Common health problems of newborn – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.

Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity.

Table of Contents

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

[Ref-Paediatric Nursing, Parul Datta/3rd/73-751]

Hyperbilirubinemia/Jaundice

Hyperbilirubinemia:

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

[Ref-Annamma Jacob/2/318]

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.

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.

[Ref-Suraj Gupta/11/228]

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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)

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

[Ref-Suraj Gupta/11/248]

Physiological Mechanisms of Neonatal Jaundice:

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.

[Ref-Piyush Gupta/1″/246]

Types of Neonatal Jaundice:

1. Physiological jaundice.

2. Pathological jaundice

[Ref-Paediatric Nursing, Parul Datta/34/96]

Clinical Feature:

Pallor.
Hepatosplenomegaly.
Any evidence of sepsis
Abnormal neurological behaviour.

Management of Neonatal Jaundice:

1. Sunlight exposure.

2. Phototherapy

If S. bilirubin level is > 12 mg/dl for term baby.
If S. bilirubin level is > 10 mg/dl for preterm baby.

3. If Rh incompatibility: (if detect within two days of birth)-

Exchange blood transfusion.

4. Ensure exclusive & frequent breast feeding.

5. Spontaneous récovery is usual in physiological jaundice within 7-10 days.

6. Treat the underlying cause.

Hypothyroidism
Congenital hypertrophic pyloric stenosis

7. Enzyme induction: Phenobarbitone

90mg/24 hours 1-2 wks prior to delivery for mother or
At birth in a dose of 10 mg/kg/24 hours to infants.

Read more:

Nutritional Anaemia | CHAPTER 15 | Pediatric Nursing

Common health problems of newborn | CHAPTER 18 | Pediatric Nursing