Fetus or Newborn Problems During Delivery

7/31/2019 Fetus or Newborn Problems During Delivery

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Fetus or Newborn ProblemsDuring Delivery

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If labor does not proceed normally, the fetus or newborn may have problems.

FETAL DISTRESS

Fetal distress refers to signs before and during childbirth indicating that the fetus is not well.

Fetal distress is an uncommon complication of labor. It typically occurs when the fetus has not

been receiving enough oxygen. Fetal distress may occur when the pregnancy lasts too long

(postmaturity) or when complications of pregnancy or labor occur.

Usually, doctors identify fetal distress based on an abnormal heart rate pattern in the fetus.Throughout labor, the fetus's heart rate is monitored. It is usually monitored continuously with

electronic fetal heart monitoring. Or, a handheld Doppler ultrasound device may be used to

check the heart rate every 15 minutes during early labor and after each contraction during late

labor.

If a significant abnormality in the heart rate is detected, it can usually be corrected by the

following:

Giving the woman oxygen

Increasing the amount of fluids given intravenously to the woman

Turning the woman on her left side

If these measures are not effective, the baby is delivered as quickly as possible by a vacuum

extractor, forceps, or cesarean delivery.

If the amniotic fluid appears green after the membranes have ruptured, the fetus may be in

distress (but usually is not). This discoloration is caused by the fetus's first stool (called

meconium). Meconium can sometimes be inhaled before labor or during delivery, causing the

baby to have difficulty breathing shortly after birth.

Did You Know...

An abnormal heart rate in a fetusmay be the earliest sign of fetal distress.
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BREATHING PROBLEMS

Rarely, a baby does not start to breathe at birth, even though no problems were detected

before delivery. Then the baby requires resuscitation. Personnel skilled in resuscitating babies

may attend the delivery for this reason.

ABNORMAL POSITION AND PRESENTATION OF THE FETUS

Position refers to whether the fetus is facing rearward (toward the woman's back, or face down

when the woman lies on her back) or forward (face up). Presentation refers to the part of the

fetus's body that leads the way out through the birth canal. The most common and safest

combination consists of the following:

Head first (called a vertex or cephalic presentation)

Facing down

Face and body angled toward the right or left

Neck bent forward

Chin tucked in

Arms folded across the chest

If the fetus is in a different position or presentation, labor may be more difficult and delivery

through the vagina may not be possible.

Position and Presentation of

the Fetus

Toward the end of pregnancy, the fetusmoves into position for delivery. Normally,the position of a fetus is facing rearward(toward the woman's back) with the faceand body angled to one side and the neckflexed, and presentation is head first. Anabnormal position is facing forward, andabnormal presentations include face,brow, breech, and shoulder.


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When a fetus faces forward (an abnormal position), the neck is often straightened rather than

bent, and the head requires more space to pass through the birth canal. Delivery by a vacuum

extractor or forceps or cesarean delivery may be necessary.

There are several abnormal presentations.

Breech Presentation: The buttocks present first. Breech presentation occurs in 2 to 3% of full-

term deliveries. When delivered vaginally, babies that present buttocks first are more likely to

be injured than those that present head first. Such injuries may occur before, during, or after

birth and include death. Complications are less likely when breech presentation is detected

before labor or delivery.

Sometimes the doctor can turn the fetus to present head first by pressing on the woman's

abdomen before labor begins, usually at the 37th or 38th week of pregnancy. However, if labor

begins and the fetus is in breech presentation, problems may occur. The passageway made by

the buttocks in the birth canal may not be large enough for the head (which is wider) to pass

through. In addition, when the head follows the buttocks, it cannot be molded to fit through the

birth canal, as it normally is. Thus, the baby's body may be delivered and the head may be

caught inside the woman. As a result, the spinal cord or other nerves may be stretched,

leading to nerve damage. When the baby's navel is first seen outside the woman, the umbilical

cord is compressed between the baby's head and the birth canal, so that very little oxygen can

reach the baby. Brain damage due to lack of oxygen is more common among babies

presenting buttocks first than among those presenting head first. In a first delivery, these

problems are worse because the woman's tissues have not been stretched by previous

deliveries. Because the baby could be injured or die, cesarean delivery is preferred when the

fetus is in breech presentation.

Other Presentations: In face presentation, the neck arches back so that the face presents

first. In brow presentation, the neck is moderately arched so that the brow presents first.


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Usually, fetuses do not stay in a face or brow presentation. They often correct themselves. If

they do not, forceps, vacuum extractor, or cesarean delivery may be used.

Occasionally, a fetus lying horizontally (transversely) across the birth canal presents shoulder

first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a

case, the fetus may be turned to be delivered through the vagina.

MULTIPLE BIRTHS

The term multiple births refers to the presence of more than one fetus in the uterus.

The number of twin, triplet, and other multiple births has been increasing during the last two

decades. About 1 of 70 to 80 deliveries involves more than one fetus. The following make

women more likely to become pregnant with more than one fetus:

Taking fertility drugs

Using assisted reproductive techniques

Having had a pregnancy with more than one fetus

Being older

Carrying more than one fetus overstretches the uterus, and an overstretched uterus tends to

start contracting before the pregnancy reaches full term. As a result, the babies are usually

born prematurely and are small. In some cases, the overstretched uterus does not contract

well after delivery, causing bleeding in the woman after delivery. Because the fetuses can be in

various positions and presentations, vaginal delivery can be complicated. Also, the contraction

of the uterus after delivery of the first baby may shear away the placenta of the remaining baby

or babies. As a result, the baby or babies that follow the first may have more problems during

delivery.

Carrying more than one fetus also increases the risk of problems for the woman. They include

high blood pressure plus protein in the urine (preeclampsia), gestational diabetes, excessive

bleeding at delivery (postpartum hemorrhage), the need for cesarean delivery, small neonates

(growth restriction), and preterm delivery.

During pregnancy, ultrasonography is done to confirm the number of fetuses.

Because problems can result from multiple births, doctors may decide in advance whether to

deliver twins vaginally or by cesarean. If the first twin is in an abnormal position (anything other

than head first), cesarean delivery is used. Occasionally, the first twin is delivered vaginally, but

a cesarean delivery is considered safer for the second twin. For triplets and other multiple


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births, a cesarean delivery is usually done.

SHOULDER DYSTOCIA

Shoulder dystocia occurs when one shoulder of the fetus lodges against the woman's pubic

bone, and the baby is therefore caught in the birth canal.

Because the fetus's shoulder is lodged against the woman's pubic bone, the fetus's head

comes out, but it is pulled back tightly against the vaginal opening. The baby cannot breathe

because the chest and umbilical cord are compressed by the birth canal. As a result, oxygen

levels in the baby's blood decrease. Shoulder dystocia is more common with large fetuses,

particularly when labor is difficult or when a vacuum extractor or forceps is used because the

fetus's head has not fully moved down (descended) in the pelvis. It is also more common when

women are obese, have diabetes, or have had a previous baby with shoulder dystocia.

When this complication occurs, the doctor quickly tries various techniques to free the shoulder

so that the baby can be delivered vaginally. Sometimes when these techniques are tried, the

baby's nerves are damaged or the baby's arm bone or collarbone may be broken. An

episiotomy (an incision that widens the opening of the vagina) may be done to help with

delivery. If these techniques are unsuccessful, the baby may be pushed back into the vagina

and delivered by cesarean.

PROLAPSED UMBILICAL CORD

Prolapse of the umbilical cord means that the cord precedes the baby through the vagina.

A prolapsed umbilical cord occurs in about 1 of 1,000 deliveries. When the umbilical cord

prolapses, the fetus's body may put pressure on the cord and thus cut off the fetus's blood

supply. This uncommon complication may be obvious (overt) or not (occult).

Overt Prolapse: The membranes have ruptured, and the umbilical cord protrudes into or out of

the vagina before the baby emerges. Overt prolapse usually occurs when a baby emerges feet

or buttocks first (breech presentation). But it can occur when the baby emerges head first,

particularly if the membranes rupture prematurely or the fetus has not moved down into the

woman's pelvis. If the fetus has not moved down, the rush of fluid as the membranes rupture

can carry the cord out ahead of the fetus.

If the cord prolapses, cesarean delivery must be done immediately to prevent the blood supply

to the fetus from being cut off. Until surgery begins, a nurse or doctor holds the fetus's body off

the cord so that the blood supply through the prolapsed cord is not cut off.


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Occult Prolapse: The membranes are intact, and the cord is in front of the fetus or trapped in

front of the fetus's shoulder. Usually, occult prolapse can be identified by an abnormal pattern

in the fetus's heart rate. Changing the woman's position usually corrects the problem.

Occasionally, a cesarean delivery is necessary.

NUCHAL CORD

A nuchal cord is an umbilical cord that is wrapped around the fetus's neck.

A nuchal cord occurs in about one fourth of deliveries. Normally, the baby is not harmed.

Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is

required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the

cord over the baby's head. Sometimes if the cord is tightly wrapped, it is clamped and cut

before the shoulders are delivered.

Last full review/revision December 2008 by Julie S. Moldenhauer, MD

High-Risk Newborn

Neonatology/NICU(CSG)

W. Thomas Bass, MD

Deborah Devendorf,

MD

Susannah Dillender, MD

C W Gowen, MD

Glen Green, MD

M Gary Karlowicz, MD

Edward Karotkin, MD

Jamil Khan, MD

David Oelberg, MD

Tushar Shah, MD

Brett Siegfried, MD

Kenneth Tiffany, MD

Common Conditions and Complications
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Advances in technology have helped improve the care of sick newborns. Under the care of

specialized physicians and other healthcare providers, babies have much greater chances for

surviving and getting better today than ever before.

Listed in the directory below are some conditions and complications that place a newborn at higher

risk, for which we have provided a brief overview.

If you cannot find the information in which you are interested, please visit the High-Risk Newborn

Online Resources page in this Web site for an Internet/World Wide Web address that may contain

additional information on that topic.

Prematurity

Very Low Birthweight

Low Birthweight

Small for Gestational Age

Large for Gestational Age

Postmaturity

Infant of Diabetic Mother

Respiratory Disorders

Disorders of the Brain and Nervous System

Blood Disorders

Hydrops Fetalis

Heart Disorders

Digestive Disorders

Infection in Babies

Substance Exposure and Babies

Birth Injury

Birth Defects

Sudden Infant Death Syndrome (SIDS)

Vision and Hearing

High-Risk Newborn
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Neonatology/NICU(CSG)

W. Thomas Bass, MD

Deborah Devendorf,

MD

Susannah Dillender, MD

C W Gowen, MD

Glen Green, MD

M Gary Karlowicz, MD

Edward Karotkin, MD

Jamil Khan, MD

David Oelberg, MD

Tushar Shah, MD

Brett Siegfried, MD

Kenneth Tiffany, MD

Prematurity

What is prematurity?

A baby born before 37 weeks of pregnancy is considered premature, that is, born before complete

maturity. Slightly fewer than 12 percent of all babies are premature. Overall, the rate of premature

births is rising, mainly due to the large numbers of multiple births in recent years. Twins and other

multiples are about six times more likely to be premature than single birth babies. The rate of

premature single births is slightly increasing each year.

Weeks ofPregnancy

< 28weeks

28 to31

32 to35

36 37 to39

40 41

Percentage of

Births

0.7 1.2 5.5 4.4 50 20.5 10

Based on 2001 data from the National Center for Health Statistics

Very Low Birthweight
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What is very low birthweight?

Very low birthweight is a term used to describe babies who are born weighing less than 1,500

grams (3 pounds, 4 ounces). Only a few babies, 1.5 percent, are born this tiny. However, the

overall rate of very low birthweight babies in the US is increasing. This is primarily due to the

greater numbers of multiple birth babies who are more likely to be born early and weigh less.

Babies with very low birthweight look much smaller than other babies of normal birthweight. A very

low birthweight baby's head appears to be bigger than the rest of the body and he/she often looks

extremely thin, with little body fat. The skin is often quite transparent, allowing the blood vessels to

be easily seen.

What causes very low birthweight?

The primary cause of very low birthweight is premature birth (born before 37 weeks gestation).

Very low birthweight babies are often born before 30 weeks of pregnancy. Being born early means a

baby has less time in the mother's uterus to grow and gain weight. Much of a baby's weight is

gained during the latter part of pregnancy.

Another cause of very low birthweight is intrauterine growth restriction (IUGR). This is when a baby

does not grow well during pregnancy because of problems with the placenta, the mother's health, or

birth defects. Most very low birthweight babies who have IUGR are also born early, and are both

very small and physically immature.

Who is affected by very low birthweight?

Any baby born prematurely is more likely to be very small. However, there are other factors that

can also contribute to the risk of very low birthweight. These include:

race

African-American babies are twice as likely to have very low birthweight than Caucasianbabies.

age

Teen mothers (especially those younger than 15 years old) have a much higher risk of

having a baby with very low birthweight.

multiple birth

Multiple birth babies are at increased risk of very low birthweight because they often are

premature. About 10 percent of twins and one-third of triplets have very low birthweight.

mother's health

Women who are exposed to drugs, alcohol, and cigarettes during pregnancy are more likely

to have low or very low birthweight babies. Mothers of lower socioeconomic status are alsomore likely to have poorer pregnancy nutrition, inadequate prenatal care, and pregnancycomplications - all factors that can contribute to very low birthweight.


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Why is very low birthweight a concern?

A baby with very low birthweight is often at increased risk for complications. The baby's tiny body is

not as strong and he/she may have a harder time eating, gaining weight, and fighting infection.

Because they have so little body fat, very low birthweight babies often have difficulty staying warm

in normal temperatures.

Because many babies with very low birthweight are also premature, it can be difficult to separate

the problems due to the prematurity from the problems of just being so tiny. In general, the lower

the baby's birthweight the greater the risks for complications. The following are some of the

common problems of very low birthweight babies:

low oxygen levels at birth

inability to maintain body temperature

difficulty feeding and gaining weight

infection

breathing problems such as respiratory distress syndrome (a respiratory disease of

prematurity caused by immature lungs)

neurological problems such as intraventricular hemorrhage (bleeding inside the brain)

gastrointestinal problems such as necrotizing enterocolitis (NEC) - a serious disease of the

intestine common in premature babies.

sudden infant death syndrome (SIDS)

Nearly all very low birthweight babies need specialized care in the Neonatal Intensive Care Unit

(NICU) until they can gain weight and are well enough to go home.

Generally, the smaller the baby, the higher the risk. The survival of these tiny babies is directly

related to their weight at birth.

Risks for long-term complications and disability are increased for babies with very low birthweight.

Generally, the lower the birthweight, the greater the chances for developing intellectual and

neurological problems, which may include the following:

cerebral palsy

blindness

deafness

mental retardation

Consult your baby's physician for information about your baby's risks.


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How is very low birthweight diagnosed?

During pregnancy, a baby's birthweight can be estimated in different ways. The height of the fundus

(the top of a mother's uterus) can be measured from the pubic bone. This measurement in

centimeters usually corresponds with the number of weeks of pregnancy after the 20th week. If the

measurement is low for the number of weeks, the baby may be smaller than expected. Ultrasound

(a test using sound waves to create a picture of internal structures) is a more accurate method of

estimating fetal size. Measurements can be taken of the fetus' head and abdomen and compared

with a growth chart to estimate fetal weight.

Babies are weighed within the first few hours after birth. The weight is compared with the baby's

gestational age and recorded in the medical record. A birthweight less than 2,500 grams (5 pounds,

8 ounces) is diagnosed as low birthweight. Babies weighing less than 1,500 grams (3 pounds, 5

ounces) at birth are considered very low birthweight.

Treatment for very low birthweight:

Specific treatment for very low birthweight will be determined by your baby's physician based on:

your baby's gestational age, overall health, and medical history

your baby's tolerance for specific medications, procedures, or therapies

your opinion or preference

Care for very low birthweight babies often includes:

care in the NICU

temperature controlled beds

special feedings, sometimes with a tube into the stomach if a baby cannot suck

other treatments for complications

Very low birthweight babies may have a harder time "catching up" in physical growth because they

often have other complications. Many very low birthweight babies are referred to special follow-up

healthcare programs.

Prevention of very low birthweight:

Because of the tremendous advances in care of sick and premature babies, more and more babies

are surviving despite being born early and being born very small. However, prevention of preterm

births is one of the best ways to prevent very low birthweight.

Prenatal care is a key factor in preventing preterm births and very low birthweight babies. At

prenatal visits, the health of both mother and fetus can be checked. Because maternal nutrition and

weight gain are linked with fetal weight gain and birthweight, eating a healthy diet and gaining the

proper amount of weight in pregnancy are essential. Mothers should also avoid alcohol, cigarettes,

and illicit drugs, which can contribute to poor fetal growth, among other complications.


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Disclaimer:This information is not intended to substitute or replace the professional medical

advice you receive from your child's physician. The content provided on this page is for

informational purposes only, and was not designed to diagnose or treat a health problem or

disease. Please consult your child's physician with any questions or concerns you may have

regarding a medical condition.

Last reviewed on 7/7/2006

Small for Gestational Age

What is small for gestational age (SGA)?

Small for gestational age (SGA) is a term used to describe a baby who is smaller than the usual

amount for the number of weeks of pregnancy. SGA babies usually have birthweights below the

10th percentile for babies of the same gestational age. This means that they are smaller than 90

percent of all other babies of the same gestational age.

SGA babies may appear physically and neurologically mature but are smaller than other babies of

the same gestational age. SGA babies may be proportionately small (equally small all over) or they

may be of normal length and size but have lower weight and body mass. SGA babies may be

premature (born before 37 weeks of pregnancy), full term (37 to 41 weeks), or post term (after 42

weeks of pregnancy).

What causes small for gestational age (SGA)?

Although some babies are small because of genetics (their parents are small), most SGA babies are

small because of fetal growth problems that occur during pregnancy. Many babies with SGA have a

condition called intrauterine growth restriction (IUGR). IUGR occurs when the fetus does not receive

the necessary nutrients and oxygen needed for proper growth and development of organs and

tissues. IUGR can begin at any time in pregnancy. Early-onset IUGR is often due to chromosomal

abnormalities, maternal disease, or severe problems with the placenta. Late-onset growth

restriction (after 32 weeks) is usually related to other problems.

Some factors that may contribute to SGA and/or IUGR include the following:

Maternal factors:

o high blood pressure

o chronic kidney disease

o advanced diabetes

o heart or respiratory disease

o malnutrition, anemia

o infection

o substance use (alcohol, drugs)

o cigarette smoking


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Factors involving the uterus and placenta:

o decreased blood flow in the uterus and placenta

o placental abruption (placenta detaches from the uterus)

o placenta previa (placenta attaches low in the uterus)

o infection in the tissues around the fetus

Factors related to the developing baby (fetus):

o multiple gestation (twins, triplets, etc.)

o infection

o birth defects

o chromosomal abnormality

Why is small for gestational age (SGA) a concern?

When the fetus does not receive enough oxygen or nutrients during pregnancy, overall body and

organs growth is limited, and tissue and organ cells may not grow as large or as numerous. Some

of the conditions that cause SGA and IUGR restrict blood flow through the placenta. This can cause

the fetus to receive less oxygen than normal, increasing the risks for the baby during pregnancy,

delivery, and afterwards.

Babies with SGA and/or IUGR may have problems at birth including the following:

decreased oxygen levels

low Apgar scores (an assessment that helps identify babies with difficulty adapting after

delivery)

meconium aspiration (inhalation of the first stools passed in utero) which can lead to

difficulty breathing

hypoglycemia (low blood sugar)

difficulty maintaining normal body temperature

polycythemia (too many red blood cells)

How is small for gestational age (SGA) diagnosed?

The baby with SGA is often identified before birth. During pregnancy, a baby's size can be estimated

in different ways. The height of the fundus (the top of a mother's uterus) can be measured from the

pubic bone. This measurement in centimeters usually corresponds with the number of weeks of

pregnancy after the 20th week. If the measurement is low for the number of weeks, the baby may

be smaller than expected.

Although many SGA babies have low birthweight, they are not all premature and may not

experience the problems of premature babies. Other SGA babies, especially those with IUGR,

appear thin, pale, and with loose, dry skin. The umbilical cord is often thin, and dull-looking rather

than shiny and fat. They sometimes have a wide-eyed look.


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Other diagnostic procedures may include the following:

ultrasound

Ultrasound (a test using sound waves to create a picture of internal structures) is a moreaccurate method of estimating fetal size. Measurements can be taken of the fetus' head and

abdomen and compared with a growth chart to estimate fetal weight. The fetal abdominalcircumference is a helpful indicator of fetal nutrition.

Doppler flow

Another way to interpret and diagnose IUGR during pregnancy is Doppler flow, which usesound waves to measure blood flow. The sound of moving blood produces wave-forms that

reflect the speed and amount of the blood as it moves through a blood vessel. Bloodvessels in the fetal brain and the umbilical cord blood flow can be checked with Dopplerflow studies.

mother's weight gain

A mother's weight gain can also indicate a baby's size. Small maternal weight gains in

pregnancy may correspond with a small baby

gestational assessment

Babies are weighed within the first few hours after birth. The weight is compared with the

baby's gestational age and recorded in the medical record. The birthweight must becompared to the gestational age. Some physicians use a formula for calculating a baby's

body mass to diagnose SGA.

Treatment of babies who are small for gestational age (SGA):

Specific treatment for SGA will be determined by your baby's physician based on:


extent of the condition


expectations for the course of the condition


Babies with SGA may be physically more mature than their small size indicates. But they may be

weak and less able to tolerate large feedings or to stay warm. Treatment of the SGA baby may

include:

temperature controlled beds or incubators

tube feedings (if the baby does not have a strong suck)

checking for hypoglycemia (low blood sugar) through blood tests

monitoring of oxygen levels

Babies who are SGA and are also premature may have additional needs including oxygen and

mechanical help to breathe.

Prevention of small for gestational age (SGA):

Prenatal care is important in all pregnancies, and especially to identify problems with fetal growth.

Stopping smoking and use of substances such as drugs and alcohol are essential to a healthy

pregnancy. Eating a healthy diet in pregnancy may also help.


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What is large for gestational age (LGA)?

Large for gestational age (LGA) is a term used to describe babies who are born weighing more than

the usual amount for the number of weeks of pregnancy. LGA babies have birthweights greater than

the 90th percentile for their gestational age, meaning that they weigh more than 90 percent of all

babies of the same gestational age.

The average baby weighs about 7 pounds at birth. About 10 percent of all babies weigh more than

4,000 grams (8 pounds, 13 ounces). Rarely do babies weigh over 10 pounds.

Although most LGA babies are born at term (37 to 41 weeks of pregnancy), a few premature babies

may be LGA.

What causes large for gestational age (LGA)?

Some babies are large because their parents are large; genetics does play a part. Birthweight may

also be related to the amount of a mother's weight gain in pregnancy. Excessive weight gain can

translate to increased fetal weight.

By far, maternal diabetes is the most common cause of LGA babies. Diabetes during pregnancy

causes the mother's increased blood glucose (sugar) to circulate to the baby. In response, the

baby's body makes insulin. All the extra sugar and the extra insulin production can lead to excessive

growth and deposits of fat, thus, a larger baby.

Why is large for gestational age (LGA) a concern?

Because LGA babies are so large, delivery can be difficult. Delivery problems may include the

following:

prolonged vaginal delivery time

difficult birth

increase in cesarean delivery

Because many large babies are born to diabetic mothers, many problems of LGA babies are related

to problems with glucose regulation. These may include the following:

hypoglycemia (low blood sugar) of baby after delivery

increased incidence of birth defects


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respiratory distress (difficulty breathing)

Many babies with LGA also have hyperbilirubinemia (jaundice - yellowing of the skin, eyes, and

mucous membranes).

How is large for gestational age (LGA) diagnosed?

During pregnancy, a baby's birthweight can be estimated in different ways. The height of the fundus

(the top of a mother's uterus) can be measured from the pubic bone. This measurement, in

centimeters, usually corresponds with the number of weeks of pregnancy. If the measurement is

high for the number of weeks, the baby may be larger than expected. Other diagnostic procedures

may include the following:

Ultrasound (a test using sound waves to create a picture of internal structures) is a more

accurate method of estimating fetal size. Measurements can be taken of the fetus' head andlimbs and compared with a growth chart to estimate fetal weight.

A mother's weight gain can also influence a baby's size. Large maternal weight gains inpregnancy may correspond with a big baby.

Babies are weighed within the first few hours after birth. The weight is compared with the baby's

gestational age and recorded in the medical record. The birthweight must be compared to the

gestational age. Generally, a baby weighing more than 4,000 grams (8 pounds, 13 ounces) is

considered LGA.

Treatment for large for gestational age (LGA):

Specific treatment for large for gestational age will be determined by your baby's physician based

on:






If ultrasound examinations during pregnancy show a fetus is quite large, some physicians may

recommend early delivery before the baby grows much bigger. A mother may need induction of

labor, or a planned cesarean delivery if the baby is estimated to be very large.

After delivery, a LGA baby will be carefully examined for any birth injuries. Blood glucose testing is

also performed to check for hypoglycemia. Early feeding with a glucose/water solution is sometimes

needed to counter the low blood sugar.


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Prevention of large for gestational age (LGA):

Prenatal care is important in all pregnancies, and especially to monitor fetal growth when a baby

seems to be too small or too large. Examinations during pregnancy that show a large baby can help

identify a mother who may have undetected diabetes, or other problems. Careful management of

diabetes in pregnancy can help lower some of the risks to the baby.







Respiratory Disorders

There are many respiratory disorders that place a newborn at higher risk and require clinical care by

a physician or other healthcare professional. Listed in the directory below are some, for which we

have provided a brief overview.




Breathing in babies:

An important part of lung development in babies is the production of surfactant. This is a substance

made by the cells in the small airways and consists of phospholipids and protein. It begins to be

produced in the fetus at about 24 to 28 weeks of pregnancy. Surfactant is found in amniotic fluid

between 28 and 32 weeks. By about 35 weeks gestation, most babies have developed adequate

amounts of surfactant. Surfactant is normally released into the lung tissues where it helps lower

surface tension in the airways. This helps keep the lung alveoli (air sacs) open. Premature babies

may not have enough surfactant in their lungs and may have difficulty breathing.

Hyaline Membrane Disease/Respiratory Distress Syndrome

What is hyaline membrane disease?

Hyaline membrane disease (HMD), also called respiratory distress syndrome (RDS), is one of the

most common problems of premature babies. It can cause babies to need extra oxygen and help

breathing. The course of illness with hyaline membrane disease depends on the size and gestational
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age of the baby, the severity of the disease, the presence of infection, whether or not a baby has a

patent ductus arteriosus (a heart condition), and whether or not the baby needs mechanical help to

breathe. HMD typically worsens over the first 48 to 72 hours, then improves with treatment.

What causes HMD?

HMD occurs when there is not enough of a substance in the lungs called surfactant. Surfactant is

made by the cells in the airways and consists of phospholipids and protein. It begins to be produced

in the fetus at about 24 to 28 weeks of pregnancy. Surfactant is found in amniotic fluid between 28

and 32 weeks. By about 35 weeks gestation, most babies have developed adequate amounts of

surfactant.

Surfactant is normally released into the lung tissues where it helps lower surface tension in the

airways. This helps keep the lung alveoli (air sacs) open. When there is not enough surfactant, the

tiny alveoli collapse with each breath. As the alveoli collapse, damaged cells collect in the airways

and further affect breathing ability. These cells are called hyaline membranes. The baby works

harder and harder at breathing, trying to re-inflate the collapsed airways.

As the baby's lung function decreases, less oxygen is taken in and more carbon dioxide builds up in

the blood. This can lead to increased acid in the blood called acidosis, a condition that can affect

other body organs. Without treatment, the baby becomes exhausted trying to breathe and

eventually gives up. A mechanical ventilator (breathing machine) must do the work of breathing

instead.

Who is affected by HMD?

HMD occurs in over half of babies born before 28 weeks gestation, but only in less than one-third of

those born between 32 and 36 weeks. Some premature babies develop HMD severe enough to need

a mechanical ventilator (breathing machine). The more premature the baby, the higher the risk and

the more severe the HMD.

Although most babies with HMD are premature, other factors can influence the chances of

developing the disease. These include the following:

Caucasian or male babies

previous birth of baby with HMD

cesarean delivery

perinatal asphyxia

cold stress (a condition that suppresses surfactant production)


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perinatal infection

multiple births (multiple birth babies are often premature)

infants of diabetic mothers (too much insulin in a baby's system due to maternal diabetes

can delay surfactant production)

babies with patent ductus arteriosus

What are the symptoms of HMD?

The following are the most common symptoms of HMD. However, each baby may experience

symptoms differently. Symptoms may include:

respiratory difficulty at birth that gets progressively worse

cyanosis (blue coloring)

flaring of the nostrils

tachypnea (rapid breathing)

grunting sounds with breathing

chest retractions (pulling in at the ribs and sternum during breathing)

The symptoms of HMD usually peak by the third day, and may resolve quickly when the baby

begins to diurese (excrete excess water in urine) and begins to need less oxygen and mechanical

help to breathe.

The symptoms of HMD may resemble other conditions or medical problems. Always consult your

baby's physician for a diagnosis.

How is HMD diagnosed?

HMD is usually diagnosed by a combination of assessments, including the following:

appearance, color, and breathing efforts (indicate a baby's need for oxygen).

chest x-rays of lungs - often show a unique "ground glass" appearance called a

reticulogranular pattern. X-rays are electromagnetic energy used to produce images of

bones and internal organs onto film.

blood gases (tests for oxygen, carbon dioxide and acid in arterial blood) - often show

lowered amounts of oxygen and increased carbon dioxide.

echocardiography (EKG) - sometimes used to rule out heart problems that might cause

symptoms similar to HMD. An electrocardiogram is a test that records the electrical activityof the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart

muscle damage.

Treatment for HMD:

Specific treatment for HMD will be determined by your baby's physician based on:



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Treatment for HMD may include:

placing an endotracheal (ET) tube into the baby's windpipe

mechanical breathing machine (to do the work of breathing for the baby)

supplemental oxygen (extra amounts of oxygen)

continuous positive airway pressure (CPAP) - a mechanical breathing machine that pushes a

continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungsopen

surfactant replacement with artificial surfactant - most effective if started in the first six

hours of birth. Surfactant replacement has been shown to reduce the severity of HMD.Surfactant is given as prophylactic (preventive) treatment for some babies at very high risk

for HMD. For others it is used as a "rescue" method. The drug comes as a powder to be

mixed with sterile water and then is given through the ET tube (breathing tube). Surfactantis usually given in several doses.

medications (to help sedate and ease pain in babies during treatment)

Complications of HMD:

Babies with HMD sometimes develop complications of the disease or problems as side effects of

treatment. As with any disease, more severe cases often have greater risks for complications. Some

complications associated with HMD include the following:

air leaks of the lung tissues such as:

o pneumomediastinum - air leaks into the mediastinum (the space in the thoracic

cavity behind the sternum and between the two pleural sacs containing the lungs).

o pneumothorax - air leaks into the space between the chest wall and the outer

tissues of the lungs.

o pneumopericardium - air leaks into the sac surrounding the heart.

o pulmonary interstitial emphysema (PIE) - air leaks and becomes trapped between

the alveoli, the tiny air sacs of the lungs.

chronic lung disease, sometimes called bronchopulmonary dysplasia

Prevention of HMD:

Preventing a preterm birth is the primary means of preventing HMD. When a preterm birth cannot

be prevented, giving the mother medications called corticosteroids before delivery has been shown

to dramatically lower the risk and severity of HMD in the baby. These steroids are often given to

women between 24 and 34 weeks gestation who are at risk of early delivery.


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Meconium Aspiration

What is meconium aspiration?

Meconium aspiration occurs when a baby breathes in amniotic fluid containing meconium (the

baby's first stools).

What causes meconium aspiration?

Before or during labor, the fetus sometimes passes the meconium stool into the amniotic fluid. It is

not clearly understood why this happens. It may be a natural event, but it is also thought to be

related to fetal distress in some babies. When the thick meconium mixes into the amniotic fluid, it is

swallowed and breathed into the airways of the fetus. As the baby takes the first breaths at

delivery, meconium particles enter the airways and can be aspirated (inhaled) deep into the lungs.

Who is affected by meconium aspiration?

Meconium is passed into the amniotic fluid in about 5 to 15 percent of births. It usually occurs in

babies born at term (37 to 41 weeks) or post-term (after 42 weeks).

Why is meconium aspiration a concern?

Meconium particles in the amniotic fluid can block small airways and prevent the exchange of

oxygen and carbon dioxide after birth. Some babies have immediate respiratory distress and have

to be resuscitated at birth. Others develop respiratory distress within a few hours.

Some babies with meconium aspiration need a mechanical ventilator (breathing machine) because

of the difficulty breathing. The plugged airways may cause air to be trapped and leak into the

tissues in and around the lungs. Infection can also occur causing pneumonia. Although the condition

often improves within a few days, severe meconium aspiration, and the respiratory problems it

causes, may lead to death in a small number of babies.


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What are the symptoms of meconium aspiration?

Meconium in the amniotic fluid gives the fluid a greenish color. This is called meconium staining.

Babies who have been exposed to meconium in the amniotic fluid for a long time may have

yellowed skin and nails.

The following are the most common symptoms of meconium aspiration. However, each baby may

experience symptoms differently. Symptoms may include:

rapid breathing

retractions (pulling in of the chest wall)

grunting sounds with breathing


overdistended chest

The symptoms of meconium aspiration may resemble other conditions or medical problems. Always

consult your baby's physician for a diagnosis.

How is meconium aspiration diagnosed?

The presence of meconium in the amniotic fluid is key to the diagnosis. A chest x-ray also helps

diagnose meconium aspiration. X-rays are a diagnostic test which uses invisible electromagnetic

energy beams to produce images of internal tissues, bones, and organs onto film.

Treatment for meconium aspiration:

Specific treatment for meconium aspiration will be determined by your child's physician based on

the following:

the amount and thickness of the meconium

the length of time the baby was exposed

the degree of respiratory distress

At delivery, treatment may include:

suctioning of the upper airways (nose, mouth, and throat)

suctioning of the lower airways through an endotracheal tube (ET) placed in the windpipe

supplemental oxygen given by face mask or mechanical ventilator

Prevention of meconium aspiration:

Early identification of meconium aspiration is essential to preventing severe aspiration problems. A

technique called amnioinfusion is sometimes used during labor with meconium-stained amniotic

fluid. This procedure uses a small tube inserted into the uterus through the vagina. Sterile fluid is

infused through the tube to help dilute the thick meconium. Suctioning of the upper airways as soon

as a baby's head is delivered may also help reduce the effects of meconium aspiration.


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Infection in Babies

Fighting infectious diseases today is much easier than in the past. Proper hygiene and proper

precautions, along with numerous vaccines and rapidly advancing medical technology, help prevent

many infections. However, a newborn baby has limited ability to prevent and fight infectious

diseases. Special care may be needed for babies who develop an infection before, during, or after

birth.

Prevention is the key to fighting many infectious diseases. At any time of life, but especially during

pregnancy and after the birth of a baby, part of preventing the spread of an infectious disease

includes the following:

receiving prenatal care from a qualified healthcare provider

proper hand washing techniques

taking certain precautions, depending on the disease

following the nationally recommended immunization schedule for children and adults

taking medication correctly

Even with proper prevention, sometimes a disease is unavoidable. Some reasons may be attributed

to the following:

evolution of drug-resistant strains of a disease

changes in a person's environment

increased travel

inappropriate use of prescription drugs

lack of attention to proper personal hygiene

Infections in babies require clinical care by a physician or other healthcare professional. Listed in the

directory below is some additional information regarding infections, for which we have provided a

brief overview.


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HypoglycemiaHypoglycemiaWhat is hypoglycemia?

Hypoglycemia is a condition in which the amount of blood glucose (sugar) is lower than normal.

Babies who are more likely to develop hypoglycemia include the following:

Babies born to diabetic mothers may develop hypoglycemia after delivery when the source

of glucose (the mother's blood) is gone and the baby's insulin production uses up the existing

glucose.

Small for gestational age or growth-restricted babies may have too few glycogen stores.

Premature babies, especially those with low birthweights, often have limited glycogen

stores or an immature liver function.

The brain depends on blood glucose as its main source of fuel. Too little glucose can impair the

brain's ability to function. Severe or prolonged hypoglycemia may result in seizures and serious

brain injury.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia may not be obvious in newborn babies. The following are the most

common symptoms of hypoglycemia. However, each baby may experience symptoms differently.

Symptoms may include:

jitteriness


apnea (stopping breathing)

hypothermia (low body temperature)

poor body tone

poor feeding

lethargy

seizures

The symptoms may resemble other conditions or medical problems. Always consult your baby's

physician for a diagnosis.

How is hypoglycemia diagnosed?

A simple blood test for blood glucose levels can diagnose hypoglycemia. Blood may be drawn from a

heelstick, with a needle from the baby's arm, or through an umbilical catheter (a tube placed in the

baby's umbilical cord).

Treatment for hypoglycemia:

Specific treatment for hypoglycemia will be determined by your baby's physician based on:


extent of the disease
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expectations for the course of the disease


Treatment includes giving the baby a rapid acting source of glucose. This may be as simple as

giving a glucose/water mixture or formula as an early feeding. Or, the baby may need glucose given

intravenously. The baby's blood glucose levels are closely monitored after treatment to see if the

hypoglycemia occurs again.

JaundiceJaundice

What is jaundice?

Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin, during

the first week. This is usually a temporary condition, but may be a more serious sign of another

illness. Jaundice is caused by the breakdown of red blood cells. As the old cells are broken down,

hemoglobin is changed into bilirubin and removed by the liver. The build-up of bilirubin in the blood

is called hyperbilirubinemia. Because bilirubin has a pigment, or coloring, it causes a yellowing of

the baby's skin and tissues. As liver function matures, the jaundice goes away. A premature infantis more likely to develop jaundice. The yellow tint to the skin can often be seen by gently pressing

on the baby's forehead or chest and watching the color return.

There are several types of jaundice:

physiologic jaundice

Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete

bilirubin in the first days of life.

breast milk jaundice

About 2 percent of breastfed babies develop jaundice after the first week. Some develop breast

milk jaundice in the first week due to low calorie intake or dehydration.

jaundice from hemolysis

Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the

newborn (Rh disease), having too many red blood cells, or bleeding.

jaundice related to inadequate liver function

Jaundice may be related to inadequate liver function due to infection or other factors.

Why is jaundice a concern?

Although low levels of bilirubin are not usually a concern, large amounts can circulate to tissues in

the brain and may cause seizures and brain damage. This is a condition called kernicterus.

What are the symptoms of jaundice?

The following are the most common symptoms of jaundice. However, each baby may experience

symptoms differently. Symptoms may include:

yellow coloring of the baby's skin - usually beginning on the face and moving down the

body

poor feeding or lethargy

Symptoms of jaundice may resemble other conditions or medical problems. Always consult your

baby's physician for a diagnosis.


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How is jaundice diagnosed?

The timing of the appearance of jaundice helps with the diagnosis. Jaundice appearing in the first 24

hours is quite serious and usually requires immediate treatment. When jaundice appears on the

second or third day, it is usually "physiologic." However, it can be a more serious type of jaundice.

When jaundice appears on the third day to the first week, it may be due to an infection. Later

appearance of jaundice, in the second week, is often related to breast milk feedings, but may have

other causes.

Laboratory testing for hyperbilirubinemia may include:

direct and indirect bilirubin levels - These levels reflect whether the bilirubin is bound with

other substances by the liver so that it can be excreted (direct), or is circulating in the blood

circulation (indirect).

red blood cell counts

blood type and testing for Rh incompatibility (Coomb's test)

Treatment for jaundice:

Specific treatment for jaundice will be determined by your baby's physician based on:


extent of the disease


expectations for the course of the disease


Treatment depends on many factors, including the cause of the jaundice and the level of bilirubin.

The goal is to keep the level of bilirubin from increasing to dangerous levels. Treatment may

include:

phototherapy

Because bilirubin absorbs light, jaundice and increased bilirubin levels usually decrease whenthe baby is exposed to special blue spectrum lights. Phototherapy may take several hours to

begin working and it is used throughout the day and night. The baby's position is changed to

allow all of the skin to be exposed to the light. The baby's eyes must be protected and the

temperature monitored during phototherapy. Blood levels of bilirubin are checked to monitor if

the phototherapy is working.

use of a fiberoptic blanket

Another form of phototherapy is a fiberoptic blanket placed under the baby. This may be used

alone or in combination with regular phototherapy.

exchange transfusion

Exchange transfusion may be used to replace the baby's damaged blood with fresh blood. This

helps increase the red blood cell count and lower the levels of bilirubin. An exchange transfusion

is done by alternating giving and withdrawing blood in small amounts through a vein or artery.

Exchange transfusions may need to be repeated if the bilirubin levels remain high.

discontinued breastfeeding

Treatment of breast milk jaundice often requires stopping the breastfeeding for one to two

days. Giving the baby formula often helps lower the bilirubin levels. Breastfeeding can then be

resumed.

treatment of underlying conditions

Treating any underlying cause of hyperbilirubinemia, such as infection.


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Prevention of jaundice:

While jaundice cannot be totally prevented, early recognition and treatment are important in

preventing bilirubin levels from rising to dangerous levels. If your baby's color is turning more

yellow, promptly call your baby's physician.

Newborn Screening TestsNewborn Screening Tests

What are newborn screening tests?

Nearly all babies will have a simple blood test to check for disorders that are not immediately

apparent after delivery. Some of these disorders are genetic, metabolic, blood, or hormone related.Each state in the United States requires screening tests, but the specific tests performed vary

among the states. Some disorders are more common in some states, making testing more

important.

A heel-prick is usually used to sample the baby's blood. The blood drops are collected in a small vial

or on a special paper. The blood is then sent for testing. The baby's heel may have some redness at

the pricked site, and some babies may have bruising, but this usually disappears in a few days.

Newborn screening tests may include:

phenylketonuria(PKU)

PKU is an inherited disease in which the body cannot metabolize a protein called phenylalanine.

It is estimated that one baby in 10,000 to 25,000 is born with PKU in the United States. Withouttreatment, PKU can cause mental retardation. Newborn screening for PKU is required in all 50

states.

congenital hypothyroidism

This is a condition in which the baby is born with too little thyroid hormone. Hypothyroidism is

also quite common, occurring in about one in every 6,000 to 7,000 births in the United States.

Untreated low thyroid hormone levels can lead to mental developmental problems and poor

growth. All 50 states screen for hypothyroidism.

galactosemia

This is an inherited disorder in which the baby is unable to metabolize galactose, a milk sugar.

It occurs in about one baby in every 60,000. Without treatment (avoidance of milk),

galactosemia can be life-threatening. Symptoms may begin in the first two weeks of life. Nearly

all states screen for galactosemia.

sickle cell disease

This inherited disorder occurs primarily in African-Americans, but may also occur in Hispanics

and Native Americans. The disease causes a severe form of anemia. There are different types of

the disease. The incidence ranges from one in 400 to one in 1,400, depending on the type of

disease. Early diagnosis of sickle cell disease can help lower some of the risks which include

severe infections, blood clots, and stroke.

maple syrup urine disease

This is an inherited disorder that is very common in the Mennonite population. The disorder is

caused by an inability of the body to properly process certain parts of protein called amino


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acids. The name comes from the characteristic odor of maple syrup in the baby's urine caused

by the abnormal protein metabolism. If untreated, it is life-threatening as early as the first 2

weeks of life. Even with treatment, severe disability and paralysis can occur.

homocystinuria

This inherited disorder affects one in 335,000 babies and causes mental retardation, bone

disease, and blood clots. It is caused by a deficiency of an enzyme necessary to digest an

amino acid called methionine. biotinidase deficiency

This inherited disorder is characterized by a deficiency of the biotinidase enzyme. This enzyme

is important in metabolizing biotin, a B vitamin. It affects one in 60,000 babies in the United

States and is most common in the Caucasian population. Lack of the enzyme can lead to severe

acid buildup in the blood, organs, and body systems.

congenital adrenal hyperplasia

Most states screen for this inherited disease of the adrenal glands. Babies born with congenital

adrenal hyperplasia (CAH) cannot make enough of the hormone cortisol, which helps control

energy, sugar levels, blood pressure, and how the body responds to the stress of injury or

illness. The Endocrine Society estimates the incidence of CAH at about one in 15,000,

depending on the severity of the disease. CAH may also affect the development of the genitals

and the hormones of puberty.

medium chain acyl-CoA dehydrogenase deficiencyThis disorder of fatty acid oxidation can cause sudden death in infancy and serious disabilities in

survivors, such as mental retardation. MCAD affects about one baby in 20,000, and at least

eight states are testing for this disorder.

hearing loss

Three to four in 1,000 newborns have significant hearing loss, and about 25 states are currently

testing newborns.

Other tests screen for disorders including congenital toxoplasmosis and cystic fibrosis. Some states

are using a new testing technique called tandem mass spectrometry (MS/MS) which can detect

more than 30 disorders using a simple blood sample, including those involving protein and fatty acid

metabolism.

Most screenings cannot be performed until babies have received at least 24 hours of breast milk orformula. Your baby may need follow-up testing if you are discharged before this time or the baby is

unable to be tested before discharge.

nderstanding Your Newborn

While each baby is a unique individual there are certain characteristics and behaviorsthat are common to newborns. This section will describe some of the physical andbehavioral traits you may notice in your baby during the first few weeks of life.

PHYSICAL CHARACTERISTICS

Weight and LengthThe average baby weighs between six and nine pounds, and is between 18 to 21inches long. Infants may lose up to five to ten percent of their birth weight during thefirst week of life, due mainly to loss of extra fluid accumulated by the mother and babyas the pregnancy nears term.If the baby is approaching a ten percent weight loss wewill advise you as to frequency and type of feedings to ensure proper regain of weight.

HeadShape: Because of pressure before or during birth, your babys head may be


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temporality misshapen. Normal head shape usually returns by the end of the firstweek. Babies delivered by Cesarean usually dont have as much of this headmolding.Soft spots: Your baby has two obvious soft spots or fontanelles. One is on the top ofthe head and the other is near the back of the head. Both the fontanelles are coveredby a tough membrane and with normal handling care, you cant damage the soft spotswhen shampooing, brushing, or stroking your babys head.

EyesColor, tears, and swelling: Caucasian infants usually have grayish-blue eyes atbirth. Infants of other ethnic backgrounds may have grayish-brown or brown eyes.However, an infants true eye color may not be known for several months. Tears areusually not produced in noticeable amounts with crying until your baby is one to twomoths of age. Swollen and puffy eyelids or red hemorrhages on the whiteconjunctivae are normal after birth and result from pressure during birth. Swelling andinflammation usually go away in a few days.Eye discharge: Occasionally, a baby may have irritation from the antibiotic ointmentgiven at birth. You may notice a small amount of yellow discharge from your babyseyes during your hospital stay. This usually clears within 24 hours. If you notice asmall amount of yellow discharge form your babys lids or lashes after you get home,

just gently wipe it away with a warm moist cloth or cotton ball. If the discharge ispurulent (yellow or green), in large amounts and accumulates frequently, please notifyus; this can be a symptom of an infection or a blocked tear duct in need of antibioticdrop therapy.

EarsNewborns have a wide variety of ear sizes, shapes, and positions that are normal. Atbirth your babys ears may bend easily. In time, the ear will feel firmer.Ear Discharge: It is normal for a babys ears to produce wax. It is not normal forthem to produce any other kind of discharge. If you think the discharge from yourbabys ears is not wax, please call us. Cotton swabs should not be used in yourbabys ears at any time; one can inadvertantly be tamping wax down into the canaldeeply without realizing it. Ears can be cleaned well with the corner of a clean, damp

washcloth. Just clean what you can see.

BreastsSwollen breasts: During the first days after birth, it is normal for both boys and girlsto have swollen breasts. This swelling is caused by hormones a baby gets from themother during pregnancy. Occasionally a baby may produce a small amount of milk.If your baby does produce milk or have breast swelling, do not attempt to squeeze outthe milk, as this might cause infection. The swelling will go down as the babys bodymetabolizes the mothers hormones. If the breasts are markedly swollen, tender orreddened, please call us so that we can evacuate the child for the possibility ofmastitis.

Skin

Color: The skin is thin and dry. You may see some veins through it. The skin is theCaucasian newborn is a pink or reddish color. As babies cry, they may become adeeper red. In the Black infant, the skin color appears as a reddish-black color thatdarkens as the baby gets older. In Asian babies the skin is a tea rose color.Frequently, dark bluish spots may appear on the lower portion of the back or buttocksof babies of Black, Asian, or Mediterranean descent. These are called Mongolianspots. They are caused by a temporary accumulation of pigment under the skin andthey fade without treatment during preschool years. Despite the names, these spotshave nothing to do with Mongolism or Downs Syndrome. In the newborn it iscommon for the babys hands and feet to appear bluish. This is called acrocyanosis.


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This is common in the first few days of life a decreases gradually.Milia: These are tiny white spots often seen on the nose and chin. They are causedby obstruction of oil or sebaceous glands. You should not squeeze these spots. Theyusually disappear in several weeks.Lanugo: your babys body is covered with fine downy hair. This hair is mostnoticeable on the back, shoulders, and ear lobes. It will fall out in time.Vernix: A white, cheese-like substance called vernix at one time covered your babysskin to protect it while in the bag or waters. Traces of it are usually found in the bodyscreases. It is not necessary to scrub this off.Peeling: Most babies skin peels after birth because they have been in fluid for manymonths. This generalized peeling is completely normal and requires no treatment,including oils or lotions.Rashes: A temporary rash, called erythema toxicum, may occur during the first fewweeks. It is small areas of redness with raised yellowish-white centers and it mayresemble a flea bite or hives. This rash requires no treatment. Washing clothing witha mild detergent, such as Dreft or Ivory, omitting fabric softeners and double rinsing ifnecessary, will help minimize rashes.Red blotches: Many babies have reddened areas of skin on their upper eyelids andforehead. These are areas of dilated blood vessels. These areas usually fade withtime (months to years) as the blood vessels contract and as the babys skin grows

thicker and less transparent. Redness may reappear when your baby cries. Theseare often called Stork Bites or Angel Kisses and are distinct from the deeper purplePort-Wine stains which are permanent. they are areas of tangled capillaries. As thebaby gets older ,these vessels contract and the visible redness fades.Diaper rash: Diaper rash is often caused by irritants in the urine or stool. Tominimize diaper rashers, be sure to change your babys diaper frequently (every twoto three hours during the day). Always wash the diaper area with plain water at eachchange. If you launder your own diapers, double rinses with one-half cup of vinegarper rinse load may help eliminate any soap and neutralize the ammonia. If your babydevelops a rash in spite of these precautions, try to change diapers more frequentlyand expose the reddened area to the air several times a day. A diaper rash ointment(vaseline or A&D) applied to the rash area after air-drying may be helpful.Occasionally babies develop a yeast infection of the diaper area. This is usually a

deep red colored rash covering a continuous area and with accentuation in the skinfolds and satellite lesions at the outer edge. If you suspect this, use Lotrimin AFointment (clotrimazole) which is available over-the-counter or call us for furtherguidance.Genitals- Swelling & Vaginal Discharge: The genitals of both boys and girls areusually large and swollen from hormones passed from the mother through theplacenta. Girls may also have a white, mucoid, and sometimes blood-tinged vaginaldischarge. As your baby metabolizes your hormones, these changes will disappear.

INBORN REFLEXES

Moro (Startle): The Moro reflex is a sudden reaction to a loud noise or change inposition. It appears as jerky, generalized muscular activity with a flinging out of your

babys arms and legs, then bringing them back in towards the body.Rooting: When an object touches your babys cheek, your baby turns his headtoward the side touched, opens his mouth and begins to suck.Sucking and Swallowing: Touching your babys lips will trigger the sucking reflexwhich is followed by the swallowing reflex.Gag: The gag reflex helps your baby get rid of mucus in his stomach that heswallowed during birth or to regurgitate excess milk taken at a feeding.Hiccups: Hiccups are a common occurrence. They do not bother your baby and willgo away without any special treatment.Cough & Sneeze: These reflexes help your baby remove irritating substances from


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him nose and throat. They are not necessarily signs of a cold.Blinking: Your babys eyes will blink when they are exposed to bright light. Blinkingalso protects the eyes from foreign objects.Walking: When you hold your baby around the chest in an upright position with hisfeet touching a hard surface, he will make prancing movements with his feet.Grasping: This reflex is present in both the hands and the feet. Your baby will graspany object put into his hands, hold it briefly and then drop it.

SLEEP/WAKE STATES

Deep Sleep: In this state your baby is nearly still except for an occasional startle ortwitch. Breathing is regular. There are no eye movements and few facialmovements. It is very difficult to arouse your baby in this state.Light Sleep: In this state your baby shows some body movement. Breathing isirregular. You can see rapid eye movements beneath the eyelids and your baby maysmile or briefly fuss. This state usually comes just before awakening or you may beable to awaken your baby to feed at this time.Drowsy: In the drowsy state you babys activity level varies. The eyes may open andclose occasionally and seem heavy. Breathing is also irregular in this state. Yourbaby may go back to sleep or awaken more.

Quite Alert: When your baby is in the quiet alert state, his eyes are wide open, hisbreathing is regular, and he is very attentive to what is going on around him. Duringthis time, your baby is most interested in eating and learning about his new world.Active Alert: In this state your baby becomes very active and may fuss. Hisbreathing is again irregular and he is increasingly sensitive to stimulation or personalneeds such as hunger, discomfort, fatigue, etc. At this time it is best to comfort yourbaby and bring him to a lower state.Crying: Crying is your babys way of telling you that he needs something or thatsomething is bothering him. Some causes of crying include hunger, physicaldiscomfort, fatigue, boredom, needing to be burped, being over stimulated, or needingclose physical contact. As you live with your baby, you will learn to tell the differencein his cries and discover what works best to soothe him.

Copyright 2012, Clinical Pediatric Associates

The First 3 Months:

The first 3 months of your newborn's physical development will pass by more quickly

than you can imagine. During this time you will note changes in your infant's growth,

appearance, motor abilities, and sensory development.

Growth Predictors:

Curious about how big little Johnny will get in the early months? Concerned your

baby is either bigger than or smaller than the average newborn? The truth is, rarely

is there cause for concern. There is a wide range of "normal" height and weight

development. The size of your baby will be related to a few factors:

The size of the birth parents as newborns

How long the mother carried to term

Nutrition


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The environment and culture of the birth parents

Height and Weight Milestones:

A clear understanding of what doctors expect of newborn height and weight gain can

save you needless worry about his overall growth. You can expect your

pediatrician to check for the following growth milestones.

A 5 - 7% weight loss during the first week of life. Breastfed infants may lose as

much as 10% if their birthweight, but should be monitored closely by a doctor.

A return to birth weight at around the second week.

After that, a gain of about an ounce a day is normal.

At around 3 months, he can be expected to pack on a pound a month, give or

take a few ounces while his height will increase by about 20%.

Physical Appearance of the Head:

It's no secret that your newborn's head makes up the greatest portion of his body.

His skull is somewhat flexible as compared to an adult's, and because of that you will

notice several soft spots, fontanelles on his head. The head may be slightly

misshaped frommolding during birth, but no need to worry. That conehead will

eventually round out nicely.

Physical Features:

Newborns have their share of quirks in physical appearance. Don't be concerned if

you notice the following traits. They will subside as your baby ages.

Swollen eyes at birth

Flattened ears

A blister that forms on the lip from feeding

Body hair (particularly so for preterm infants)

Dry skin

Enlarged genitals

Smushed nose

Motor Skills:

Think of your baby's motor skill development as a top-down process. He first

masters movements of the head, then progresses to movements of the trunk, hands,

and legs.

Until 8 weeks, his movements are largely out of his control. Involuntary movements are

without intention, so don't think he's pushing you away during a feeding orgrabbing at

a toy. It isn't until about 3 months that you may notice him gazing at his hands. He is
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starting to understand that those waving fists he sees aren't just another toy in his line

of vision, but a part of his body. He may begin to shake a fist at your face or a toy that

is nearby.

Sensory Development - Taste and Smell:

It may surprise you to know that your baby could smell and taste while still in the

womb. Some research indicates that a mother's diet while pregnant and nursing can

influence her baby's palate later in life.

You can use his sense of smell to your advantage at time. He recognizes his mom's

familiar smell and may find comfort in the odor that comes from a piece of her clothing

during her absence.

Sensory Development - Hearing:

Likely you have noticed that your baby can hear when he startles at noises or by

turns toward voices. Your baby could hear in utero, but at birth his hearing is not as

advanced as an adult's. His hearing will rapdily progres in the oncoming months.

Sensory Development - Sight:

You've spent hours gazing into those beautiful, and most likely blue, eyes of your

baby. Those peepers fluttered open shortly after birth, but, because of pressure in

the womb, they will be swollen for several days. His eyesight is the least developedof his senses.

In the beginning, he can only focus on objects near to his face, no more than 15 inches

away. His blurred vision has yet to master depth perception, and he shows a

preference for bright, contrasting colors.

As far as the eye color, almost all babies show off blue eyes. It won't be until around 9

months of age that his eye color will be established.

Sensory Development - Touch:

Your infant's sense of touch is, perhaps, the most highly developed sense he has at

birth. You might notice this as he craves skin-to-skin contact, soothes during

swaddling, or responds to various touches (bouncing, rubbing,

Documents

Fetus or Newborn Problems During Delivery