normally, infants sense such inadequate air intake, and the brain triggers the babies to wake from sleep and cry, and changes their heartbeat or breathing patterns to compensate for the insufficient oxygen and excess carbon dioxide. A baby with a flawed arcuate nucleus, however, might lack this protective mechanism and succumb to SIDS. Such a scenario might explain why babies who sleep on their stomachs are more susceptible to SIDS, and why a disproportionately large number of SIDS babies have been reported to have respiratory infections prior to their deaths. Infections as a trigger for sudden infant death may explain why more SIDS cases occur during the colder months of the year, when respiratory and intestinal infections are more common.
The numbers of cells and proteins generated by the immune system of some SIDS babies have been reported to be higher than normal. Some of these proteins can interact with the brain to alter heart rate and breathing during sleep, or can put the baby into a deep sleep. Such effects might be strong enough to cause the baby's death, particularly if the baby has an underlying brain defect.
Some babies who die suddenly may be born with a metabolic disorder. One such disorder is medium chain acylCoA dehydrogenase deficiency, which prevents the infant from properly processing fatty acids. A build-up of these acid metabolites could eventu ally lead to a rapid and fatal disruption in breathing and heart functioning. If there is a family history of this disorder or childhood death of unknown cause, genetic screening of the parents by a blood test can determine if they are carriers of this disorder. If one or both parents is found to be a carrier, the baby can be tested soon after birth.
What Might Help Lower the Risk of SIDS?
There currently is no way of predicting which newborns will succumb to SIDS; however, there are a few measures parents can take to lower the risk of their child dying from SIDS.
Good prenatal care, which includes proper nutrition, no smoking or drug or alcohol use by the mother, and frequent medical check-ups beginning early in pregnancy, might help prevent a baby from developing an abnormality that could put him or her at risk for sudden death. These measures may also reduce the chance of having a premature or low birth weight baby, which also increases the risk for SIDS. Once the baby is born, parents should keep the baby in a smoke-free environment.
Parents and other caregivers should put babies to sleep on their backs as opposed to on their stomachs. Studies have shown that placing babies on their backs to sleep has reduced the number of SIDS cases by as much as a half in countries where infants had traditionally slept on their stomachs. Although babies placed on their sides to sleep have a lower risk of SIDS than those placed on their stomachs, the back sleep position is the best position for infants from 1 month to 1 year. Babies positioned on their sides to sleep should be placed with their lower arm forward to help prevent them from rolling onto their stomachs.
Many parents place babies on their stomachs to sleep because they think it prevents them from choking on spit-up or vomit during sleep. But studies in countries where there has been a switch from babies sleeping predominantly on their stomachs to sleeping mainly on their backs have not found any evidence of increased risk of choking or other problems.
In some instances, doctors may recommend that babies be placed on their stomachs to sleep if they have disorders such as gastro esophageal reflux or certain upper airway disorders which predispose them to choking or breathing problems while lying on their backs. If a parent is unsure about the best sleep position for their baby, it is always a good idea to talk to the baby's doctor or other health care provider.
A certain amount of tummy time while the infant is awake and being observed is recommended for motor development of the shoulder. In addition, awake time on the stomach may help prevent flat spots from developing on the back of the baby’s head. Such physical signs are almost always temporary and will disappear soon after the baby begins to sit up.
Parents should make sure their baby sleeps on a firm mattress or other firm surface. They should avoid using fluffy blankets or covering as well as pillows, sheepskins, blankets, or comforters under the baby. Infants should not be placed to sleep on a waterbed or with soft stuffed toys.
Recently, scientific studies have demonstrated that bed sharing, between mother and baby, can alter sleep patterns of the mother and baby. These studies have led to speculation that bed sharing, sometimes referred to as co-sleeping, may also reduce the risk of SIDS. While bed sharing may have certain benefits (such as encouraging breast feeding), there are not scientific studies demonstrating that bed sharing reduces SIDS. Some studies actually suggest that bed sharing, under certain conditions, may increase the risk of SIDS. If mothers choose to sleep in the same beds with their babies, care should be taken to avoid using soft sleep surfaces. Quilts, blankets, pillows, comforters, or other similar soft materials should not be placed under the baby. The bed sharer should not smoke or use substances such as alcohol or drugs which may impair arousal. It is also important to be aware that unlike cribs, which are designed to meet safety standards for infants, adult beds are not so designed and may carry a risk of accidental entrapment and suffocation.
Babies should be kept warm, but they should not be allowed to get too warm because an overheated baby is more likely to go into a deep sleep from which it is difficult to arouse. The temperature in the baby's room should feel comfortable to an adult and overdressing the baby should be avoided.
There is some evidence to suggest that breast feeding might reduce the risk of SIDS. A few studies have found SIDS to be less common in infants who have been breast fed. This may be because breast milk can provide protection from some infections that can trigger sudden death in infants.
Parents should take their babies to their health care provider for regular well baby check-ups and routine immunizations. Claims that immunizations increase the risk of SIDS are not supported by data, and babies who receive their scheduled immunizations are less likely to die of SIDS. If an infant ever has an incident where he or she stops breathing and turns blue or limp, the baby should be medically evaluated for the cause of such an incident.
Although some electronic home monitors can detect and sound an alarm when a baby stops breathing, there is no evidence that such monitors can prevent SIDS. A panel of experts convened by the National Institutes of Health in 1986 recommended that home monitors not be used for babies who do not have an increased risk of sudden unexpected death. The monitors are recommended, however, for infants who have experienced one or more severe episodes during which they stopped breathing and required resuscitation or stimulation, premature infants with apnea, and siblings of two or more SIDS infants. If an incident has occurred or if an infant is on a monitor, parents need to know how to properly use and maintain the device, as well as how to resuscitate their baby if the alarm sounds.
How Does a SIDS Baby Affect the Family?
A SIDS death is a tragedy that can prompt intense emotional reactions among surviving family members. After the initial disbelief, denial, or numbness begins to wear off, parents often fall into a prolonged depression. This depression can affect their sleeping, eating, ability to concentrate, and general energy level. Crying, weeping, incessant talking, and strong feelings of guilt or anger are all normal reactions. Many parents experience unreasonable fears that they, or someone in their family, may be in danger. Over-protection of surviving children and fears for future children is a common reaction.
As the finality of the child's death becomes a reality for the parents, recovery occurs. Parents begin to take a more active part in their own lives, which begin to have meaning once again. The pain of their child's death becomes less intense but not forgotten. Birthdays, holidays, and the anniversary of the child's death can trigger periods of intense pain and suffering.
Children will also be affected by the baby's death. They may fear that other members of the family, including themselves, will also suddenly die. Children often also feel guilty about the death of a sibling and may feel that they had something to do with the death. Children may not show their feelings in obvious ways. Although they may deny being upset and seem unconcerned, signs that they are disturbed include intensified clinging to parents, misbehaving, bed wetting, difficulties in school, and nightmares. It is important to talk to children about the death and explain to them that the baby died because of a medical problem that occurs only in infants in rare instances and cannot occur in them. The National Institute of Child Health and Human Development (NICHD) continues to support research aimed at uncovering what causes SIDS, who is at risk for the disorder, and ways to lower the risk of sudden infant death.
Thrush
Thrush is a very mild infection that causes white patches to coat the inside of the cheeks and tongue of your baby. These patches cannot be easily wiped off and do not come off in-between feedings (like formula might). It is caused by a yeast infection and is easily cleared up with a prescription medicine called Nystatin. Thrush does not usually cause any discomfort and your baby should continue to feed normally, even without treatment.
Upper Respiratory Infections
Upper respiratory infections include symptoms of a clear or green runny nose and cough and are usually caused by cold viruses. The best treatment is to use salt water nasal drops and a bulb suctioner to keep their nose clear. You can also use an over the counter decongestant, such as Pediacare Infant Drops. Call your doctor if your child is fussy, has high fever, difficulty breathing or is not improving in 7-10 days.
A cool mist humidifier can also be helpful.
Watery Eyes
Tearing, or having watery eyes are usually caused by a blocked tear duct and is not a concern unless the eyes become infected (let us know so we can prescribe antibiotic eye drops). It usually clears up on its own before your baby is 12 months old without treatment.
