Common health problems of newborn

Common health problems of newborn | Chapter 24 | Midwifery For Diploma In Nursing

Common health problems of newborn – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.

 

Common health problems of newborn

Common health problems of newborn

Common health problems of neonate

Neonates may have some physical or physiological peculiarities which are of no consequence. The conditions should be evaluated to detect any possible pathology.

The common health problems of neonate:

1. Vomiting

2. Diarrohoea

3. Constipation

4. Hiccups

5. Excessive sleepiness

6. Excessive crying

7. Nose block and sneezing

8. Cradle cap

9. Breath holding spells

10. Napkin rash

11. Dehydration fever

12. Evening colic or 3 months colic

13. Physiological phimosis (male baby)

14. Vaginal bleeding and mucoid secretions (female baby)

15. Umbilical granuloma

16. Obstructed nasolacrimal duct

17. Mastitis neonatorum

Hyperbilirubinemia

Jaundice or hyperbilirubinemia is an excess of bilirubin in blood which causes yellow discoloration of the neonates skin, mucous membranes and sclera.

Or

Hyperbilirubinemia is a condition in which there is too much bilirubin in the blood. When red blood cells break down, a substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin and it can build up in the blood and other tissues and fluids of the baby’s body.

Or

An elevated level of the pigment bilirubin in the blood. A sufficient elevation of bilirubin produces jaundice. Some degree of hyperbilirubinemia is very common right after birth, especially in premature babies.

 

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Causes of hyperbilirubinemia

Important causes of neonatal jaundice based on age of onset are given below:

A. First day (1 day)
  • Rh and ABO incompatibilities (hemolytic disease of the newborn)
  • Intrauterine infections like toxoplasmosis and cytomegalic inclusion disease.
  • G-6-PD deficiency.
  • Hereditary spherocytosis..
  • Drug administration to mother (vitamin K. sulfisoxazole, salicylates).
  • Homozygous alpha-thalassemia.
B. Second and third day
  • Physiologic.
  • Hyperbilirubinemia of newborn.
  • Birth asphyxia.
  • Cephalhematoma.
  • Acidosis.
  • Hypothermia.
  • Hypoglycemia.
  • Drugs.
  • Familial nonhemolyic icterus as in, Crigler-Najjar disease, Gilbert disease
C. 4th to 7th day
  • Septicemia.
  • Syphilis.
  • Toxoplasmosis.
  • Cytomegalic inclusion disease.
  • Extrahepatic atresia of bile duct.
  • Breast-milk jaundice
D. After first week
  • Septicemia.
  • Extrahepatic atresia of bile duct.
  • Hereditary spherocytosis.
  • Neonatal hepatitis.
  • Drug-induced hemolytic anemia.
  • Galactosemia
E. Persistent jaundice during first month
  • Inspissated bile syndrome.
  • Cretinism.
  • Congenital hypertrophic pyloric stenosis

 

Risk factors of severe hyperbilirubinemia

Major risk factors:

1. Pre discharge total serum bilirubin (TSB) or transcutaneous bilirubin (TCB) level in the high-risk zone.

2. Jaundice observed in the first 24 hours.

3. Blood group incompatibility with positive direct antiglobulin test, other known hemolytic disease (eg. G6PD deficiency)

4. Elevated end tidal carbon-monoxide content in exhaled air (ETCO2)eird als

5. Gestational age 35-36 wks.

6. Previous sibling received phototherapy.

7. Cephalohematoma or significant bruising

8. Exclusive breastfeeding particularly if nursing is not going well and weight loss is excessive.

Minor risk factors

1. Pre discharge TSB or TCB level in the high intermediate risk zone.

2. Gestational age 37-38 wks.

3. Jaundice observed before discharge.

4. Previous sibling with jaundice.

5. Macrosomic infant of a diabetic mother.

6. Maternal age> 25 years.

7. Male gender

Physiological mechanisms of neonatal jaundice

 

Common health problems of newborn

 

Neonatal jaundice occurs due to the following mechanisms:

1. Increased bilirubin production:

  • Higher erythrocyte mass.
  • Shorter RBC lifespan (90 days vs 120 days)
  • Increased ineffective erythropoiesis.
  • Increased turnover of nonhemoglobin heme proteins.

2. Reduced hepatic metabolism:

  • Defective uptake.
  • Defective conjugation.

3. Increased enterohepatic circulation due to high levels of intestinal B (beta) glucuronidase, paucity of intestinal bacteria and decreased gut motility.

Types of neonatal jaundice

1. Physiological jaundice.

2. Pathological jaundice

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