Jaundice in newborns

March 11, 2011 Posted by

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 infant is 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.
  • 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.

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.

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

baby with jaundice

Symptoms of jaundice may resemble other conditions or medical problems. Always consult your baby’s physician for a diagnosis.

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)

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

  • Your baby’s gestational age, overall health, and medical history.
  • Extent of the disease
  • Your baby’s tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference- This 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:

  1. Phototherapy– 
Because bilirubin absorbs light, jaundice and increased bilirubin levels usually decrease when the 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.
  2. 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.
  3. Discontinued breast feeding
- 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.
  4. Treatment of underlying conditions
- Treating any underlying cause of hyperbilirubinemia, such as infection.

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.

Prune Belly Syndrome

March 10, 2011 Posted by

Prune Belly Syndrome is also known as Triad Syndrome or Eagle-Barrett syndrome. It is characterized by a triad of abnormalities that include the following:

  • Absence of abdominal muscles
  • Undescended testicles – a condition seen in newborns whereby one (or both) of the male testes has not passed down into the scrotal sac.
  • An abnormal, expanded bladder and problems in the upper urinary tract, which may include the bladder, ureters, and kidneys.

Because of the substantial involvement of the urinary tract, children with prune belly syndrome are usually unable to completely empty their bladders and have serious bladder, ureter, and kidney impairment.

A child with prune belly syndrome may also have other birth defects. Most commonly, these defects involve the skeletal system, intestines, and heart. Girls may have defects in their external genitalia, as well.
Some infants who have prune belly syndrome may be stillborn or die within a few months of birth.

Prune belly syndrome is an uncommon birth defect occurring in about one in 30,000 to 40,000 births. In 95 percent of the cases, it occurs in males. It may occur if there is a urethral obstruction during fetal development preventing any urine from flowing through the urinary tract. The urethra is the tube that drains urine from the bladder to the outside of the body for elimination. If there is obstruction, urine can reverse flow and cause an expanded bladder.

The cause of prune belly syndrome is unknown, however, some cases have been reported in siblings, suggesting a genetic component.

The syndrome may occur in varying degrees from mild to severe. The following are the most common symptoms of prune belly syndrome. However, each child may experience symptoms differently.

Symptoms may include:

  • The abdomen may have a wrinkly appearance with multiple folds of skin.
  • An abdominal mass may sit above the pubic bones – this is a result of an expanded bladder.
  • The urinary tract organs may be easy to feel through the abdominal area.
  • An outline of the intestines may be visualized through the abdomen including visualization of peristalsis (the worm-like movements of the intestines shifting food forward.)
  • Absence of testes in the scrotum may be present in males.
  • There may be underdeveloped muscles of the abdomen preventing a child from sitting upright.
  • A child may experience frequent urinary tract infections (usually uncommon in children younger than 5 years and unlikely in boys at any age, unless an obstruction is present.)

The symptoms of prune belly syndrome may resemble other conditions and medical problems. Always consult your child’s physician for a diagnosis.

The severity of the defects often determines how a diagnosis is made. Often prune belly syndrome is diagnosed by fetal ultrasound while a woman is still pregnant. Because of the distinct abnormalities of prune belly syndrome, a physician is usually able to make a diagnosis after initial examination during the newborn period. A child who may not have the outward signs of prune belly syndrome may experience a urinary tract infection, which will prompt further testing by your child’s physician.

Additional diagnostic procedures may include the following:

  • Renal Ultrasound – a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  • Voiding Cystourethrogram (VCUG) – a specific x-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.
  • Intravenous Pyelogram (IVP) – a diagnostic imaging technique which uses an x-ray to view the structures of the urinary tract. An intravenous contrast of dye is given so that the structures can be seen on film. An IVP also reveals the rate and path of urine flow through the urinary tract.
  • Blood Tests (to determine how well the kidneys may be functioning.)
  • Specific treatment for prune belly syndrome will be determined by your child’s physician based upon:

    • Your child’s age, overall health, and medical history the extent of the disease.
    • Your child’s tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the disease
    • Your opinion or preference

    Treatment for the syndrome depends on the severity of symptoms. If your child has mild prune belly syndrome, he/she may be maintained on precautionary antibiotic therapy to prevent upper and lower urinary tract infections.

    Your child may be referred to an urologist (physician who specializes in disorders and care of the urinary tract and the male genital tract). Some children may require a vesicostomy (a small opening made in the bladder through the abdomen) to facilitate emptying the bladder of urine. Other children may need to undergo extensive surgical remodeling of the abdominal wall and urinary tract. In boys, a surgical procedure to advance the testes into the scrotum may be performed, called an orchiopexy. Despite available surgical interventions, some children may develop extensive kidney failure.

    Herpangina

    February 28, 2011 Posted by

    Herpangina is an illness caused by a virus, characterized by small blister-like bumps or ulcers that appear in the mouth, usually in the back of throat or the roof of the mouth. The child often has a high fever with the illness.

    Herpangina is caused by a virus. The most common viruses that cause herpangina include the following:

    hyperpangina

    Herpangina is a very common disease in children and is usually seen in children between the ages of 1 and 4. It is seen most often in the summer and fall. Good hand washing is necessary to help prevent the spread of the disease.

    The following are the most common symptoms of herpangina. However, each child may experience symptoms differently.

      Symptoms may include:

    • Blister-like bumps in the mouth, usually in the back of the throat and on the roof of the mouth
    • Headache
    • Quick onset of fever
    • High fever, sometimes up to 106 º F
    • Pain in the mouth or throat
    • Drooling
    • Decrease in appetite

    Herpangina is usually diagnosed based on a complete history and physical examination of your child. The lesions of herpangina are unique and usually allow for a diagnosis simply on physical examination.

    Specific treatment for herpangina will be determined by your child’s physician based on:

    • Your child’s age, overall health, and medical history
    • Extent of the disease
    • Your child’s tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the disease
    • Your opinion or preference

    The goal of treatment for herpangina is to help decrease the severity of the symptoms. Since it is a viral infection, antibiotics are ineffective.

    Treatment may include:

    • Increased fluid intake
    • Acetaminophen for any fever
    • Proper hand washing is essential in helping to prevent the disease from being spread to other children.

    If you suspect your child may have these underline symptoms, please consult your child’s pediatrician for more information.

    Nebulizers

    January 24, 2011 Posted by

    Nebulizers are commonly used for treatment of cystic fibrosis, asthma, COPD and other respiratory diseases. The common technical principle for all nebulizers is to either use oxygen, compressed air or ultrasonic power, as means to break up medical solutions/suspensions into small aerosol droplets, for direct inhalation from the mouthpiece of the device. When using a nebulizer for inhalation therapy with medicine to be administered directly to the lungs, it is important to note that inhaled aerosol droplets can only penetrate into the narrow branches of the lower airways, if they have a small diameter of 1-5 micrometers. Otherwise they are only absorbed by the mouth cavity, where the effect is low. They also accept their medicine in the form of a liquid solution, which is often loaded into the device’s difuser chamber upon use.

    Cleaning procedures for medical nebulizer equipment

    After each use, disassemble the nebulizer as directed and rinse arts thoroughly in hot running water.

    The mouthpiece should be washed in a detergent solution once a day.

    The following disinfecting procedure should be followed twice a week:

    Disassemble the nebulizer and immerse all parts in a warm detergent solution (Ivory, Joy, etc,) and scrub with a soft bottle-brush. If the tube, which connects the compressor to the nebulizer, is clear and dry, it does not have to be washed. If it has moisture inside or is dirty, wash it along with the other parts. Do not immerse compressor in water!

    Rinse all articles in hot water and shake off excess.

    Completely immerse all articles in a white vinegar solution and allow soaking for 30 minutes. Vinegar solution is 1 part vinegar to 2-3 parts water.

    Rinse well in hot water and shake off excess and drain small parts on a clean towel.

    When everything is completely dry, it may be reassembled for the next use.

    It is also a good idea to dip a cloth in the vinegar solution and wipe down the outside of the compressor machine.

    Asperger Syndrome

    January 19, 2011 Posted by

    What is Asperger Syndrome?

    Asperger Syndrome or (AS) disorder is a neurological disorder characterized by poor social interactions, obsessions, odd speech and mannerisms. The syndrome is considered part of the spectrum of pervasive developmental delay and is sometimes referred to as “high-functioning autism.”

    Like children with autism and other pervasive development delay disorders, children with Asperger syndrome have difficulty with social interactions. They have the most difficulty with interpreting nonverbal cues from other people such as facial expressions and body language. Direct eye contact may be difficult. As a result, they have a hard time forming friendships with their peers. In addition, they do not seek to share interests or experiences with other people. For example, if they like toy trains, they do not bring the toy over to someone to show it off.

    Unlike most children with other forms of pervasive developmental delay, children with Asperger syndrome do not have obvious delay in language development. They often have very large vocabularies that seem advanced compared to other children their age; this sometimes earns them the moniker of the “little professor.” Despite their large vocabularies, these children are quite literal in their understanding of what others are saying. Also, with the exception of social skills, children with Asperger syndrome usually acquire self-help skills like toileting and dressing at the same ages as their peers.

    In addition to their problems with social interactions, children with Asperger syndrome often have an obsessive interest in a particular subject and very little interest in much else. They may obsessively seek information about maps or clocks or some other topic. They may also be very inflexible in their habits and rigidly adhere to certain routines or rituals. Children with Asperger syndrome may show odd mannerisms such as hand-flapping or peculiar postures that make them appear clumsy.

    At this time, there is no ‘cure’ for Asperger syndrome. Children with Asperger syndrome often grow up to be consider an “odd” or “eccentric” adult. However, they can be helped tremendously by treatment with social skills training, parental education and training, behavior modification and other psychosocial interventions. Because children with Asperger disorder can also have debilitating compulsions and anxiety related to social interactions, sometimes medications can be prescribed that will help with those aspects of the condition.

    Like so many behavioral disorders, there is a spectrum and it can be a difficult diagnosis to make. Because people with Asperger syndrome often have obsessive or compulsive behavior, they are frequently diagnosed with Obsessive-Compulsive Disorder (OCD); however, most people with OCD do not have difficulty in their social interactions or understanding body language. Another common misdiagnosis is anxiety disorder because of the distress noted with changes in routine or with social interactions. But again, people with anxiety disorders do not have difficulty with nonverbal language or obsessive interests or rituals.
    Aspergers syndrome is a type of Pervasive Developmental Disorder, and others include Autism and Retts syndrome.

    Chicken Pox

    January 18, 2011 Posted by

    CHICKEN POX

    Chicken pox is a viral infection caused by the Herpes varicella zoster virus. It’s spread in droplets inhaled into the respiratory tract. Complications are rare but serious, and can occur in previously healthy children.

    chicken pox

    Chicken pox tends to affect children under ten. Most children have had the infection by this age. In older children and adults, chickenpox can be more severe.
    It’s more common in late winter and spring. Children who are immunosuppressed (for example, on steroids) are particularly vulnerable to complications, as are newborn babies who may catch the infection from their mother in late pregnancy.

    The incubation period (from exposure to onset of symptoms) is 14 to 24 days. The initial symptoms are mild fever and headaches. Younger children may seem generally grouchy. These are followed within hours by the appearance of a typical rash. Crops of red spots appear, which quickly develop central fluid-filled blisters that are intensely itchy. After a couple of days these scab over and dry up.
    The rash mostly affects the trunk, but may appear anywhere on the body, including the scalp and the mouth. In about one in ten cases symptoms are so minimal the infection goes unnoticed. Complications of the infection are uncommon but include viral pneumonia, secondary bacterial infection and encephalitis.

    The doctor should be notified if the child seems particularly unwell, has a cough, headache, if the skin is particularly inflamed or infected, or there are other worrying symptoms. For young babies or children with immunity problems, always seek medical advice. Give pain-relieving syrup and plenty of fluids. Calamine lotion and antihistamine medicines may relieve the itching. Keep the child’s hands clean and their fingernails short. Try to discourage them from scratching the spots, as they can scar.

    The spots may be infectious until they’ve fully scabbed over, but no child should need to be kept from school for more than five days. In severe cases, antiviral treatment may be recommended.

    Most children recover without long-term problems. But children at high risk who are exposed to chicken pox must be treated with immunoglobulin injections to prevent the infection, or antiviral drugs to treat it. There is also a vaccine that can be given to prevent chickenpox. After infection the virus lies dormant in the body but can emerge later to cause shingles.

    Croup

    January 17, 2011 Posted by

    What is Croup?

    Croup is a common childhood viral illness that is easily recognized because of the distinctive characteristics that children have when they become infected. Like most viral illnesses, there is no cure for croup, but there are many symptomatic treatments that can help the child to feel better faster.

    croup

    Croup, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2-6 days after being exposed to someone with croup.

    One of the distinctive characteristics of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, and will then wake up in the middle of the night with a croupy cough and trouble breathing. The cough that children with croup have is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or deep cough, croup causes a cough that sounds like a barking seal.

    Another common sign or symptom of croup is inspiratory stridor, which is a loud, high-pitched, harsh noise that children with croup often have when they are breathing in. Stridor is often confused with wheezing, but unlike wheezing, which is usually caused by inflammation in the lungs, stridor is caused by inflammation in the larger airways.

    The pattern of croup symptoms is also characteristic. In addition to beginning in the middle of the night, symptoms, which are often better during the day, worsen at night, although they are usually less intense each night. Symptoms also become worse if the child becomes anxious or agitated.

    The symptoms of croup are caused by inflammation, swelling and the buildup of mucus in the larynx, trachea (windpipe) and bronchial tubes. Since younger infants and children have smaller airways, it makes sense that they are the ones most affected by croup. In contrast, older children will often just develop cold symptoms when they are infected by the same virus.

    Children with croup will usually also have a hoarse voice, decreased appetite and a fever, which is usually low grade, but may rise up to 104 degrees F.

    Croup Assessment

    Because of the characteristic signs and symptoms of croup, this diagnosis is usually fairly easy to make. You can often tell a child has croup while they are still in the waiting room or before you enter the exam room, therefore, testing is usually not necessary.

    Specifically, an xray is usually not required, and is usually only done to rule out other disorders, such as ingestion of a foreign body. When an xray is done, it will usually show a characteristic ‘steeple sign,’ which shows a narrowing of the trachea.

    When assessing a child with croup, it is important to determine if he is having trouble breathing. Fortunately, most children have mild croup and have no trouble breathing, or they may only have stridor when they are crying or agitated. Children with moderate or severe croup will have rapid breathing and retractions, which is a sign of increased work of breathing. They may also have stridor when they are resting.

    The croup score is an easy and standardized way to figure out if a child has mild, moderate or severe croup, which can help to dictate what treatments are necessary. The croup score is based on a child’s color, level of alertness, degree of stridor, air movement, and degree of retractions, with 0 points given if these findings are normal or not present, and up to 3 points given for more severe symptoms.

    • Inspiratory Stridor
    • None (0 points)
    • When agitated (1 points)
    • On/off at rest (2 points)
    • Continuous at rest (3 points)
    • Retractions
    • None (0 points)
    • Mild (1 points)
    • Moderate (2 points)
    • Severe (3 points)
    • Air Movement/Entry
    • Normal (0 points)
    • Decreased (1 points)
    • Moderately decreased (2 points)
    • Severely decreased (3 points)
    • Cyanosis (Color)
    • None (0 points)
    • Dusky (1 point)
    • Cyanotic on room air (2 points)
    • Cyanotic with supplemental oxygen (3 points)
    • Level of Alertness (Mentation)
    • Alert (0 points)
    • Restless or anxious (1 points)
    • Lethargic/Obtunded (2 points)

    In general, children with a croup score of less than 4 have mild croup, 5-6 have mild/moderate croup, 7-8 have moderate croup, and greater than 9 have severe croup.

    Treatments

    Although, like most viral infections, there is no cure for croup, there are many treatments that can help improve the symptoms and make the child feel better. Mild croup symptoms can usually be safely treated at home. Common treatments include using humidified air, which can be delivered by a cool mist humidifier. Using a hot steam vaporizer is usually discouraged because of the risk of the child getting burned if he touches it. Instead, warm steam can be delivered by turning on all of the hot water in the bathroom, including from the shower and sink, close the bathroom door and holding the child as he breathes in the steamy, humidified air.

    On cool nights, exposure to the cool nighttime air may also help symptoms, and this phenomenon is responsible for another characteristic finding of croup, the fact that children often get better on the way to the emergency room. To take advantage of this, it may help to bundle the child up and walk around outside for several minutes. It is probably not a good idea to keep his window open though, as you don’t want him to get too cold.

    Other treatments can include using a fever reducer (acetaminophen or ibuprofen containing products) and/or a non-narcotic cough suppressant (although they probably won’t suppress the cough of croup).

    Since symptoms worsen if the child is crying and agitated, trying to keep the child calm may also improve his symptoms.

    Children with moderate or severe croup, or who aren’t quickly responding to home treatments, will need medical attention for further treatments, which usually includes administering a steroid to help decrease swelling and inflammation and improve breathing. An injection of dexamethasone has been the standard way of administering this steroid, but new studies have shown that an oral steroid (Prelone, Orapred, etc) or steroid delivered by a nebulizer (Pulmicort) may also be effective.

    For children with severe respiratory distress, treatment, in a hospital setting may include a breathing treatment with racemic epinephrine. Because there is a risk of a ‘rebound’ and worsening breathing, children are usually observed for 2-4 hours after receiving racemic epinephrine. Chlildren who continue to have difficulty breathing, or who require more than one treatment, are usually hospitalized.

    A mist or oxygen tent has long been used to treat children who are hospitalized, but there use has been decreased because it makes it harder for the hospital staff to observe the child and notice if he is getting worse. Instead, blow by oxygen or cool mist may be used.

    A newer treatment that is being researched is the use of a helium-oxygen mixture for children with severe croup.

    The main symptoms of croup typically last only 2-5 days, but more rarely, they can last several weeks. Once the barking cough and difficulty breathing improve, the child may continue to have cold symptoms for 7-10 days.