Common Issues in Newborn

DIAPER RASH

It is an irritant contact dermatitis which can be complicated by Candida or bacterial infections. To prevent this, increase diaper free time, minimise skin contact with the etiological factors. i.e wet diaper, stools and urine. Do not vigorously wipe the genital area instead use luke warm water and dry by patting. If fungal infection is suspected, topical Cotrimazole can be prescribed for seven days.

COLICY PAIN

During the initial days, a new born baby sleep throughout the day but is cranky at night. This is because of continuity of “in-womb”day-night cycle of activity. The fetussleeps through out the day as it is rocked in the amniotic fluid when the mother sleeps at night the fetusis active and plays moving all the limbs. Also the tired mother has to sleep at night at peaceful hours, the less fed baby cries breaking the silence of night waking the sleeping mother and the family and interested neighbours. Crying may be due to multiple reasons such as unpleasant sensation of full bladder, painful passing of stool, wet diaper due to urine and stools and boredom. If the baby cries even after feeding changing the wet diaper and rocking the baby, it may be due to abdominal cramps, such baby may produce abdominal cramps and may produce abdominal gurgling sounds and feels better when air passes from mouth or anus once the baby is patted, burped or made to sleep prone. Mosquito net should be used to avoid its bite disturbing baby’s sleep. If the baby cries at night arching its back it is likely to be due to gastroesophageal reflux. Besides most babies are cranky when falling asleep.

EVENING COLIC

There is unexplained crying episodes in the evening after few days of life. There will be excessive gurgling or peristaltic sounds on feeling the baby’s abdomen. Excessive crying will again add swallowed air in the gut aggravating the problem. Burping the baby, putting on prone position will provide temporary relief. Antispasmodic drop helps to an extend. No artificial milk should be given blaming the breast milk or the mother having less milk.

VOMITING

Vomiting on the first day in a normal baby may be due to irritation of stomach by swallowed amniotic fluid.The regurgitation or vomiting soon after feeds is often due to swallowing of air and is non-projectile and the baby continue to gain weight.If vomiting is persistent,projectile or bile stained,not passed meconium in first 24 hours,abdominaldistention,not gaining weight then baby has to be taken to a doctor.

PASSAGE OF STOOL AND URINE

All healthy newborn pass stool (meconium) within 24 hour.In first 2-3 days the stool is black followed by greenish stool(transitional stool) for next 1-2 days then yellow coloured stools. All healthy newborn should pass urine by 48 hours.The stream of urine should be good and forceful and there should be no straining during micturition or dribbling in the end. If the baby doesn’t pass stool by 24 hour and urine by 48 hour, further investigation has to be done.

JAUNDICE

In around 2/3rd of the term babies, physiological jaundice appears on 2nd day of life and reaches maximum intensity on 5th or 6th day.If the mother’s blood group is O or Rh negative, further investigation has to be done.It is better to consult doctor for the severity of jaundice.Phototherapy is decided on the basis of severity of jaundice, gestational age, weight and risk factor(s)of the baby.

HICCUPS AND SNEEZING

These are normal physiological body responses,common in healthy newborn babies.These are positive attributes of a healthy baby.

SUPPLEMENT

All breastfeed term baby should be supplemented with Vitamin D for a year as recommended by WHO.However, preterm babies should be supplemented with Vitamin D,multivitamins, Iron and Calcium.

HEMANGIOMA

Dilatation of capillaries, red or purplish ,soft, compressible mass on the skin mostly in the head and neck regions.It enlarges during infancy later regresses.Parents should be counselled about the benign nature.

UMBILICAL HERNIA

It occurs due to defective anterior abdominal wall.Most of the cases are benign and self limiting before 5 year of age.

VAGINAL BLEEDING

In some female newborn,there is vaginal bleeding typically starting from 3-5 days of life due to withdrawal of maternal estrogen.It lasts 2-3 days and is benign.

MUCOID VAGINAL DISCHARGE

Most female babies have thin greyish-white glair-mucoid vaginal secretions.They should be gently cleaned.

MASTITIS NEONATORUM

The engorgement of breasts occurs in full term babies of both sexes on the third or fourth day and may last for a few days or even weeks.Mother should be counselled regarding its benign nature and practice of local massage, fomentation and expression of milk should be refrained.

CONSTIPATION

Babies on cow’s milk or formula feeds are often constipated.Baby on breastmilk pass 2-6 golden -yellow,sticky,semi-loose stool due to high content of lactose.For treatment of constipation lubricated rectal thermometer works many a times.

DIARRHOEA

Many babies pass stool soon after they are fed due to exaggerated gastrocolic reflex.These babies continue to gain weight but the family members are too worried for which counselling is enough.Diarrhoea due to infection is more likely due to bottle feeding.Stools are watery with mucus and pus cells.It has to be treated with intravenous fluid and antibiotics in hospital.

SUPERFICIAL INFECTION

They are skin pustules, conjunctivitis, umbilical sepsis and thrush are common in newborn babies esp. during summer months.

1. PYODERMA:-Pustules are commonly seen on scalp, neck, groin and axillae.The isolated lesions should be punctured.Application of hexachlorophene over the punctured lesions is enough most of the time to limit the spread of infection.In cases, where lesions are multiple, oral or intravenous antibiotics are needed.The baby should be observed for any possible dissemination of staphylococcal infection.
2. CONJUCTIVITIS:-The sticky eyes without purulent discharge are common during first 2 to 3 days after birth which needs washing with sterile cotton swabs soaked in saline.Unilateral or purulent conjunctivitis may be infective ;will require consultation with doctor.Persistent watery discharge may be due to blocked nasolacrimalduct.
3. UMBILICAL SEPSIS:-Red, inflamed periumbilical area ,pus discharge and foul smell are indicative of umbilical sepsis.In mild case ,cleaning with spirit or alcohol and application of antibiotic powder are enough.In severe case with systemic manifestation,intravenous antibiotics will be required.
4. ORAL THRUSH:-Candida infection can occur in neonatal period due to infected feeding bottles, candidiasis of breast nipples, vaginal pathway and prolonged antibiotics.It is characterised by adhesive distinct white patches or spots over the tongue and buccal mucosa.Oral instillation of clotrimazole 1% for 2 weeks are effective.If there is associated systemic manifestation, consult doctor.

OBSTRUCTED NASOLACRIMAL DUCT

It presents as persistent wetness or watering (epiphora) from one or both the eyes.There is no pus discharge nor inflammation.It is due to blockage of nasolacrimal duct which drains tear from eyes into the nostrils.Firm pressure with little finger of mother when the baby has closed eyes is applied from inner canthusalong lateral margin of nose from above downwards 15-20 times at a time three times a day at least 1-2 months till the symptom resolves.If the issue persists for 6 months,consult ophthalmologist.

UMBILICAL GRANULOMA

It appears as a small flesh-like pale nodule at the base of umbilicus managed by chemical cauterization.

CAPUT SUCCEDANEUM

It is boggy,diffuse,edematous swelling of soft tissues of scalp over the presenting part, present at birth .It is not limited by sutures and disappears in few days of life.

CEPHALHEMATOMA

It is subperiostealcollection of blood secondary to injury during delivery.It appears after 2-3 days of birth.The swelling is limited by suture line.It also resolves spontaneously after few days or weeks.

CRADLE CAP

It is characterized by presence of seborrheic scalp with crusting.The condition is self-limited and parents can be reassured.Application of oil followed by combing a few hours later will help most of the time.

ASYMMETRIC HEAD SHAPE

A baby may have in-born or post natal positionally acquired odd shaped head.If head size is normal, there is no cause for concern.Proper positioning of head with support of soft pillowor pillow with mustard seed to ensure that the most prominent part of the head touches the cot leading to gradual rounding of head shape in due course.