A healthy start in life is important to every newborn baby. The first 28 days, called the neonatal period, is especially critical. It is during this time that fundamental health and feeding practices are established. It is also during this time that the child is at highest risk for death.
Newborns have the highest risk of death among all children.
Angola in Africa has the highest infant mortality rate (180.21 deaths per 1,000 infants). The United States has 6.26 deaths per 1,000 infants. Singapore has the lowest infant mortality rate (2.31 deaths per 1,000 infants). It has been estimated that about four million newborns die every year, which represents 40% of all deaths to children under age five. Death rates among children under age five have declined in recent decades, but newborn death rates have not changed significantly in the United States.
Some common neonatal disorders include sudden infant death syndrome (SIDS) and neonatal jaundice. SIDS is the leading cause of death among infants who are one month to one year old. According to the American SIDS Institute, about 2,500 infants die from this condition each year in the United States. Neonatal jaundice is jaundice that begins within the first few days after birth. Jaundice is a yellowish discoloration of the skin, conjunctiva (a clear covering over the sclera, or whites of the eyes), and mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in red blooded animals). Neonatal jaundice is usually harmless but should be monitored by a qualified healthcare provider as a precaution.
Most newborn deaths could be prevented if women had access to basic healthcare, such as immunizations to protect expectant mothers and newborns against tetanus, breastfeeding to provide nutrition and immune support, timely and appropriate treatment of newborn infections, and proper attention to hygiene of the newborn.
Routine visits to the doctor are important to a newborn's health. Babies will get their recommended immunizations during routine visits. Routine exams and screenings help to prevent and treat health problems in infants, as well as chart their growth and development.
A baby's immune system is not fully developed until he/she is about six months old. In the meantime, pregnant mothers pass immunoglobulin antibodies from their bloodstream, through the placenta, and to the fetus. These antibodies are an essential part of immune system. They identify and bind to harmful substances that enter the body, such as bacteria, viruses, and fungi. The antibodies then trigger other immune cells to destroy the foreign substance and prevent infection and disease.
A specific type of immunoglobulin, called immunoglobulin G (IgG), is the only antibody that crosses the placenta to the fetus during pregnancy. IgG antibodies are the smallest, but most abundant antibodies, making up 75-80% of all the antibodies in the body. They are present in all body fluids and they are considered to be the most important antibodies for fighting against bacterial and viral infections.
These antibodies help protect the fetus from developing an infection inside the womb.
Immediately after birth, the newborn has high levels of the mother's antibodies in the bloodstream. Babies who are breastfed continue to receive antibodies via breast milk. Breast milk contains all five types of antibodies, including immunoglobulin A (IgA), immunoglobulin D (IgD), immunoglobulin E (IgE), IgG, and immunoglobulin M (IgM). This is called passive immunity because the mother is "passing" her antibodies to her child helping protect the baby from diseases and infections.
During the next several months, the antibodies passed from the mother to the infant in breastfeeding steadily decrease. When healthy babies are about two to three months old, the immune system will start producing its own antibodies. Initially, the infant produces antibodies at a much slower rate than adults. Once healthy babies reach six months of age, their antibodies are produced at a normal rate.
Acquired immunodeficiency syndrome, AFP test, AIDS, ALD, alpha-fetoprotein test, amniocentesis, amniotic banding syndrome, ancephaly, Apgar Scale, arcuate nucleus, biliary atresia, Brazelton scale, chlamydia, chorionic villi, chorionic villi sampling, Clostridium tetani, CVS, cystic fibrosis, diaper rash, Down's syndrome, duodenal atresia, esophageal artresia, FAE, FAS, fetal alcohol effects, fetal alcohol syndrome, fetal echocardiography ultrasound, fluoride, folic acid, genital warts, gonorrhea, hemoglobin, hepatitis B, herpes, HIV, HPV, human immunodeficiency virus, human papilloma virus, Huntington's chorea, hyperbilirubinemia, IgA, IgD, IgE, IgG, IgM, immunoglobulin D, immunoglobulin E, immunoglobulin G, immunoglobulin M, infant botulism food poisoning, infant brain development, infant development, infant eye development, infant health, infant mortality, infantile colic, listeria, neonatal adrenoleukodystrophy, neonatal care, neonatal jaundice, neonatal lupus, neonatal myasthenia gravis, neonatal ophthalmitis, neonatal respiratory distress syndrome, neonatal tetanus, neural tube defects, omega-3 fatty acids, placenta previa, prenatal care, Rh factor, sickle-cell anemia, SIDS, spina bifida, stomach sleeping, sudden infant death syndrome, syphilis, Tay-Sachs, toxoplasma, transabdominal CVS, transcervical CVS, trichomoniasis, unconjugated bilirubin, vaccination.
Getting early and regular prenatal care is one of the most effective ways to ensure a healthy pregnancy. Prenatal care is very important and includes education and counseling about how to handle different aspects of pregnancy, such as nutrition and physical activity, what to expect from the birth itself, and basic skills needed to properly care for the infant.
Prenatal visits also give the woman and her family a chance to talk to a healthcare provider about any questions or concerns related to pregnancy, birth, or parenthood.
The objective of prenatal care is to monitor the health of the pregnant mother and fetus. It is important to visit the doctor as soon as a woman suspects she is pregnant. At each visit, a doctor examines the person and make sure that the baby and the mother are healthy. This examination includes: monitoring weight gain or loss, blood pressure, circumference of the abdomen, position of the fetus, and fetal heartbeat. Such variables are going to be closely followed during the course of the pregnancy.
A doctor may schedule monthly visits during the first two trimesters (from week one to week 28 of pregnancy), every two weeks from weeks 28-36 of pregnancy, and weekly after week 36 (until the day of delivery that could be between 38 to 40 weeks).
Food and nutrition during pregnancy: It is important for an expectant mother to eat a healthful diet. Unless she has a specific health problem (such as diabetes mellitus), common sense nutritional advice should be followed: balancing carbohydrates, fat, and proteins and eating a variety of foods, including dairy products and several fruits and vegetables daily. A pregnant woman should consult her obstetrician for specific advice. Some specific nutritional needs for pregnancy are listed below.
Energy needs increase in the pregnant woman only about 15%. However, pregnancy does not mean increasing the caloric intake. The individual should increase his/her intake of certain nutrients, including folate (folic acid), iron, and calcium. Pregnant women need to choose nutrient-dense foods to assure an adequate nutrient intake without increasing calories. For many women, this requires some change in their current eating habits. Grains, fruits and vegetables, protein (red meat), dairy (for calcium), healthful fats (such as omega-3 fatty acids), and plenty of water (6-8 glasses daily) are recommended.
Folic acid, also called folate or vitamin B9, is strongly recommended by healthcare professionals at the start of pregnancy and even before conception. Folic acid is needed for the closing of fetus' neural tube. In the developing fetus, the neural tube is the precursor to the central nervous system, which includes the brain and spinal cord. Folic acid thus helps prevent neural tube defects, including spina bifida and anencephaly. Folates are abundant in spinach (fresh, frozen, or canned) and are also found in green vegetables, salads, melon, and eggs. In the United States and Canada, most wheat products (such as flour or noodles) are supplemented with folic acid.
Calcium and iron are particularly needed by the rapidly growing fetus who needs these minerals more than the average individual. Pregnant women should eat the recommended daily allowance of dairy products (for calcium) and red meat (for iron) if they are not lactose intolerant or vegetarian. Women who do not eat dairy or meat can obtain calcium and iron from fortified soy milk and juice, soybeans, and certain leafy greens. Doctors may prescribe iron supplements if pregnant women develop anemia. Calcium is effective only if women also obtain enough vitamin D. Milk and dairy products are good sources of vitamin D. Salmon and fatty fishes are also good sources.
Fluoride helps to build strong teeth by changing the nature of calcium crystals. If water or salt does not contain fluoride, it is wise to take fluoride mini-pills at the end of pregnancy and during breastfeeding, but high doses are toxic. In many American cities, drinking water is supplemented with fluoride.
Oils from salmon, trout, tuna, herring, sardine, mackerel, and some chicken eggs contain omega-3 fatty acids that are needed to build neuron membranes. Thus, fatty fish intake during pregnancy may provide nutrition for proper brain and retina development of the fetus. However, large fish such as tuna and swordfish, may contain too much toxic mercury and one should balance risks with benefits; fish two or three times per week seems to bring enough good fat, but not too much mercury. Omega-3 fatty acids are also present in walnuts, flaxseed, and marine algae.
Dangerous bacteria or parasites may contaminate foods, particularly listeria and toxoplasma. To avoid those two hazards, hygiene rules should be strictly adhered to: carefully wash fruits and raw vegetables, overcook meats, avoid raw-milk cheeses (due to listeria), try to avoid contact with cat feces (due to toxoplasma), and clean the fridge often with diluted bleach (then rinse).
It is best to maintain a healthy weight and diet and to exercise regularly before, during, and after pregnancy. Pregnant women should talk to their doctors to determine what types of exercise and how much physical activity is safe during pregnancy. In general, healthcare professionals recommend that pregnant mothers avoid smoking, alcohol, and drug use before, during, and after pregnancy.
selected neonatal health conditions
Sudden infant death syndrome (SIDS)
Sudden infant death syndrome (SIDS) is the sudden and unexplained death of an infant younger than one year of age. It is a frightening prospect because it can strike without warning, usually in a seemingly healthy infant.
SIDS is the leading cause of death among infants who are one month to one year old. According to the American SIDS Institute, about 2,500 infants die from this condition each year in the United States. Most SIDS deaths are associated with sleep (hence the common reference to "crib death"), and infants who die of SIDS show no signs of suffering.
When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined cause an at-risk infant to die of SIDS.
Most deaths due to SIDS occur between two and four months of age, and incidence increases during cold weather. African-American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than Caucasian infants. More boys than girls fall victim to SIDS. Other potential risk factors include: smoking, drinking, or drug use during pregnancy; poor prenatal care; prematurity or low birth-weight; mothers younger than 20; smoke exposure following birth; overheating from excessive sleepwear and bedding; and sleeping on the stomach.
The most common risk factor for SIDS is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child's jaw, therefore narrowing the airway and hampering breathing.
Another theory is that stomach sleeping may increase an infant's risk of "rebreathing" his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby's mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS.
Also, infants who succumb to SIDS may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him or her at greater risk for SIDS.
Neonatal jaundice is jaundice that begins within the first few days after birth. It is normal for bilirubin levels in the blood to become elevated in almost all infants during the first few days following birth, and jaundice occurs in more than half of newborns. For all but a few infants, the elevation and jaundice represents a normal physiological phenomenon and does not cause problems.
The cause of normal, physiological jaundice is well understood. During life in the uterus, the red blood cells of the fetus contain a type of hemoglobin (the oxygen carrying protein in the blood) that is different than the hemoglobin that is present after birth. When an infant is born, the infant's body begins to rapidly destroy the red blood cells containing the fetal-type hemoglobin and replaces them with red blood cells containing the adult-type hemoglobin. This destruction of red blood cells floods the liver with bilirubin derived from the fetal hemoglobin. The liver in a newborn infant is not mature, and its ability to process and eliminate bilirubin is limited. As a result of both the influx of large amounts of bilirubin and the immaturity of the liver, bilirubin accumulates in the blood. Within two or three weeks, the destruction of red blood cells ends, the liver matures, and the bilirubin levels return to normal.
There is another uncommon syndrome associated with neonatal jaundice, referred to as breast-milk or breastfeeding jaundice. In this syndrome, jaundice appears to be caused, or at least accentuated by, breastfeeding. Although the cause of this type of jaundice is unknown, it has been suggested that there is something in breast milk that reduces the ability of the infant's liver to process and eliminate bilirubin. With breast-milk jaundice, the bilirubin levels rise and reach peak levels in about two weeks, remain elevated for a week or so, and then decline to normal over several weeks or months. This timing of the elevation in bilirubin and jaundice is different than normal physiological jaundice described previously and allows the two causes of jaundice to be differentiated. The real importance of the more prolonged jaundice associate with breast-milk jaundice is that it raises the possibility that there is a more serious cause for the jaundice that needs to be sought, for example, biliary atresia (destruction of the bile ducts). Breast-milk jaundice alone usually does not cause problems for the infant.
Neonatal jaundice and breast-milk jaundice usually do not cause problems for the infant; however, there is a concern that high or prolonged elevations in levels of unconjugated bilirubin (the main type that is present in physiologic and breast-milk jaundice) will cause neurological damage to the infant. Therefore, when unconjugated bilirubin levels are high or prolonged, treatment usually is started to lower the levels of bilirubin.
Fortunately, because of modern management of pregnancy, this cause of jaundice is rare.
Other neonatal complications
Pregnancy complications: Pregnancy takes about 40 weeks. If contractions cause the cervix to open earlier than normal, between the 20th and 37th week, labor may be premature. This may result in the birth of a premature baby. Babies born before the 37th week may have trouble breathing, eating, and keeping warm. The signs of premature labor include: uterine contractions every 10 minutes or faster; repeating or constant menstrual-like cramps in the lower abdomen; abdominal cramps with or without diarrhea; pelvic pressure that feels like the fetus is pushing down; increase or change in vaginal discharge; sudden gush of watery fluids from the vagina (water breaking); or a feeling like the fetus is "balling up."
In some pregnancies, known as high-risk pregnancies, the mother and/or fetus are at an increased risk of experiencing complications. A pregnancy may be classified as high risk for a number of reasons, including:
Mother's age: Women older than age 35 have an increased risk of having children with certain chromosomal abnormalities, such as Down's syndrome, as well as placental problems (such as placenta previa). Studies also suggest an increased risk of miscarriage and low birth weight in pregnant women in this age group. In addition, teen mothers are more likely to give birth prematurely than woman older than age 20.
Multiples: Women carrying two or more babies are at an increased risk for a number of complications, including premature labor and low birth weight.
Previous premature births: Women who have already delivered a premature baby are more likely to have pregnancy complications, including additional premature births.
STDs: A number of STDs can be transmitted to a baby before, during or after birth, resulting in medical complications. STDs include: herpes, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), genital warts (caused by human papilloma virus, or HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis.
Drugs: Women who were exposed to diethylstilbesterol (DES, a hormonal drug) when their mothers took the drug during pregnancy are at an increased risk for a number of complications, including ectopic pregnancy and preterm delivery.
Alcohol-related birth defects: Physical or cognitive deficits, which can range form mild to severe, that a child experiences as the result of alcohol consumption by its mother during pregnancy. This term includes, but is not limited to, fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE).
Fetal alcohol syndrome (FAS) refers to certain birth defects and serious, life-long mental and emotional impairments that may be suffered by a child as the result of heavy alcohol consumption by its mother during pregnancy. Symptoms of mental and emotional deficits may include significant learning and behavioral disorders (including attention deficits and hyperactivity), poor social judgment, diminished cause-and-effect thinking, and impulsive behaviors.
Fetal alcohol effect (FAE) is a disorder associated with cognitive and behavioral difficulties in children whose birth mothers drank alcohol during their pregnancy. Symptoms are similar to Fetal Alcohol Syndrome (FAS), but less severe or comprehensive.
Other conditions: Other health conditions that may occur in infants include: blue baby, a condition where the baby is born with a "blue" color due to congenital heart defects; childhood nephrotic syndrome, a condition where the kidney loses protein in the urine causing protein in the blood to drop and water to move into body tissues resulting swelling (edema); classic neonatal adrenoleukodystrophy (ALD) or a serious progressive, genetic disorder where the adrenal gland becomes wasted and ceases to function normally, which leads to progressively severe symptoms (occurs in boys); diarrhea; diaper rash; hemolytic disease of the newborn; infant botulism food poisoning; infantile colic; neonatal lupus, an autoimmune condition; neonatal myasthenia gravis, a lack of muscular control; neonatal ophthalmitis, inflammation of the eyes; neonatal respiratory distress syndrome, a syndrome caused in premature infants by developmental insufficiency of protein production and structural immaturity in the lungs; and neonatal tetanus, an often fatal infection with toxins from the bacterium Clostridium tetani.