the study of disorders of the newborn

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Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn.

Neonatal disorders mean disturbance of normal state of body, organs and abnormal function of a newborn. Obstetricians play a major role to minimise the number of neonatal disorders. Prematurity, respiratory dysfunction, birth trauma, congenital malformations, neonatal infection and haemolytic disorders of the newborn are some examples of neonatal disorders commonly encountered. Preventive obstetrics is most important in reducing these disorders. Regular antenatal check-up, balanced diet, iron and folic acid tablet, avoiding repeated pregnancies are some measures which can prevent prematurity.

the study of disorders of the newborn — The newborn falls asleep in the mother’s hands.

Any factors which cause maternal hypoxia during pregnancy are responsible for foetal hypoxia. Proper antenatal care and avoidance of narcotic drugs in pregnancy are the pillars to combat respiratory dysfunction. Obstetricians play an important part to minimise birth trauma which is single handedly an important example of neonatal disorders. Proper antenatal care to detect any obstetrical anomaly reduces birth trauma to a large scale. In case of congenital anomalies, genetic counselling and early abortion in gross congenital anomaly are important aspects which can be looked after by the obstetricians.

Neonatal infections can be minimised by the obstetricians themselves if they take care of any suspicious vaginal discharge in antenatal period. Dirty dressings are to be avoided in delivery time. Proper immunisation to the mother and also counselling of HIV transmission are also important. Haemolytic diseases of the newborn can be confronted by proper Rh and ABO blood groupings in antenatal period and proper intervention at the time of delivery.

Newborn Disease

In newborn disease states, the pulmonary and cardiovascular systems often are simultaneously involved and interdependent.

Disorders present at birth

Infectious diseases of the fetus are caused by many different types of organisms, including viruses, bacteria, spirochetes, and protozoa (e.g., toxoplasmosis). Most of these infections are the result of infection of the mother, the infectious agents being transmitted through the placenta (the temporary organ by means of which the fetus receives nourishment and discharges waste) by way of fetal circulation. Bacterial infection is most often associated with premature rupture of the membranes and infection of the amniotic fluid.

Maternal rubella (German measles) occurring during the first eight weeks of pregnancy is associated with congenital malformation of the fetus in more than 50 percent of cases, the figure decreasing to about 20 percent by the 16th week and dropping sharply thereafter. Infection of the fetus with a virus of the cytomegalovirus type involves many organs, has a high fatality rate, and may result in severe brain damage in fetuses who survive.

Infection by the intracellular parasite Toxoplasma gondii produces a disease called toxoplasmosis, which may cause death or may result in microcephalus (abnormal smallness of the head), hydrocephalus (excessive accumulation of fluid in the brain cavities), or mental retardation. Congenital syphilis may have a variety of effects in the infant, including involvement of the skin, liver, spleen, lymph nodes, and kidneys. Malformations of the bones and teeth appear later, and severe involvement of the central nervous system may become apparent after many years.

Just as infectious agents may cross the placenta, so also most drugs administered to the mother may pass through the placenta and have important effects on the fetus. A most dramatic and devastating example of this effect occurred in Europe during the early 1960s, when the birth of thousands of infants with absent or short limbs resulted from the maternal ingestion of the apparently harmless drug thalidomide. Anesthetics, analgesics (pain relievers), sedatives, antihypertensive drugs, and antibiotics all may have adverse effects on the fetus. Congenital goitres (enlargement of the thyroid) have been produced by administration of antithyroid drugs to the mother. It is now clear that adverse effects on the fetus must be considered whenever drug therapy of the mother is contemplated.

The abuse of narcotics or alcohol by the mother can also lead to dire fetal consequences. Infants born to mothers addicted to heroin, morphine, or other opiates commonly share their mothers’ addiction and suffer withdrawal symptoms within 72 hours of birth. Many infants of alcoholic mothers are afflicted with a combination of malformations, known as the fetal alcohol syndrome, which include mental retardation, growth retardation, and microcephaly.

The entire nutrient supply of the fetus derives from the mother. Although maternal deficiency states may, therefore, be reflected by parallel deficiencies in the fetus, in general the needs of the fetus will be met ahead of those of the mother, and an adequate amount of a given nutrient may be supplied to the fetus, despite maternal deficiency. Mild to moderate deficiencies of iron or calcium in the mother, for example, are not usually associated with deficiencies in the fetus. On the other hand, protein and caloric malnutrition may be associated with decreased fetal size.

Deficiencies in the fetus may also arise from placental dysfunction (malfunctioning). The consequences of abnormalities of the placenta depend upon the time of onset and the severity of placental inadequacy. Serious placental insufficiency early in pregnancy may result in the death of the fetus. It is also likely that placental insufficiency can be a factor in decreasing fetal growth. Toward the end of pregnancy, placental dysfunction is associated with premature delivery or evidence of varying degrees of fetal distress, ranging from yellow staining of the skin to fetal wasting and to signs of severe lack of oxygen.

Injuries incurred during birth

The physical trauma of delivery may result in a number of injuries to the infant. Of little consequence is the diffuse soft-tissue swelling of the scalp referred to as caput succedaneum. Difficult delivery may result in more extensive bruising, abrasions, and edema—particularly after breech delivery; however, serious harm is rare. Bleeding under the periosteum (the covering membrane) of the skull produces a large swelling in 1 to 2 percent of babies, and in some it is associated with a small fracture of the underlying skull;

fortunately, spontaneous healing occurs speedily. Injuries to the spinal cord are rare, but injuries of peripheral nerves as a result of traction on the head are not uncommon. Such injuries include Erb’s paralysis, with weakness of the arm and shoulder because of damage to the fifth and sixth cervical nerves. Injury to the phrenic nerve, with paralysis of the diaphragm—the muscular partition between the chest and the abdomen—and facial-nerve injury resulting in facial palsy also are encountered. In the vast majority of such instances of peripheral-nerve injury, recovery is complete.

An extremely important form of birth injury is that associated with lack of oxygen (anoxia). Fetal anoxia may occur from inadequate oxygenation of the mother, low maternal blood pressure, or abnormalities in the uterus, placenta, or umbilical cord that result in inadequate blood flow to the fetus. After birth, anoxia may result from blood loss, shock, or inadequate respiration. Clinical manifestations include decreased activity, slowing of the heart, and blueness of the skin (cyanosis). Severe anoxia may cause death of the newborn, although recovery is more common. The major significance of anoxia is that it may result in brain damage if prolonged more than a few minutes.

Prematurity and low birth weight

The usual length of the gestation period is 40 weeks. Infants born prior to 37 weeks of gestation are considered to have been born early and are referred to as preterm or premature. Infants who at birth weigh 2,500 grams (about 5.5 pounds) or less are considered to be of low birth weight and either are prematurely born or have had less than the expected rate of growth within the uterus.