Diseases & Conditions


Problems in Newborns

After birth, a newborn may have a number of problems. Some problems may be due to difficulties during the birthing process; many of these problems affect the newborn's ability to breathe properly. A newborn may be bigger or smaller than usual or suffer from problems affecting blood, such as the levels of sugar (glucose) in the blood being too high or too low. Birth defects may be present (see Chromosomal and Genetic Abnormalities: Introduction ). A newborn may have problems due to the mother's health and health habits, such as smoking or use of alcohol or drugs (especially those given immediately before birth (see Drug Use During Pregnancy )). Infection may pass from mother to child, either during pregnancy or during delivery.

Doctors may be able to anticipate many problems by monitoring fetal growth and development, particularly using ultrasound. Many newborns with problems are cared for in a neonatal intensive care unit (NICU).

What Is a Neonatal Intensive Care Unit?

Often referred to as the “NICU,” this specialized facility brings together the medical team and technology needed to care for newborns with a variety of disorders. The largest group of newborns needing such care is those born very prematurely. Other newborns need care because of sepsis or pneumonia, respiratory disorders, and birth defects that require surgery. These newborns are cared for in incubators to keep them warm or they are placed under overhead radiant warmers, which provide warmth while allowing increased access to the newborn by the staff. Newborns are attached to monitors that can continuously measure their heart rate, breathing, blood pressure, and oxygen levels in the blood. They may have catheters placed inside the artery and vein running inside the umbilical cord to permit continuous blood pressure monitoring, to allow repeated blood sampling, and to administer intravenous fluids and drugs.

The NICU tends to be a very busy place. This is sometimes at odds with the parents' need for time and space to become acquainted with their newborn, to learn the newborn's personality, likes and dislikes, and ultimately to learn any special care that they will need to provide at home. A trend to make the NICU quieter and to design units to allow families increased privacy has helped. Visiting hours have been greatly extended so that families can spend much more time with their newborns, and often hospitals arrange for nearby sleeping facilities for the parents.

Sometimes, parents feel that they have little to offer to a newborn in a NICU. However, their presence, including stroking, speaking, and singing, is very important. The newborn has heard his mother's voice even before birth and is accustomed to it, and he often responds better to his own parents' attempts to calm him. Skin-to-skin contact (also termed kangaroo care), in which the newborn is allowed to lie directly on the mother or father's chest, is comforting to the newborn and enhances bonding. Increasing evidence indicates that premature newborns fed breast milk are significantly protected from developing necrotizing enterocolitis and infections and that breastfeeding is otherwise beneficial.

Parents need to be kept informed of their newborn's condition and the doctor's plans, as well as the expected course and time of discharge. Regular meetings with the doctors and nurses are essential. Many NICUs have a social worker who can help to see that parents are kept informed.

Source: The Merck Manual Home Edition