If you're expecting a baby, you're
probably learning all you can about how to make your
pregnancy, labor, and delivery go smoothly and leave you and your
baby in good health. But it's also important to understand that
certain health problems and complications can't be prevented,
no matter how smoothly the pregnancy goes.
There's no way to be completely prepared for complications
during delivery or for the discovery that your child has a birth
defect or medical problem. But understanding common newborn health
problems and how they're treated might reduce anxiety about the
potential that something might go wrong.
Before Your Baby Is Born
With
prenatal tests
, doctors often can detect certain
birth defects
, such as
spina bifida
,
Down syndrome
,
congenital heart disease
, exposed bowel, or
cleft lip
, before the baby is born.
Other birth defects can't be discovered until after the baby
is born. Delivery complications such as
meconium aspiration
(when a newborn inhales a mixture of meconium - the baby's
first feces, ordinarily passed after birth - and amniotic fluid
during labor and delivery) can occur.
If a birth defect is discovered prenatally, your doctor may
discuss what will happen in the time right after you deliver the
baby. You and your doctor should discuss which hospital is best
prepared to deal care for your baby so that you can plan to
deliver there.
You might want to ask if you can tour the intensive or special
care unit at the hospital to become familiar with it and meet the
team of health care professionals who may care your baby. This team
may include neonatologists, pediatric anesthesiologists, pediatric
surgeons, neonatal nurses, nurse practitioners, and doctors in
training (like fellows and residents).
Common Newborn Problems
It is very common for infants, particularly those born
prematurely, to have
jaundice
or breathing problems.
Many
preemies
and even full-term infants can develop jaundice if their immature
liver initially can't get rid of excess bilirubin (a
yellow pigment produced by the normal breakdown of red blood cells)
in the blood. Jaundice can make a baby's skin and whites of the
eyes appear yellowish.
If your baby has jaundice, the doctor may order blood tests to
measure the bilirubin levels and determine if treatment is
necessary. Usually, jaundice is treated by exposing the baby to
special lights that help break down the extra bilirubin so the
baby's body can process it.
Immature lungs, another common problem, occurs when a baby's
lungs lack sufficient surfactant, a chemical that prevents the air
sacs from collapsing during breathing. Surfactant isn't usually
fully in the fetal lungs until after 34 weeks' gestational age,
so many preemies need help with their breathing. Ventilators,
machines that are hooked up to a small plastic tube that goes into
the baby's windpipe, are often used to aid in
breathing.
Synthetic surfactant is now routinely given (down a breathing
tube) to very premature babies soon after birth. Premature babies
do not have enough of their own surfactant to keep their lungs
expanded. Giving extra surfactant allows infants to breathe on
their own much sooner than in the past, and they sustain less lung
damage because they don't need long-term ventilator
use.
In the Delivery Room
Most babies are born in a labor and delivery room. But if there
are complications, the mother may be transferred to a delivery room
with additional medical equipment. Besides the obstetrician,
midwife, or family doctor, there might also be nurses,
neonatologists, or other specialists on hand to provide
special medical attention the baby might need.
For example, if a newborn has spina bifida (exposed spinal
structures) or hydrocephalus (excess fluid inside of or surrounding
the brain), the doctors will take special care to support the head
or cover the opening in the spine. For a newborn with an exposed
bowel, the intestines are covered to protect them from infection
and from heat and fluid losses.
In the case of meconium aspiration, usually the doctor tries to
clear the baby's airways with suction to draw out any fluid
interfering with breathing. A baby who continues to have trouble
breathing or is very premature may need a breathing tube.
Whenever there is a problem, the medical staff, including a
pediatrician or neonatologist, will monitor the baby's
breathing and heart rate and make sure that the infant is kept
warm. If necessary, they will perform a special kind of CPR for
newborns. When stable enough to be moved, the baby is likely
to be taken directly to the
neonatal intensive care unit (NICU)
for further treatment.
The obstetrics (OB) team will stay with the mother while the
baby is being treated, providing any medical care she needs. The OB
team makes sure that the mother delivers the placenta, that she
receives any needed stitches, and in the case of cesarean delivery,
completes the surgery.
Communicating With the Doctor
Ask the medical team caring for your baby in the NICU to
communicate with you about your baby's condition. If your baby
has a condition that was diagnosed before birth, the doctor will
explain any changes from the original plan and update you on the
baby's progress. When a problem is unanticipated, the doctor or
nurse will explain what is going on. In an emergency, the medical
staff may not be able to explain things right away, but will do so
as soon as things calm down.
Beyond the Delivery Room
Once out of the delivery room, the baby might
need intravenous (IV) medications or fluids. And because
babies lose heat quickly, your newborn will be put in an
incubator or radiant warmer to maintain proper body
temperature.
If the baby's breathing is too fast or labored, the medical
team may order chest X-rays to determine its cause. Sometimes,
blood tests or a foot or hand oxygen monitor can tell the doctor
how much help breathing the baby needs. The team may need to give
the baby a little extra oxygen or put the baby on a ventilator to
assist with breathing.
When the baby's breathing and heartbeat are stabilized,
treatment for any birth defects may begin. This evaluation and
treatment period can last days or weeks, depending on the
baby's condition.
Doctors may also want to take blood tests to rule out any other
problems and measure such things as the baby's blood count
and blood sugar levels. Some blood tests can take blood from the
baby's heel, while others must draw it directly from a
vein in the baby's arm.
Getting the Care You Need
Time apart from a newborn is extremely difficult for the family
- particularly the parents.
It's common to feel disappointment and even guilt. It can
help to talk about these feelings with a member of the medical team
or a hospital social worker. And getting as much information as
possible about your baby's medical problem might help ease
feelings of anxiety and powerlessness.
Most hospitals encourage parents to spend as much time as they
can with their babies. If the baby is transferred to a hospital
with a special neonatal care unit, consider asking if the mother
can get necessary postpartum care there, too, so that they can
recover together.
Sometimes it is necessary for babies to stay in the hospital
after the mother has gone home. It's hard for new moms to leave
without their babies, but it can help to talk about your feelings
with friends, family, and the medical staff.
And parents should get plenty of rest and regular exercise and
be sure to eat well during this time. If the mother wants to
breastfeed, talk with a nurse or lactation consultant about using a
breast pump so she can freeze breast milk for when the baby is
ready for it.
If your baby is born with a health problem, you have many
options for information and support. Start by asking your doctors
for information on hospital- or community-based resources. Support
groups, both in person and online, are available for many disorders
and conditions.
Reviewed by:
Michael L. Spear, MD
Date reviewed: April 2009
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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