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Women's Health and Education Center (WHEC)

Newborn Care

List of Articles

  • Vitamin K Deficiency Bleeding
    Prevention of early vitamin K deficiency bleeding (VKDB) of the newborn, with onset at birth to 2 weeks of age (formerly known as classic hemorrhagic disease of newborn), by oral or parenteral administration of vitamin K is accepted practice. Vitamin K is essential for the synthesis of few coagulation factors. Infants can easily develop vitamin K deficiency owing to poor placental transfer, low vitamin K content in breast milk, and poor intestinal absorption due to immature gut flora and malabsorption. VKDB in infancy is classified according to the time of presentation: early (within 24 hours), classic (within 1 week after birth), and late (between 2 week and 6 months of age). Prophylactic administration of vitamin K to prevent VKDB has been in practice for decades in USA, in both term and preterm infants. A single dose (1.0 mg) of intramuscular (IM) vitamin K after birth is effective in the prevention of classic VKDB in term infants. Either IM (1.0 mg) or oral vitamin K prophylaxis improves biochemical indices of coagulation status at one to seven days. This review presents updated recommendations for the use of vitamin K in the prevention of early and late VKDB.

  • Neonatal Seizures
    Neonatal seizures typically indicate significant underlying disease. Neonatal seizures differ in clinical description from those in adults, and seizures in preterm infants differ from those in term infants. Cerebral cortical organization, synaptogenesis, and myelination of cortical efferent pathways are poorly developed in human neonates, leading to weakly propagated, fragmentary seizures whose electrical activity may not spread to surface EEG electrodes. There are four recognizable clinical seizure types: Subtle; Clonic; Tonic; and Myoclonic. The neonatal period is a period of intense physiological synaptic excitability, as synaptogenesis occurring at this time point is wholly dependent upon activity. In the human, synapse and dendritic spine density are both peaking around term gestation and into the first month of life. Recognition is often helpful in prognosis and treatment; the most common is hypoxic-ischemic encephalopathy (HIE). Patients generally have a poor prognosis, with most developing a severe encephalopathy and epilepsy. The review of literature suggest that neonatal seizures and their etiology have a significant impact on the developing brain; it is critical to recognize seizures early and initiate immediate antiepileptic therapy. Continuous computerized simultaneous video electroencephalograph (EEG) monitoring is imperative; at-risk infants will frequently have electrographic seizures without clinical manifestations. Poor prognosis for premature infants with seizures is reflected in high rates of subsequent long-term disability and mortality. The severity and timing of the pathologic process continue to be the major determinants for outcome. Although there are antiepileptic therapies for neonatal seizures, they are ineffective in over 35% of cases. The prognosis is determined primarily by etiology. The goal of research should be the development of more effective therapies for neonatal seizures, regardless of etiology.

  • Neonatal Group B Streptococcal Infection
    Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. This review addresses the epidemiology, microbiology, disease pathogenesis, and management strategies for neonatal early- and late-onset GBS infection. While most babies recover from their GBS infection, some are stillborn, more die in the first weeks of life and others suffer lifelong disability. Prevention strategies (intrapartum antibiotic prophylaxis) for early-onset invasive infant GBS disease are currently limited to developed countries, and only around the time of birth. Recurrent neonatal and young infant GBS disease can occur after completed appropriate treatment of the primary infection. There are no good prospective studies to indicate optimal choice of therapy in newborn infant with possible sepsis, but ampicillin and gentamycin are usually appropriate based on the usual susceptibilities of the predominant organisms causing early-onset sepsis. Vaccination against GBS would be acceptable to most women and GBS vaccines are in the early stages of development. While most babies recover from their GBS infection, some are stillborn, more die in the first weeks of life and others suffer lifelong disability.

  • Newborn Hearing Loss Detection and Intervention
    Hearing loss can affect a child’s ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. The most important time for a child to learn language is in the first 3 years of life, when the brain is developing and maturing. In fact, children begin learning speech and language in the first 6 months of life. In 2017 the Early Hearing Detection and Intervention (EHDI) law re-authorizes Health Resources and Service Administration (HRSA) to continue funding awards to states, territories, and healthcare providers to support continuous improvement of EHDI programs. These projects help to identify effective strategies to address screening, loss to follow-up diagnosis and services, enrollment into early intervention services, and family engagement. There are different types of communication options and interventions available for children with hearing loss. With help from healthcare providers and intervention specialists, families are able to select the options that best meet their needs.

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