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Women's Health and Education Center (WHEC)

Newborn Care

List of Articles

  • Birth Trauma: Neonatal Brachial Plexus Injury
    The review emphasizes on neonatal brachial plexus palsy (NBPP) with special focus on its pathophysiology, causation, and management. Some strategies that demonstrate either a reduction in NBPP or an increased rate of successful resolution of shoulder dystocia are included. The primary objective in the presence of clinically recognizable shoulder dystocia continues to be the delivery of fetus before the fetal brain experiences hypoxic-ischemic injury. Perinatal disorders are prone to malpractice litigation. NBPP results from stretching the nerves in the perinatal period and may lead to paresis or paralysis and sensory loss in the affected arm. The knowledge about NBPP is continually evolving. What is known at this time with reasonable certainty is that NBPP occurs infrequently and can be caused by maternal (endogenous) forces or clinician-applied (exogenous) forces or a combination of both. Regularly perform multidisciplinary drills for shoulder dystocia. Cesarean birth reduces, but does not eliminate, the risk of birth trauma and NBPP associated with macrosomia. In general, with regard to surgical treatment, primary surgery includes surgical procedures involving nerve transfer, and the ulnar, median, and phrenic nerves are used as grafts/donors in this type of surgery.

  • Sudden Infant Death Syndrome
    Significant new information has been forthcoming in recent decades on sudden infant death and apnea during early infancy. Sudden Infant Death Syndrome (SIDS) also known as Sudden Unexpected Infant Death (SUID) and Sudden Unexpected Death in Infancy (SUDI), are the terms used to describe unexpected death of an infant less than 12 months of age. The cause of death that cannot be explained after thorough investigation, death scene examination, and review of clinical history. Back-to-Sleep position for every sleep time campaign, has helped educate millions of caregivers, parents, grandparents, aunts, uncles, babysitters, childcare providers, health care providers, and others, about ways to reduce the risk to reduce SIDS and other sleep-related causes of infant death. Tummy Time describes the times when you place your baby on his or her stomach while your baby is awake and while someone is watching. Tummy Time is important. Newborn safety should be routinely taught in obstetrics curricula, and the Women's Health and Education Center (WHEC) has partnered with the United Nations (UN) and the World Health Organization (WHO), to disseminate updated literature and guidelines to health care providers regarding newborn safety.

  • Neonatal Jaundice: Part I
    Jaundice (hyperbilirubinemia) occurs in most newborns. Jaundice is benign in most newborns, but because of potential toxicity of bilirubin, newborns must be monitored to identify those who might develop severe hyperbilirubinemia, and in rare cases, acute bilirubin encephalopathy or kernicterus. Based on a consensus of expert opinion and review of available evidence, universal pre-discharge bilirubin screening is recommended. This can be accomplished by measuring the total serum bilirubin level (ideally at the time of routine metabolic screening) or transcutaneous bilirubin level and plotting the result on an hour-specific nomogram to determine the risk of subsequent hyperbilirubinemia that will require treatment. If an infant is discharged before 24 hours postnatal age, the bilirubin should be rechecked within 48 hours. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. Kernicterus in detail is discussed in Neonatal Jaundice: Part II. In every infant, the Women’s Health and Education Center (WHEC) recommends that clinicians: 1) Promote and support successful breastfeeding; 2) Perform a systematic assessment before discharge for the risk of severe bilirubinemia; 3) Provide early and focused follow-up based on the risk assessment; and when indicated 4)Treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia, and possibly bilirubin encephalopathy (kernicterus).

  • Neonatal Jaundice: Part II
    The term kernicterus literally means "yellow kern," with kern indicating the most commonly afflicted region of the brain (i.e. the nuclear region). Historically, the term refers to an anatomic diagnosis made at autopsy based on a characteristic pattern of staining found in babies who had marked hyperbilirubinemia before they died. This document discusses overview, clinical management and management of kernicterus. Despite the lack of a clear-cut cause-and-effect relationship between kernicterus and the degree of hyperbilirubinemia. Laboratory investigations have demonstrated that bilirubin is neurotoxic at a cellular level. Prevention of hyperbilirubinemia is the best way to minimize the incidence of kernicterus. However, because some babies develop kernicterus with relatively modest bilirubin levels, no known absolute level of bilirubin below which the infant is completely safe is recognized. Additionally, because other factors contribute to the ability of bilirubin to cross the blood-brain barrier, management of these components must be appropriately considered. Any infant at risk for significant hyperbilirubinemia and possible neurotoxicity should be cared for in a nursery capable of rendering appropriate care for the hyperbilirubinemia and any contributing diagnoses. Developmental potential can be maximized by early identification of and intervention for neurologic deficits.

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