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Common Problems and Diseases of Newborn Babies
What is anemia? Anemia is having too few red blood cells. Red blood cells carry oxygen to the body. How do the doctors know if my baby has anemia? Two laboratory tests, HEMATOCRIT and HEMOGLOBIN, are used to determine red blood cells in blood. The value for the hematocrit is usually about three times larger than the hemoglobin. How do my baby's doctors know if my baby is making blood? A blood test called the RETICULOCYTE COUNT measures the percent of newly made red blood cells. Why do babies get anemia? They may be born with anemia
Babies may become anemic later
How is anemia treated? Anemia is usually treated by transfusions of red blood cells obtained from the blood bank. This is the only way to increase the number of red blood cells rapidly. Anemia can also be treated by erythropoietin. This is a drug similar to the substance the body normally produces to increase the number of red blood cells. It works slowly over days to weeks. It is not useful if the anemia needs to be treated more rapidly. Anemia does not always need to be treated if it is not severe and if the baby is not sick or having frequent laboratory tests. Eventually the baby will make more red blood cells. Later, as the baby grows, s/he may need an additional source of iron. This may be an iron fortified formula, vitamins with iron, or iron drops. Iron is needed by the body to make red blood cells. Can my baby have my blood for transfusions? Women who have recently given birth are not usually considered for blood donation because they have already lost blood with the delivery of the baby. Blood for a baby must be from someone with a compatible blood type and it must pass several screens for exposures to certain viruses. The majority of potential donors are not acceptable for these reasons. Even if you give blood regularly, your blood may not be acceptable for your baby. If you are interested in finding out if you, a friend, or a relative are an acceptable donor, ask your baby's doctor if the hospital has a directed donor program. How many blood transfusions will my baby need? That depends on how sick your baby is and how often blood need to be taken from your baby for laboratory tests. Apnea and Bradycardia What is apnea? Apnea is a pause in breathing that has one or more of the following characteristics:
What is bradycardia? Bradycardia is a slowing of the heart rate, usually to less than 80 beats per minute for a premature baby. Bradycardia often follows apnea or periods of very shallow breathing. Sometimes it is due to a reflex, especially with the placing of a feeding tube or when the baby is trying to have a stool. Is all apnea due to prematurity? No, apnea of prematurity is by far the most common cause of apnea in a premature infant. However, apnea can be caused or increased by many problems including infection, low blood sugar, patent ductus arteriosus, seizures, high or low body temperature, brain injury or insufficient oxygen. Why do premature babies have apnea? Premature babies have immature respiratory centers in the brain. Preemies normally have bursts of big breaths followed by periods of shallow breathing or pauses. Apnea is most common when the baby is sleeping. Will apnea of prematurity go away? As your baby gets older, his/her breathing will become more regular. The time course is variable. Usually apnea of prematurity markedly improves or goes away by the time the baby nears his/her due date. How is apnea treated? Several treatments are possible. Your baby may be treated with one or more of the following:
How do I know if my baby has apnea? Your baby's respirations are monitored continuously if s/he is at risk for apnea. An alarm will sound if there is no breath for a set number of seconds. What happens if the monitor sounds?
Does my baby have to stay in the hospital until the apnea goes away completely? Most infants are over their apnea completely when they go home; however, some babies reach all other criteria for discharge before their apnea is completely gone. Some babies are candidates for home apnea monitoring. Your baby may be a candidate for home apnea monitoring if:
Once apnea goes away, will it come back? Apnea of prematurity is a result of immaturity. Once a baby matures and the apnea resolves, it will not return. If a baby should have breathing pauses after apnea goes away, it is not apnea of prematurity. It is due to some other problem and needs to be discussed with your baby's physician. This is not common. Is apnea of prematurity related to sudden infant death syndrome (SIDS)? No, these are two entirely different problems. Most babies who die of SIDS are born at term and have normal newborn stays. Babies who have needed newborn intensive care for any reason are at a slightly higher risk of SIDS than other babies. Apnea of prematurity does not determine this risk. Blood Pressure (low) Why does a baby have low blood pressure? Babies can have low blood pressure for many reasons. It is especially common in babies just after birth. Reasons for low blood pressure include:
Sometimes it is not known why a baby's blood pressure is low. How can low blood pressure be treated?
Blood Sugar What kind of blood sugar problems can sick babies have? Their blood sugar may be either too low or too high. Low blood sugar is common soon after birth. High blood sugar is more common in babies who are getting most or all of their nutrition by vein. How is blood sugar monitored? It can be monitored by placing a drop of blood onto a chemical strip. Or, a sample of blood can be sent to the laboratory for a blood sugar determination. How is low blood sugar treated? It is treated by giving the baby more sugar. If your baby is on feedings by vein (IV), the amount of sugar in the intravenous fluids is increased. If your baby does not have an IV, s/he may be fed sooner and/or more often, or an IV may be started in order to give your baby sugar water. After your baby starts feeding the amount of sugar by vein will be decreased slowly. How is high blood sugar treated? If your baby is being fed by vein, the amount of sugar in the IV fluids may be decreased. Or, your baby's doctors may decide to give your baby insulin to help your baby use more sugar in his/her body. Do blood sugar problems in a baby mean s/he will get diabetes? No, sugar problems in a baby do not relate to whether s/he will develop diabetes later on in life. But, infants of mothers who had diabetes in pregnancy are more likely to have low blood sugar in the newborn period. Once a baby is feeding regularly, blood sugar problems seldom recur. Bronchopulmonary Dysplasia What is bronchopulmonary dysplasia? Bronchopulmonary dysplasia (BPD) is a form of longer lasting lung disease. It occurs in term infants who have had severe lung problems including infection, meconium aspiration or poor lung development before birth (pulmonary hypoplasia). What causes BPD? BPD is an imflammatory reaction of the baby's lung to the lung disease and to the oxygen and mechanical ventilation that were needed to treat the infants lung disease. How will I know if my baby has BPD? BPD is usually diagnosed if a baby continues to have an abnormal chest x-ray and still needs oxygen for a month or more. However, your baby's doctor may be concerned enough to treat your baby's continuing lung disease long before this date. A baby with BPD may also have one or more of the following: * rapid breathing * more difficult breathing * wheezing or noisy breathing * wet or crackling sound to the lungs heard with a stethoscope * more difficult time growing How is BPD treated? A baby with BPD needs extra oxygen for a long period of time. This may be several weeks or months, occasionally for more than a year. Babies with BPD may be discharged on home oxygen. Some babies are treated with other medications. These might include: * Steroids - drugs to decrease the body's reaction to oxygen * Diuretics - drugs to help the body to get rid of extra water * Drugs to decrease wheezing Feeding and Nutrition How will my baby get nutrition when s/he is sick? When your baby is sick, your baby will receive nourishment by vein. At first your baby will receive mainly sugar water for calories. However, if it appears that your baby will not tolerate feedings within a few days, he/she may be started on total parenteral nutrition (TPN). With TPN, protein, fat, sugar, vitamins and minerals are added to the fluids that the baby receives by vein. Your baby can receive complete nutrition and grow on TPN alone. As your baby tolerates other feedings, the TPN will be decreased. If your baby is breathing too fast or for some other reason can't breast or bottle feed, your baby may be started on tube feedings. A tube is passed through the mouth or the nose into your baby's stomach. Milk is put through the tube. This may be as a constant slow drip, called continuous infusion or drip feeds, or as prescribed amounts given every few hours, called gavage feeding. Either way, the amounts will be small at first and gradually increase. There is often a transition period between TPN and oral or tube feedings where the amount of nutrition from TPN slowly decreases as the amount from other feeding increases. Occasionally drip feedings are given into the intestine instead of the stomach. In this case the end of the tube is passed beyond the stomach into the intestine. When will my baby gain weight? Almost all babies lose weight before they begin to gain weight. This weight loss typically is 5-15% of the baby's birth weight. Much of the weight loss is loss of water because the baby is no longer surrounded by fluid. Sometimes very sick babies gain weight the first few days. This is not real weight gain; it is retention of water. As the baby's condition improves, the baby will lose weight. Usually a baby does not regain his/her birth weight until two or more weeks of age. Should I plan to breast or bottle feed my baby? Just because your baby is sick does NOT mean s/he must have formula. In fact, there are many advantages to mother's breast milk over formula. These advantages include:
Early breast milk, called colostrum, is especially rich in antibodies and cells that help fight infection. Babies who are too sick or weak to suckle at the breast can get your milk in by tube feedings once feeding are started. Are there mothers who can't or shouldn't breast feed? Very few mothers can't or shouldn't breast feed. Most drugs do not get to the baby in large enough amounts to prevent breast feeding. Be sure you let your baby's doctor know ALL medicines, herbs or other drugs that you are taking. The following mothers usually should not breast feed:
If you have had surgery or radiation to your breasts (especially near the nipple), it may be difficult to lactate (produce milk). If only one breast has had surgery or radiation, the other should be able to produce enough milk for your baby. I can't or don't wish to breast feed. Will I be hurting my baby? Babies can and do develop normally when fed only formula. Although encouraged, breast feeding is a personal choice. Will my milk provide my baby with all the things that s/he needs to grow? Milk from mothers who deliver early is different from milk from mothers who deliver on time. It has more protein, sodium, calcium and some other nutrients. Even so, it not as rich in some of these things as what the baby would receive from the placenta if s/he were not born early. Some preemies grow well on their mother's milk alone. Others, especially very small or sick preemies, cannot handle the amount of milk that it would take to get all the calories and nutrients that they need. The same is true of formula-- preemie formulas are richer in these things than regular formulas. Your baby's doctor may decide to enrich your milk to provide your baby with more calories and/or minerals. There are many ways to do this:
As the baby gets older and no longer needs to be tube fed, his/her need for extra nutrients and calories also decreases. So, by the time the baby can completely breast feed, usually breast milk supplies all the calories that s/he needs. Your baby may still need additional vitamins and iron. How is breast milk formed? The breasts contain many glands which make milk. They collect nutrients and liquid from the mother's blood and make them into milk. The milk then travels to ducts which help store the milk. The ducts are behind the brown part of the nipple and each duct has a connection to the nipple. When the nipple is stimulated by sucking (or suction), hormones are released in the mother's brain which help bring the milk to the nipple, called "let down". How will my body know to produce milk? After delivery, hormones change rapidly, signaling to your breast to begin making milk. With stimulation by the baby's sucking (or by the breast pump) the breasts will continue to make milk. The more stimulation the more milk the breasts make. When should I start pumping? It is best to start as soon after delivery as you can, within the first 6 hours is best, but definitely within the first 24 hours. Early pumping is very important for establishing a milk supply. Even if your baby is very sick and not being fed, you need to pump your breast regularly so there will be milk when your baby is ready. Electric breast pumps are the best. Ask your nurse or a lactation consultant for assistance in learning to use one and in preparing to rent one when you are out of the hospital. How often should I pump? You should pump at least five times a day and for a total time of at least 100 minutes a day. Ideally increase this to 8 to 10 times a day for 10 minutes per side. Frequent pumping signals your body to keep making milk. At first you may get very little milk, sometimes just a few drops. But, it is important to save all that you get of this early milk for your baby. About the third day your breasts will become full and swollen. This is your milk coming in. At this time your milk supply will increase. With frequent pumping you will produce more than your baby can use, but don't decrease the amount of pumping. It is important to build a good supply early. My baby is sick and not eating. What do I do with my milk? Pumped milk can be frozen for later use. Unless told otherwise, the milk from an entire pumping should be pooled and then divided into containers for freezing. The nutrients of milk are not changed by freezing, but frozen milk does not protect against infection. Your baby's doctor may want to use fresh milk when the baby starts to feed. Fresh milk is milk that has not been frozen, but it can be refrigerated for 24-48 hours. Ask you baby's nurse about the quidelines for your nursery. Asphyxia and Hypoxic-Ischemic Encephalopathy What is asphyxia? Asphyxia is when there is less than normal oxygen delivered to the body or an organ and there is build up of carbon dioxide in the body or tissue. Not enough blood flow to an organ can cause asphyxia. When does asphyxia occur? It can happen any time--a long time before birth, shortly before birth, during delivery or after birth. What happens with asphyxia? If the period of asphyxia is short, the body may recover without damage. If the time is longer there may be injury that is reversible, not permanent. If the period is very long there may be permanent injury to one or more organs of the body. How does someone know if there is asphyxia? Before birth, asphyxia may occur without people knowing. If the pregnancy is high risk, the obstetrician may monitor the baby before birth looking for heart rate patterns, activity, and amount of amniotic fluid. If a baby is not doing well in the womb the heart rate pattern may become abnormal and/or the baby may stop moving. After birth, doctors can observe more directly the baby's heart rate, color, breathing and activity. Sick babies often have their heart rate, breathing rate, blood pressure, and oxygen monitored all the time. How is asphyxia treated? The goals of treatment are to:
Your baby may need:
If your baby has seizures, s/he will probably have an EEG - electroencephalogram or brain wave test. In addition, your baby's doctors may choose to do other tests ( Head ultrasound, CT scan or MRI) if they think they are needed. What is Ischemic-Hypoxic Encephalopathy (IHE)? Ischemic means not enough blood flow. Hypoxic means too little oxygen. Encephalopathy means abnormal brain function. IHE means that for a peroid of time there was too little oxygen and blood flow to the brain. This causes the brain to act abnormal. How does a baby with IHE act?
When will I know if there is permanent brain damage? Those caring for your baby will be best able to answer this question. Often the answer is known only over time. Babies are most like to have severe problems if they:
What kinds of long term problems are possible if there is permanent damage? Serious abnormalities appear gradually. These may include: Motor (Movement) Problems * tight or stiff muscles * holding legs straight and crossed most of the time * difficulty sitting * slow to crawl, stand, or walk or inability to do these * abnormal crawling, toe walking * frequent arching of the back (not just when angry or at play) * one side weaker than the other Slow Mental Development does not listen to your voice by age 3-4 months after hospital discharge does not make different sounds by 8-9 months after discharge doesn't seem to understand or say any words by one year after discharge Seizures Poor Hearing or Deafness Poor Vision Less serious problems appear more slowly, are more difficult to detect, and may not be obvious until preschool or grade school. These can include: * poor coordination or balance * specific learning disabilities (math or reading) * very short attention span * behavioral problems * difficulty with activities that require coordination of the eyes and hands; for example, catching a ball or copying a simple drawing It is very important for babies who have IHE to receive close follow-up of their development. If your baby has IHE, s/he may be eligible for a developmental intervention program, visit Family Village for further details . Anytime in the future if you are concerned about something that you think might be abnormal, have it checked out by your baby's doctor. Infant of a Diabetic Mother (IDM) How does Diabetes in the mother affect the baby before birth? When a mother has diabetes, her body does not control blood sugar normally. Blood sugar is controlled mainly by insulin. Normally, blood sugar rises after meals. The body responds by putting insulin into the blood stream. The insulin helps the sugar get into the body's cells that use the sugar for energy and growth. With diabetes, there is not enough insulin released by the body causing the blood sugar rise abnormally high. When a mother's blood sugar is high, so is her baby's inside her because sugar travels across the placenta to the baby. The baby's body can and does make insulin. If the blood sugar is high, the baby makes extra large amounts of insulin to keep its own blood sugar normal. Diabetes may be present before pregnancy, or it may appear during pregnancy. Diabetes which occurs only during pregnancy is called "gestational diabetes" and appears after the first few months of pregnancy. In gestational diabetes, diet alone often controls the blood sugar level, but sometimes the body needs extra insulin. Diabetes which exists before pregnancy usually requires insulin and often gets worse during pregnancy. Keeping blood sugar in the normal range is very important in pregnancy. If a woman has diabetes for several years, the blood vessels in her body may be more narrow or show changes of aging. These same changes can occur in the blood vessels to the placenta. Problems of the developing baby can include:
What problems are more common in infants of diabetics during birth? Delivery may be difficult due to the large size of the baby. Normally the head is the largest part of the baby and the head comes first. So, if the head gets through, the rest of the body slips through easily. In the IDM, the shoulders may be large, making them the largest part of the baby. With delivery there may be:
What problems do IDM's have after birth? Common problems include:
Because IDM's may be delivered early, they may have the other common problems of premature infants. Will my baby develop diabetes later on? Being an IDM does NOT mean the baby will have diabetes later on or in adult life. But, because the tendency toward diabetes runs in families, the IDM is at the same risk as other members of the family, and at a little higher risk than the general population. Infant of a Mother with High Blood Pressure or Pre-Eclampsia What is Hypertension? Hypertension is high blood pressure. "Pregnancy associated hypertension" occurs only during pregnancy. "Chronic" (or long lasting) hypertension is present before pregnancy and does not go away after pregnancy. What is pre-eclampsia? Pre-eclampsia is the combination of: * high blood pressure, * edema (swelling due to extra fluid in the body) * protein in the urine. Normally there is no protein in urine. "Pre" means before and "eclampsia" refers to seizures (convulsions, fits). If pre-eclampsia becomes severe or is not treated, seizures may occur. How is pre-eclampsia in the mother treated? It is treated by any or all of the following: * Bed Rest * Medicines to lower blood pressure * Medicines to prevent seizures When pre-eclampsia is severe it may cause liver, kidney, blood clotting and other problems in the mother. If this occurs, it is called HELLP Syndrome (H-hemolysis or breakdown of red blood cells, EL- elevated values on tests of liver function, LP- low platelets). If HELLP occurs, usually the baby must be delivered early, even if it is very premature. The only cure to pre-eclampsia is delivery of the baby. How does pre-eclampsia or high blood pressure affect the baby and how are these problems treated? If high blood pressure occurs only in the last few weeks before the due date, usually the baby is fine. But, if it occurs earlier, both the mother and the baby may develop problems. The small blood vessels in the placenta tighten, allowing less blood and nutrients to get to the baby. Some problems that occur more often in infants of mothers with high blood pressure or pre-eclampsia include:
If the baby is premature, it can have any of the common problems of premature babies. Will my baby have high blood pressure in later life? Children may be at risk for high blood pressure later in life if:
Infection What kinds of infections are common in babies? Babies are susceptible to many kinds of infections. Generalized infection or infection of the blood stream is referred to as sepsis; infection of the lungs, pneumonia; infection of the fluid that surrounds the brain, meningitis; infection of the urine, urinary tract infection or UTI. Babies can also get localized infections under the skin called abscesses or infections of the skin. Infections in babies can be caused by bacteria (most common), viruses, or fungi. Infections can be present before birth, acquired near the time of birth, or acquired while the baby is in the nursery. Why do babies get infections?
How does a baby with an infection act? Signs of infection are non-specific; babies may act the same no matter what is wrong with them. These may include any or all of the following: * less active or less alert * more apnea * respiratory problems, especially pneumonia * either too high (fecer) or too low of a body temperature * poor feeding or throwing up feeds * poor skin color * problems with low blood pressure * seizures (meningitis only) How will my baby's doctors know if there is an infection? Your baby's doctor may:
How is an infection treated? Bacterial infections are treated with drugs called antibiotics. There are several different antibiotics. Your baby may be on more than one at a time because no single antibiotic controls all infections. Your baby's doctor will select the ones to control the germs that are most likely causing your baby's infection. Different drugs are used when the infection is caused by a virus or a fungus. Will there be permanent problems from infection? Most of the time the baby's infection responds rapidly to antibiotics. Usually there are no permanent problems from infection. Permanent problems are most likely if the baby has meningitis, or if there has been severe low blood pressure for a long period of time. Intra-Uterine Growth Restriction (IUGR) or Small for Gestational Age (SGA) What is IUGR? IUGR stands for intrauterine growth retardation or intrauterine growth restriction. Both describe a fetus (baby before birth) who has grown more slowly and is smaller than s/he should be for the number of weeks of pregnancy. What is SGA? SGA or small for gestational age is a term used after birth to describe a baby whose weight is less than the 10th percent (some countries use <5% or <3%) for his/her number of weeks of pregnancy. IUGR and SGA refer to the same process. What causes IUGR/SGA? There are many causes for IUGR and SGA:
What problems do IUGR babies have during birth?
What problems are common in the nursery?
Will my baby catch up in growth? This depends on the severity and cause of the growth problem.
Will my baby be normal? This too, depends on the severity and cause of the growth problem.
What will my child be like as a teen ager and adult? In a recent study, Strauss et al (see ref below) followed full term babies with birth weights <5% through school and as young adults. They excluded children with organ malformations. They compared them to normal birth weight children.
Jaundice (Bilirubin) What are jaundice and hyperbilirubinemia? "Hyper" means high; "emia" means in the blood. Hyperbilirubinemia is a high level of bilirubin in the blood. Jaundice is the yellow color to the skin that is often seen in the first few days after birth. The yellow color is due to bilirubin. What is bilirubin? Bilirubin is produced when red blood cells get old and are broken down by the body. Normally it is processed in the liver and then deposited in the intestine so it can come out in the stool. Why do babies have jaundice? The red blood cells of babies have shorter lives than adult red blood cells; bruising at birth may cause a larger number of red cells to be broken down. All of the bilirubin from these cells needs to be processed by the baby's liver. Babies do not have fully developed organs. Their livers cannot process bilirubin rapidly. Their intestines may not move much in the first few days especially if they are sick and not being fed. Sometimes when the mother and the baby have different blood types, the mother makes antibodies against the baby's red blood cells, destroying them. This is most common if the mother has blood type O and the baby is either blood type A or B. It can also occur if the mother is Rh negative and the baby is Rh positive, called Rh incompatibility. Rh incompatibility is often more severe than AO or BO. When many red cells are destroyed, the baby has anemia (low blood count) and more bilirubin. Before birth the mother's body handles the bilirubin, but after delivery, the baby must do it. This extra bilirubin makes the baby have higher bilirubin levels. Is bilirubin bad? Small or moderate increases in bilirubin are not harmful. Extremely high levels of bilirubin can be harmful, causing brain damage. Your baby's bilirubin will be measured if s/he becomes jaundiced to be sure that s/he does not come close to having harmful levels. How is jaundice treated? If the level of bilirubin is high enough to need treatment, it is usually treated with PHOTOTHERAPY. This means the undressed baby is placed under special lights. The lights may be white, blue, or green. Or, the baby can be placed on a light producing blanket. The light helps break down the bilirubin in the skin. It may cause the baby to have runny stools. Why are babies' eyes covered when they are having phototherapy? It may not be good for babies to have bright light continuously shining in their eyes. The eyes are covered to protect them from so much light. If a baby has only the phototherapy blanket, the eyes do not need to be covered. How long will my baby have jaundice? The duration of jaundice varies greatly from baby to baby. Bilirubin levels increase over the first several days and then fall slowly. Phototherapy is usually needed for a few days, but occasionally for more than a week. Babies receiving breast milk may remain yellow longer than those receiving formula, but usually these low levels are not harmful. What happens if a baby's bilirubin rises close to dangerous levels? It is uncommon for infants to need any treatment other than phototherapy. However, if a baby's bilirubin gets close to harmful levels, the doctor can do an EXCHANGE TRANSFUSION. In this procedure the baby's blood containing the bilirubin is replaced with blood from the blood bank. This procedure can be used whenever the bilirubin is too high, but it is most common when the baby's mother has made many antibodies against her baby's blood and the antibodies are destroying the baby's red blood cells rapidly. Meconium Aspiration and other aspiration syndromes What is aspiration? Aspiration is breathing something liquid or solid into the lungs. Common aspirations in newborns include:
Aspiration of meconium, amiotic fluid and blood often occur before or near the time of delivery when the baby takes its first breath. How does one know if a baby has aspirated?
How is a baby with aspiration treated?
How does one know when the baby is getting better?
Are there complications of aspiration? These are most common with severe meconium aspiration.
Necrotizing Enterocolitis What is necrotizing enterocolitis (NEC)? Necrotizing" means causing death to tissue, "entero" refers to the small intestine, "colo" refers to large intestine, "itis" is inflammation. Necrotizing enterocolitis is an inflammation causing destruction of part of the bowel. NEC may involve only the innermost lining or the entire thickness of the bowel and variable amounts of the bowel. Why do babies get NEC? The bowel of newborns is sensitive to changes in blood flow and to infection. We often do not know why an individual baby develops NEC. Did my breast milk cause NEC? No, breast milk neither causes NEC nor completely prevents a baby from developing it. Babies fed fresh breast milk get NEC less often. Is NEC serious? Yes, baby's can lose some of their bowel from it. Some babies die of NEC. For this reason doctors may start treatment on simply the suspicion that your baby might be developing symptoms of NEC. This suspicion is sometimes referred to as "rule out NEC", "possible NEC" or a "NEC scare". How will my baby act if s/he has NEC? Your baby may show any or all of the following:
What can be done for it? If your baby's doctor thinks that s/he might be developing NEC any or all of the following might be done.
What happens if part on my baby's intestine dies? If only the innermost lining of bowel dies, the body can slowly regrow it. If the entire thickness of a piece of the bowel dies, contents of the bowel spill into the abdomen and the baby will need surgery. This may involve just putting drain into the abdomen if the baby is very small or very sick. Then, if needed, the baby will have surgery later to repair the bowel. Some babies to not need later surgery, but most do. If the baby is larger, or more stable, the baby has an operation to remove the piece of the bowel that is no longer alive. The end of the bowel above the removed piece may be brought to the surface of the skin (called ostomy). At some later time, after the baby has recovered and grown bigger, the two ends of the bowel are sewn back together again in a second surgery,. Occasionally, the ends of the bowel can be sewn together during the first surgery, and then no further surgery is needed. The surgeon decides this at the time of surgery. Are there any long term problems from NEC? Most babies who recover from NEC do not have further problems; but, future problems are possible, especially if there has been bowel rupture. These include:
Pneumothorax, Pneumomediastinum and Pulmonary Interstitial Emphysema What are Pneumothorax, Pneumomediastinum and Pulmonary Interstitial Emphysema (PIE)? Normally the air that we breathe goes down the trachea (windpipe) to a series of branches of the windpipe called bronchi. The air then goes to the air sacs where oxygen is delivered to the blood and carbon dioxide is released. If the air sacs become overfilled with air, the air can break out of the air sacs and get into spaces where it should not be. This condition is sometimes referred to as AIR LEAK and includes the following:
Which babies get air leak? Although air leak can happen in any baby, it is more common if:
Why do babies get air leak?
What can be done to treat air leak? Some forms of air leak are more easily treated than others. Approaches to treatment include:
Is air leak serious? Depending on the amount of air and the space where it is located, the symptoms and seriousness of air leak may vary from mild to catastrophic. A large pneumothorax or a pneumopericardium usually causes sudden and rapid deterioration. Interstitial emphysema usually occurs more gradually. When will it get better? As your baby's underlying lung disease improves, the air leak also improves. However, babies who have had air leak often improve more slowly than babies who have not. When the tubes no longer drain air, they will be removed. Once the tubes are out for more than a day AND the baby is off the breathing machine or CPAP, airleak usually does not recur. Primary Pulmonary Hypertension or Persistence of the Fetal Circulation What is Primary Pulmonary Hypertension (PPHN)? Hypertension means high pressure. Pulmonary refers to the lung. Pulmonary hypertension means that the pressure within the blood vessels of the lung is high. This high pressure prevents the normal amount of blood from flowing into the lungs. What happens in Pulmonary Hypertension? Blood, like water, always flows where it is easiest to go. Before birth, the lungs need little blood flow because the mother and the placenta are responsible for providing oxygen and getting rid of carbon dioxide. The lungs are partly collapsed and the tiny blood vessels are coiled. It is difficult for much blood to circulate through them. Most of the blood goes through an alternate channel called the ductus arteriosus. In addition, there is a hole between the two upper chambers of the heart (atria) which allows blood to go from the right side of the heart to the left. This opening is called the foramen ovale meaning oval-shaped hole. These two, the foramen ovale and the ductus arteriosus, allow the oxygen-containing blood coming from the placenta to bypass the lungs and go directly to the rest of the baby's body. Once the baby is born everything must change rapidly. The baby must now do its own exchange of oxygen and carbon dioxide. As the baby cries, the lungs expand , uncoiling the little blood vessels. This allows most of the blood coming from the right side of the heart to go to the lungs to collect oxygen. The oxygen-containing blood is then delivered to the left side of the heart where it is pumped to the body. A thin flap of tissue covers the hole between the two upper chambers of the heart. The ductus arterisus gets much smaller and slowly closes because little blood is flowing through it. When a baby has primary pulmonary hypertension these changes in the flow of blood do not occur as they should. Instead, the baby's blood continues to circulate as it did before birth. It does this because there is an abnormally large amount of muscle in the tiny blood vessels going to the lungs preventing much blood from flowing into them. It is easier for the blood to continue to flow as it did before birth. Another name for Primary Pulmonary Hypertension is Perisitence of the Fetal Circulation. What causes PPHN? Often we do not know why a baby has PPHN or why the muscle grew far down the little arteries leading to the lung. In some cases we do know. These include:
How does a baby with PPHN act? After delivery the baby breathes abnormally fast and needs extra oxygen to stay pink. At first it may look like the baby has Transient Tachypnea of the Newborn, but instead of rapidly improving, the baby rapidly gets worse, needing higher and higher oxygen to stay pink. How is PPHN treated? The treatment of PPHN is often difficult and must be tailored to the needs of the baby. What works for one baby may not work for another. Some physicians favor one treatment over another. Babies with PPHN are often very unstable; treatments may change from hour to hour. The following might be used:
Could my baby die from PPNH? PPNH is a serious disease. Although most babies recover, some babies die from PPHN. Babies with severe pulmonary hypoplasia are most likely to die. How will I know if my baby is getting better? Usually the pressure in the pulmonary blood vessels slowly decreases over days to weeks. As this happens the baby gradually improves. The doctors are able to slowly decrease the amount of drugs, oxygen, and breathing done by the ventilator. Are there long term problems from PPHN? There can be long term problems either from the problems causing PPHN or from the therapy. Your baby's doctor can best discuss your own baby's risk. Examples of possible problems include:
Respiratory Distress Syndrome What is Respiratory Distress Syndrome? * Respiratory Distress Syndrome is the most common lung disease of premature infants. It can also occur in near-tern infants and infants with lung underdevelopment, called pulmonary hypoplasia. * RDS occurs in babies with incomplete lung development. The more premature the infant, the greater likelihood of RDS. * RDS is due to insufficient SURFACTANT in the lungs. Surfactant is a material normally produced by the lung that spreads like a film over the tiny air sacs allowing them to stay open. Open air sacs are essential for oxygen to enter the blood from the lung and for carbon dioxide to be released from the blood into the lung for exhalation. What does a baby with Respiratory Distress Syndrome look like? The baby will have difficulty breathing. S/he will have: * rapid breathing * pulling in of the ribs and center of the chest with each breath, called retractions. * an "ugh" sound with each breath, called grunting. * widening of the nostrils with each breath, called flaring. How is RDS treated?
How long does RDS last? For each baby the course is different. The disease usually gets worse for about 3-4 days. Then, the baby gradually needs less added oxygen. If a baby has relatively mild disease and has not needed a breathing machine, s/he may be off oxygen in 5-7 days. If a baby has more severe disease there is also improvement after 3-5 days but the improvement may be slower and the baby may need extra oxygen and/or a ventilator for days to weeks. Recovery is slower if:
How can I tell if my baby is getting better?
Are there long term problems after RDS? Long term problems are more likely if the disease has been severe or if there have been complications. Possible problems may include:
Will RDS cause developmental abnormalities? No, RDS does not cause abnormal development. However, babies who have been sick with RDS may have had other problems that are associated with abnormal development. Transient Tachypnea of the Newborn What is transient tachypnea of the newborn? Transient tachypnea is fast breathing that gradually gets better. What causes transient tachypnea? It is thought to be due to slow reabsorption of fetal lung fluid. Before birth the lungs continuously make fluid. Some of this fluid is squeezed out as the baby comes down the birth canal. The rest must be absorbed by the baby during the first minutes to hours of life. In babies with TTNB this process may last hours to days. TTNB is more common in babies delivered by cesarean section because they did not have fluid squeezed out with delivery. How does a baby with transient tachypnea act? The baby will have some difficulty with breathing. S/he may: * breathe rapidly * make the "ugh" sound with each breath, called grunting. * have a widening of the nostrils with each breath, called flaring. * need extra oxygen. Room air is 21% oxygen. Your baby needs higher oxygen to stay pink. How is transient tachypnea treated? Your baby will have his/ her respirations, heart rate, and blood oxygenation monitored. In addition your baby may need one of the following:
How long does transient tachypnea last? The time course is variable. It may last hours or days. Gradually the baby's need for oxygen will decrease. Then, his/her respiratory rate will slowly come down to normal. Some babies have fast respirations for several days. Will it come back?
No, once it resolves, it does not come back. If your baby develops a respiratory problem later on, it is due to some other cause.
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