Newborns form a separate group within pediatrics and they have very particular characteristics, in this transition from fetus to baby.
Some diseases that can appear in the newborn and during the first month of life , as well as their management, are different from those that can appear later. Next we will talk about the most frequent ones and others that, although they appear less frequently, are typical of these ages and are worth knowing.
Injuries during childbirth
Although the usual thing is that no injury occurs during childbirth, in some newborns they can appear; in most they are mild and improve with time.
- Head and brain injuries are the most common birth-related injuries. When it comes to instrumental deliveries (forceps, suction cup) or internal monitoring is performed (a wire is placed on the baby’s scalp to monitor his heart rate), scratches and bruises may appear on the scalp. Cephalohematoma is estimated to appear in 2.5% of newborns. It consists of the accumulation of blood below the periosteum; it is like a lump with a soft consistency. They tend to increase in size after birth and resolve only after weeks or months. The succedáneum caput is the accumulation of subcutaneous blood; We see it with some frequency in deliveries with a suction cup. Like cephalohematoma, they are usually uncomplicated and resolve spontaneously within a few days. Much less frequently, a bone in the skull may be fractured or bleeding may occur in other locations.
- Clavicle fracture is the most common birth-related fracture, occurring in up to 3% of newborns. Sometimes it is not diagnosed until a few days after birth. They have a very good prognosis and rarely require treatment. You just have to be careful because it can hurt (for example, when dressing or undressing them, start from the affected side).
- Nerve injuries also occur with some frequency; the most commonly affected nerve is the facial nerve; the baby will have a generally unilateral facial paralysis. You will not be able to close your eye completely and when you cry, your mouth will drift to the healthy side. It is usually associated with the application of forceps.
Regurgitation and gastroesophageal reflux
Newborns are immature in many ways. Thus, the esophagus does not have optimal movement at these ages and the lower esophageal sphincter, which closes the stomach, does not function normally either. This, added to the fact that they spend much of their time lying down since they only drink milk, makes the stomach content return to the mouth very easily (up to 75% of children under 4 months suffer from it). They are regurgitations or physiological gastroesophageal reflux.
In most children it is not a problem: it does not bother them and they gain weight normally. However, a few will develop gastroesophageal reflux disease: the esophagus becomes inflamed and symptoms of esophagitis such as crying, irritability and / or refusal of food appear.
- Warning signs: if esophagitis symptoms appear (crying, irritability, refusal of food) or the baby does not gain weight.
Newborn jaundice
Jaundice is the yellowing of the skin as a result of the accumulation of bilirubin. Bilirubin is a pigment in the blood that is produced by breaking down red blood cells. The liver is the main one in charge of its elimination. In newborns, and even more so in premature infants, jaundice is very common because their liver is immature.
In most cases it is not a problem: we are talking about physiological jaundice . In these cases, the yellow coloration usually appears on the second or third day of life , disappears before 2 weeks of life and does not exceed certain levels (there are tables with maximum levels of bilirubin in the blood depending on age). The conjunctiva is where jaundice is first appreciated and, as bilirubin levels increase, the yellowish color decreases (face, then chest, abdomen and finally legs). In breastfed infants, jaundice may persist beyond two weeks of age.
If the bilirubin levels are very high, the baby will need to be treated with phototherapy (it is placed under a special lamp that helps the elimination of bilirubin). In some cases, jaundice can be a symptom of an underlying problem (blood group incompatibility between mother and baby, cephalohematoma, bleeding, excessive weight loss, liver problem …). We speak then of pathological jaundice , luckily much less frequent.
- Warning signs : if jaundice appears in the first 24 hours of life, if after hospital discharge it turns more yellow, even affecting the legs; or if jaundice reappears in a baby who had been yellow and had returned to normal color. In addition, if jaundice is accompanied by other symptoms: you do not gain weight, white stools, irritability, fever … we should also consult.
Diaper rash
Newborn skin is very sensitive. Being in frequent contact with irritants such as pee and stools, as well as wearing a diaper, make it not uncommon for the area to become irritated and red. This inflammation of the skin in the area that covers the diaper is what we know as diaper rash. In some cases, in addition, fungi will appear; then we speak of diaper candidiasis.
To prevent this, it is advisable to change the diaper frequently and perform hygiene with a sponge and neutral pH soap if necessary, avoiding wipes. It is also essential to keep the area very dry . Spending a while with the area in the air, without a diaper, is very beneficial.
If despite all these measures the skin becomes irritated, we can apply a barrier cream , which prevents skin contact with moisture; if it contains zinc sulfate they reduce irritation more.
- Warning signs : redness of the diaper area that does not improve despite the above measures (avoid wipes, frequent diaper changes, use of barrier cream with zinc sulfate). The pediatrician may prescribe a corticosteroid cream to reduce inflammation or one with an antifungal if fungal superinfection is suspected.
Onfalitis
When the baby is born, the umbilical cord is cut, leaving a remnant attached to the navel. During the following days, the navel must be kept clean to prevent infections. The current recommendation is that in developed countries it is cleaned with soap and water . Despite this, it sometimes becomes infected: we call it omphalitis.
- Warning signs : if your newborn’s navel oozes, smells bad or the surrounding skin is red, you should consult.
Lacrimal duct obstruction
This is quite common in newborns (it is estimated that up to 10% of babies have it in one or both eyes). The tube that drains the tear from the eye to the nose is blocked. For this reason, the eye tears and rhymes appear frequently.
To improve it, you have to massage the tear duct area . Over time (and massages) it resolves up to 90% before one year of life. The secretions (legañas) will be cleaned with physiological saline and a gauze, from the inside out.
- Warning signs : if the eye turns red (it can be indicative of conjunctivitis), or if we notice redness and inflammation of the inner corner of the eye, in the lower part (it could be a dracryocystitis or infection of the lacrimal sac). If after 6-12 months of life you notice that he is still tearing and has a discharge, you should also consult.
Hernia umbilical
When the umbilical cord falls off, the hole through which it passed usually closes. When this does not happen and that hole in the abdominal wall remains open, we are facing an umbilical hernia. Intestinal content will now pass through that hole, especially when abdominal pressure increases (when crying, straining to defecate …). It is very common, and can affect up to 1 in 5 newborns. Most umbilical hernias do not cause any problems and close over time, usually before 4 or 5 years.
Warning signs : complications in umbilical hernia are extremely rare, but if the hernia changes color, pain or irritability appears, we should consult.
Constipation
Constipation is the difficulty to pass stool normally . In these cases, the stools are usually very hard and small (“like sheep’s poop”).
Constipation in the newborn is rare . Newborns shed meconium in the first 24 to 48 hours of life; later they carry out transitional stools and, by the third or fifth day of life, the classic mustard-colored infant stools. Newborns usually have between 1 and 4 bowel movements a day , although it is common for those who are breastfed to have more, up to one for each feeding (6-8 a day).
It is worth mentioning here the disquecia of the infant , which usually appears between 2 and 6 weeks of age. Babies push and squeeze wanting to have a bowel movement but they can’t. It is because they squeeze when the anal sphincter is closed. When they manage to defecate, they do so effortlessly and it is a stool with normal characteristics. This “problem” goes away with time.
- Warning signs: if the newborn does not have a daily bowel movement after hospital discharge, consult. In most cases it is due to lack of food. On other occasions, a disease will have to be ruled out.
Lily of the valley
Thrush is an infection caused by a fungus called Candida . White lesions appear on the inside of the cheeks, lips, and tongue. They are often mistaken for traces of milk but, unlike these, if we scrape they do not disappear. Thrush is very common in babies, especially under 3 months, and is treated with antifungals. It does not usually bother babies.
- Warning signs : if we appreciate whitish lesions in the mouth of our newborn that do not disappear easily, we should consult in case they need treatment.
Infections in the newborn
Newborns have an immature immune system and this makes them more vulnerable to infections, as well as more serious infections than at other stages of their life. For this reason, I take the opportunity to emphasize the importance of avoiding contact of the newborn with many people, and especially if one of them is ill; It is not convenient that they receive many visits, nor go to very crowded places.
- Respiratory infection. Especially common in newborns born in winter, even more so if they have older siblings. It can be a cold or a more serious condition, such as bronchiolitis. Fundamentally, if your newborn begins with a cough and snot, you go to the pediatrician to assess it.
Warning signs : if you start with shortness of breath : you breathe very fast, your chest sinks, your ribs are marked or you have nasal flaring (the nostrils open when you breathe). In addition, newborns with respiratory distress tend to become fatigued when they eat and refuse feeds. Fever is also a reason to go to the ER.
- Urine infection . In newborns and infants they are more difficult to diagnose because they do not present with the typical symptoms. Babies often have fever, irritability, rejection of feeds and / or vomiting, even little weight gain.
Warning signs : if the baby has a fever, vomits or refuses food, as well as if he is very irritable or very down or does not gain weight .
I remember here that any newborn with a fever (and I extend to babies under 3 months) should be evaluated by a pediatrician . In many cases it will be necessary to perform some test to locate the infection and assess its severity.
In Babies and more | The 17 most frequent doubts about the newborn in the first hours of life
