Swanson – Common Problems of the Newborn

Nov 9, 2019 admin NHI KHOA 0

Swanson’s Family Medicine Review 2017

Ch. 97 Common Problems of the Newborn 497
John F. Simmons

Clinical Cases

A Precipitous Delivery

A 7-pound, 2-ounce infant delivered by repeat cesarean section at 39 weeks arrives in the nursery with normal vital signs except for a respiratory rate of 80 breaths/ minute. Prenatal labs were normal and the surgery was uncomplicated.

“My Baby Is Turning Yellow.”

An 8-pound infant with history of a normal neonatal course was discharged home with the mother just 40 hours old. The infant is being breast-fed every 2-3 hours and is producing straw-colored urine 7 times a day.   The parents called the office 4 days subsequent to the baby’s birth concerned that the infant appeared yellow.

A 1-Week-Old with Fever

A 1-week-old infant with a normal physical examination is found to have a rectal temperature of 100.9° F. The baby was born at term, weighed 7 pounds and 4 ounces, and continues to feed well and to wet 6-8 diapers per day. The infant interacts appropriately and is easily consoled when crying.

  1. TTN (Transient Tachypnea of Newborn) is the most common cause of neonatal respiratory distress and is usually self-limited. Infants born after cesarean section or precipitous vaginal delivery have higher rates of TTN than do infants born vaginally after labor of normal duration. Prostaglandin-driven dilation of lymphatic vessels lags behind first breaths in infants who have not had the chest compression inherent in normal labor. Most neonates do not exhibit fever, no matter what pathology they have.
  2. Meconium aspiration syndrome occurs when stress induces the passage of meconium into the amniotic fluid, and it is aspirated by the fetus. Meconium is sterile, and exhibits its pathologic effects primarily through mechanical blockage, surfactant disruption, and chemical pneumonitis. The incidence increases with gestational age, and it is highest in post-term pregnancy. Most infants will recover completely.
  3. Physiological jaundice is manifested without worrisome symptoms and occurs in the first few days of life, whereas jaundice due to blood group incompatibility usually develops in the first 24 hours of an infant’s life.
  4. The majority of neonatal hyperbilirubinemia is unconjugated. Certain drugs, such as ceftriaxone, can bind to albumin and displace bilirubin, thereby increasing circulating levels. Sepsis weakens the blood-brain barrier, increasing the susceptibility to the neurotoxic effects of hyperbilirubinemia. Breastfeeding jaundice refers to the relative dehydration of the gut, and thus diminished fecal excretion of bilirubin, compared to bottle-fed infants.
  5. Most cases of neonatal sepsis are caused by the bacteria Streptococcus, Escherichia coli, and Staphylococcus.
  6. Febrile infants can have serious infection even with normal examination findings, and no evident source of fever is observed. Approximately 3% of these newborns have bacteremia.
  7. All infants under 30 days of age with fever should be admitted to the hospital and treated with ampicillin and either a third-generation cephalosporin or gentamicin. The treatment should include CBC with differential, blood culture, lumbar puncture, urinalysis, urine culture, and a chest radiograph.
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Suggested Reading

American Academy of Pediatrics. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297–316.

American Academy of Pediatrics Committee on Nutrition. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2005;115:496–506.

Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician. 2007;76:987–994.

Moerschel SK, Cianciaruso LB, Tracy LR. A practical approach to neonatal jaundice. Am Fam Physician. 2008;77:1255–1262.

Sur DK, Bukont EL. Evaluating fever of unidentifiable source in young children. Am Fam Physician. 2007;75:1805–1811.

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