List of Articles
- Neonatal Jaundice: Part I
Jaundice (hyperbilirubinemia) occurs in most newborns. Jaundice is benign in most newborns, but because of potential toxicity of bilirubin, newborns must be monitored to identify those who might develop severe hyperbilirubinemia, and in rare cases, acute bilirubin encephalopathy or kernicterus. Based on a consensus of expert opinion and review of available evidence, universal pre-discharge bilirubin screening is recommended. This can be accomplished by measuring the total serum bilirubin level (ideally at the time of routine metabolic screening) or transcutaneous bilirubin level and plotting the result on an hour-specific nomogram to determine the risk of subsequent hyperbilirubinemia that will require treatment. If an infant is discharged before 24 hours postnatal age, the bilirubin should be rechecked within 48 hours. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. Kernicterus in detail is discussed in Neonatal Jaundice: Part II. In every infant, the Women’s Health and Education Center (WHEC) recommends that clinicians: 1) Promote and support successful breastfeeding; 2) Perform a systematic assessment before discharge for the risk of severe bilirubinemia; 3) Provide early and focused follow-up based on the risk assessment; and when indicated 4)Treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia, and possibly bilirubin encephalopathy (kernicterus).
- Neonatal Jaundice: Part II
The term kernicterus literally means "yellow kern," with kern indicating the most commonly afflicted region of the brain (i.e. the nuclear region). Historically, the term refers to an anatomic diagnosis made at autopsy based on a characteristic pattern of staining found in babies who had marked hyperbilirubinemia before they died. This document discusses overview, clinical management and management of kernicterus. Despite the lack of a clear-cut cause-and-effect relationship between kernicterus and the degree of hyperbilirubinemia. Laboratory investigations have demonstrated that bilirubin is neurotoxic at a cellular level. Prevention of hyperbilirubinemia is the best way to minimize the incidence of kernicterus. However, because some babies develop kernicterus with relatively modest bilirubin levels, no known absolute level of bilirubin below which the infant is completely safe is recognized. Additionally, because other factors contribute to the ability of bilirubin to cross the blood-brain barrier, management of these components must be appropriately considered. Any infant at risk for significant hyperbilirubinemia and possible neurotoxicity should be cared for in a nursery capable of rendering appropriate care for the hyperbilirubinemia and any contributing diagnoses. Developmental potential can be maximized by early identification of and intervention for neurologic deficits.
- Newborn Male Circumcision
Newborn male circumcision is a surgical procedure to remove the foreskin, the skin that covers the tip of the penis. In the United States, a large percentage of male newborns are circumcised. Although circumcision has known medical benefits, the procedure generally is performed for family, religious, or cultural reasons. Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision. However, these data are not sufficient to recommend routine neonatal circumcision. Circumcision is a safe and straightforward procedure but has its risks and potential complications. In the United States, it is often done before a new baby leaves the hospital. Possible benefits include a lower risk of urinary tract infections, penile cancer, and sexually transmitted diseases. There is a low risk of bleeding or infection. The baby might also feel some pain. The Women's Health and Education Center (WHEC) recommends that parents should discuss circumcision with their baby's healthcare provider. The World Health Organization's (WHO's) program for male circumcision and HIV prevention is also discussed. Parents should make their decision based on the benefits and risks, as well as their own religious, cultural, and personal preferences. As with most surgeries, the best outcomes are achieved by practitioners who are well trained, who perform the procedure under supervision until their experience is sufficient, and who follow correct protocol during the entire operation.
- Newborn Nutrition
The landscape of breastfeeding has changed over the past several decades as more women initiate breastfeeding in the postpartum period and more hospitals are designated as Baby-Friendly Hospitals by following the evidence-based Ten Steps to Successful Breastfeeding. Human milk feeding supports optimal growth and development of the infant while decreasing the risk of a variety of acute and chronic diseases. The use of donor human milk is increasing for high-risk infants, primarily for infants born weighing <1,500 g or those who have severe intestinal disorders. Pasteurized donor milk may be considered in situations in which the supply of maternal milk is insufficient. Intramuscular vitamin K1 (phytonadione) at a dose of 0.5 to 1.0 mg should routinely be administered to all infants on the first day to reduce the risk of hemorrhagic disease of newborn. Vitamin D deficiency/insufficiency and rickets has increased in all infants because of decreased sunlight exposure secondary to changes in lifestyle, dress habits, and use of topical sunscreen preparations. Supplementary fluoride should not be provided during the first 6 months. From age 6 months to 3 years, fluoride supplementation should be limited to infants residing in communities where the fluoride concentration in water is <0.3 ppm. The Women's Health and Education Center (WHEC) strongly supports the national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants and children.
- Newborn Screening Program in the United States
Newborn screening is the largest screening program in the United States with approximately four million newborns screened yearly. It is a mandated public health program designed for the identification of disorders in children. It is designed to provide rapid diagnosis and allow early therapy for specific metabolic, infections, and other genetic disorders for which early intervention reduces disabilities and death. This important practice typically occurs before the development of signs or symptoms of disease. Newborn screening programs are comprised of a complex, integrated clinical service of education, screening, diagnosis, follow-up, evaluation, and often long-term management. The list of recommended conditions for newborn screening programs is continually being evaluated. Integrating education about newborn screening into prenatal care allows parents to be prepared for having their child undergo screening as well as for receiving newborn screening test results. Furthermore, parents often view their care from prenatal management through pediatrics as a continuum of care without health care provider distinctions. This can be accomplished at different moments in prenatal care: 1) during the first-trimester new obstetric visit and include written or web-site information along with other patient education materials, 2) later in pregnancy with other educational information is routinely distributed, such as at the time of glucola or group B streptococcal screening in the third trimester, 3) during a discussion of past adverse pregnancy outcomes related to a positive newborn screening test result or birth defect, at the same time that options for prenatal or preimplantation genetic screening or diagnostic testing are considered.
- The Apgar Score
The purpose of this document is to place the Apgar score in its proper perspective. The Apgar score describes the condition of newborn infant immediately after birth, and when properly applied, it is a tool for standardized assessment. It also provides a mechanism to record fetal-to-neonatal transition. Apgar scores do not predict individual mortality or adverse neurologic outcome. However, based on population studies, Apgar scores of less than 5 at 5-minutes and 10-minutes clearly confer an increased relative risk of cerebral palsy, and the degree of abnormality correlates with the risk of cerebral palsy. Most infants with low Apgar score, however, will not develop cerebral palsy. The Apgar score is affected by many factors, including gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions. If the Apgar score at 5- minutes is 7 or greater, it is unlikely that peripartum hypoxia-ischemia caused neonatal encephalopathy. The Neonatal Resuscitation Program (NRP) guidelines, Apgar score and subsequent neurological dysfunctions are also discussed. The review also examines the occurrence of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunctions. Perinatal asphyxia is a major cause of neurologic sequelae in term newborns. Apgar score is useful for conveying information about the newborn’s overall status and response to resuscitation. However, resuscitation must be initiated, if needed, before the 1-minute score is assigned. Therefore, Apgar score is not used to determine whether the need for initial resuscitation steps are necessary, or when to use them.
- Newborn Care: Initial Assessment & Resuscitation
Approximately 10% of term and late-preterm infants require some assistance to begin breathing that includes stimulation at birth; less than 1% will need extensive resuscitative measures. Although the vast majority do not require intervention to make the transition from intrauterine to extrauterine life, because of the large total number of births a sizable number of babies will require some degree of resuscitation. Recognition and immediate resuscitation of a distressed newborn infant requires an organized plan of action that includes the immediate availability of proper equipment and on-site qualified personnel. Anticipated newborn problems should be thoroughly communicated by the obstetric care provider to the responsible lead member of the resuscitation team. Assessment and resuscitation of the infant at delivery should be provided in accordance with the principles of guidelines for neonatal resuscitation. Most of the principles are applicable throughout the neonatal period and early infancy. Each hospital should have policies and procedures addressing the care and resuscitation of the newborn infant, including the qualifications of physicians and other health care practitioners who provide this care. The Women's Health and Education Center (WHEC) with its partners has launched the series on Newborn Care to disseminate updated literature and guidelines to health care providers regarding newborn care and safety. Current guidelines are summarized in this section.
Women's Health & Education Center
Dedicated to Women's and Children's Well-being and Health Care Worldwide
Dedicated to Women's and Children's Well-being and Health Care Worldwide