Overview of General Problems in Newborns

The mother's health problems during pregnancy Overview of Disease During Pregnancy During pregnancy, having a disorder can increase the risk of problems. The disorder may be one that Women had before they became pregnant (preexisting disorders) Develops during the pregnancy... read more can affect the growing fetus and negatively impact the health of the newborn. Although mothers rightly worry about the effects of medications on a developing fetus, they also must realize that failing to take necessary treatments can allow their medical disorders to harm the fetus. Women should discuss with their doctor the risks and benefits of different treatments for their specific conditions.

Anorexia Anorexia Nervosa Anorexia nervosa is an eating disorder characterized by a relentless pursuit of thinness, a distorted body image, an extreme fear of obesity, and restriction of food consumption, leading to... read more and bulimia Bulimia Nervosa Bulimia nervosa is an eating disorder characterized by the repeated rapid consumption of large amounts of food (binge eating), followed by attempts to compensate for the excess food consumed... read more can cause the fetus to receive inadequate nutrition, as does any other situation in which the mother does not eat adequately or take appropriate vitamins.

Asthma Asthma During Pregnancy The effect of pregnancy on asthma varies. Worsening of the disease is slightly more common than improvement, but most pregnant women do not have severe asthma attacks. (See also Asthma.) The... read more does not usually affect the fetus as long as the mother's condition is well controlled. However, some women have significant problems with their asthma during pregnancy and must take appropriate treatment to protect the fetus.

Cancer itself does not usually affect the fetus, but medications used to treat cancer may have side effects that may affect the fetus.

Diabetes Diabetes During Pregnancy For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such... read more may result in an increased risk of birth defects Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more , a small baby Small-for-Gestational-Age (SGA) Newborns A newborn who weighs less than 90% of newborns of the same gestational age at birth (below the 10th percentile) is considered small for gestational age. Newborns may be small because their parents... read more , or a large baby Large-for-Gestational-Age (LGA) Newborns A newborn who weighs more than 90% of newborns of the same gestational age at birth (above the 90th percentile) is considered large for gestational age. Newborns may be large because the parents... read more . The most common problem for newborns is low blood sugar (hypoglycemia).

Epilepsy (a seizure disorder Seizure Disorders During Pregnancy Most women who have a seizure disorder that is well-controlled by antiseizure drugs are able to safely give birth to a healthy baby. If these women get enough sleep and take antiseizure drugs... read more ) increases the risk of birth defects. Some of the increased risk is due to the antiseizure medications Seizure Disorders During Pregnancy Most women who have a seizure disorder that is well-controlled by antiseizure drugs are able to safely give birth to a healthy baby. If these women get enough sleep and take antiseizure drugs... read more that may be necessary to control seizures. However, the mother's seizures also are dangerous for the fetus. Women should discuss with their doctor the risks and benefits of drug treatment before they stop taking their antiseizure medications.

High blood pressure High Blood Pressure During Pregnancy High blood pressure (hypertension) during pregnancy is classified as one of the following: Chronic hypertension: Blood pressure was high before the pregnancy. Gestational hypertension: Blood... read more , heart disease, and kidney disease may reduce the growth of the fetus and cause other complications.

Lupus Systemic Lupus Erythematosus (Lupus) Autoimmune disorders, including Graves disease, are more common among women, particularly pregnant women. The abnormal antibodies produced in autoimmune disorders can cross the placenta and... read more (systemic lupus erythematosus) increases the risk of miscarriage Miscarriage A miscarriage is the loss of a fetus before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect) or in the woman (such... read more and prematurity Preterm (Premature) Newborns A preterm newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, preterm newborns have underdeveloped organs, which may not be ready to function outside of... read more and can cause an abnormally slow heart rate in the fetus.

Preeclampsia Preeclampsia and Eclampsia Preeclampsia is new high blood pressure or worsening of existing high blood pressure that is accompanied by excess protein in the urine and that develops after the 20th week of pregnancy. Eclampsia... read more can cause severe problems for the mother and fetus. The disease can cause the mother's blood pressure to become severely elevated and can affect the mother's kidneys, liver, brain, and other organs. The placenta too is affected, and the disease can affect the nutrition of the fetus or cause the placenta to detach from the wall of the uterus. To prevent or manage such complications, doctors may recommend early delivery. A severe complication of preeclampsia is eclampsia Preeclampsia and Eclampsia Preeclampsia is new high blood pressure or worsening of existing high blood pressure that is accompanied by excess protein in the urine and that develops after the 20th week of pregnancy. Eclampsia... read more , which is the development of seizures in a woman with preeclampsia.

Women who have sickle cell disease Sickle Cell Disease Sickle cell disease is an inherited genetic abnormality of hemoglobin (the oxygen-carrying protein found in red blood cells) characterized by sickle (crescent)-shaped red blood cells and chronic... read more may have increased sickle cell crises during pregnancy. If the father carries the sickle cell gene or is affected by sickle cell disease, there is a risk of sickle cell disease in the offspring. Testing of the parents before pregnancy can determine their risk of having a child with sickle cell disease. Genes that cause sickle cell disease can be detected in the fetus during the pregnancy, but the disease does not start until several months after birth.

Thyroid disease Thyroid Disorders During Pregnancy Thyroid disorders may be present before women become pregnant, or they may develop during pregnancy. Being pregnant does not change the symptoms of thyroid disorders. How the fetus is affected... read more that causes a low thyroid hormone level (hypothyroidism) may cause brain damage in the fetus and lead to long-term neurologic problems if it is not diagnosed soon after birth. Thyroid disease with a high thyroid hormone level (hyperthyroidism) may cause the fetus and newborn to have an overactive thyroid gland. In the United States, most states require newborns to be screened for thyroid disease.

Most prescription medications are safe during pregnancy, but women should review all their medications with their doctor when they become pregnant or plan to become pregnant. However, even prescription medications that cause some risk may still be necessary for women. Uncontrolled medical problems in the mother also can be dangerous to the fetus.

Some common prescription medications that can cause problems for the fetus include

Smoking Cigarette (tobacco) smoking during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more or being exposed to second hand smoke during pregnancy Cigarette (tobacco) smoking during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more decreases the growth of the fetus. Pregnant women should not smoke and should avoid exposure to other sources of tobacco smoke as much as possible.

Alcohol Alcohol during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more is particularly dangerous to the fetus because it is a teratogen (a substance that can cause birth defects). Alcohol increases the risk of miscarriage Miscarriage A miscarriage is the loss of a fetus before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect) or in the woman (such... read more , stillbirth Stillbirth Stillbirth is death of a fetus after 20 weeks of pregnancy. Stillbirth may result from a problem in the woman, placenta, or fetus. Doctors do blood tests to try to identify the cause of a stillbirth... read more , poor growth of the fetus, prematurity Preterm (Premature) Newborns A preterm newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, preterm newborns have underdeveloped organs, which may not be ready to function outside of... read more , and birth defects Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more . A particularly devastating effect of alcohol is fetal alcohol syndrome Alcohol during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more , which causes life-long intellectual, developmental, and behavioral disabilities. There is no safe amount of alcohol during pregnancy.

Opioid drugs Opioids during pregnancy More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more , such as heroin, morphine, opium, oxycodone, codeine, hydrocodone, fentanyl, hydromorphone, meperidine, buprenorphine, and methadone, affect the growth of the fetus and can cause withdrawal symptoms in the newborn beginning hours to several days after birth. Mothers should be aware of the ingredients of any painkiller they take. Opioid drugs such as methadone and buprenorphine that are sometimes used to treat a mother's opioid dependence also can cause withdrawal symptoms in newborns. Newborns withdrawing from methadone may need longer treatment than newborns withdrawing from other opioids.

Cocaine increases the risk of poor growth of the fetus and prematurity. The preterm separation of the placenta from the wall of the uterus (placental abruption Placental Abruption Placental abruption is the premature detachment of the placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have abdominal pain and tenderness and vaginal bleeding... read more ) is more common among cocaine users and can cause stillbirth or oxygen deprivation and brain damage in the fetus. Because cocaine narrows blood vessels, it can cause a stroke or damage other organs in the fetus.

In addition to avoiding harmful substances, expectant mothers can improve the chances of having a healthy baby by taking prenatal vitamins, receiving early prenatal care Medical Care During Pregnancy Ideally, a couple who is thinking of having a baby should see a doctor or other health care practitioner to discuss whether pregnancy is advisable. Usually, pregnancy is very safe. However,... read more , and maintaining a healthy weight and diet Self-Care During Pregnancy There is much a pregnant woman can do to take care of herself during pregnancy. If she has any questions about diet, the use of drugs or nutritional supplements, physical activity, and sexual... read more (see also Self-Care During Pregnancy Self-Care During Pregnancy There is much a pregnant woman can do to take care of herself during pregnancy. If she has any questions about diet, the use of drugs or nutritional supplements, physical activity, and sexual... read more ).

Birth defects Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more can involve almost any organ. Prenatal ultrasonography Ultrasonography Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more is used to diagnose many of these defects before birth.

Ultrasonography Ultrasonography Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more is used before birth to detect many problems and monitor the growth and development of the fetus. Ultrasonography helps doctors determine the sex of the fetus, detect abnormalities in the uterus, detect certain birth defects, and determine the fetus's gestational age Gestational age Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 9% of newborns need special care after birth due to prematurity, problems... read more . Knowing the fetus's gestational age and birth defects helps doctors anticipate problems that could develop at birth. However, ultrasonography is not 100% accurate. Some babies are born with birth defects that were not detected with ultrasonography.

A triple screen Screening for chromosomal abnormalities Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more or quad screen Screening for chromosomal abnormalities Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more is a test done on the mother's blood to measure levels of certain hormones and a protein called alpha-fetoprotein. The test results may be abnormal if the fetus has a genetic abnormality such as Down syndrome Down Syndrome (Trisomy 21) Down syndrome is a chromosome disorder caused by an extra chromosome 21 that results in intellectual disability and physical abnormalities. Down syndrome is caused by an extra chromosome 21... read more (trisomy 21), trisomy 18 Trisomy 18 Trisomy 18 is a chromosomal disorder caused by an extra chromosome 18 that results in intellectual disability and physical abnormalities. Trisomy 18 caused by an extra chromosome 18. Infants... read more , spina bifida Neural Tube Defects and Spina Bifida Neural tube defects are a certain type of birth defect of the brain, spine, and/or spinal cord. Neural tube defects can result in nerve damage, learning disabilities, paralysis, and death. The... read more , or certain other abnormalities. The blood test is done in the first trimester and is often combined with ultrasonography to measure the thickness of the skin folds of the neck of the fetus. Some of the blood tests may be repeated in the second trimester, and this combination of tests is referred to as a sequential screen.

If the results of the screening tests indicate a high risk of abnormalities in the fetus, the mother is offered further testing, most commonly a test called noninvasive prenatal screening (NIPS) or cell-free fetal DNA testing. NIPS involves genetic testing of the small amounts of fetal DNA that leak from the fetus's circulation into the mother's blood. In some cases, doctors do tests on cells from the fetus using samples taken with a needle from the amniotic fluid (amniocentesis Amniocentesis Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more ), placenta (chorionic villus sampling Chorionic Villus Sampling Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more ), or the umbilical cord (cordocentesis).

Increasingly, NIPS combined with a single blood test of the alpha-fetoprotein level is replacing the triple, quad, and sequential screens. This approach to testing has increased accuracy at an overall lower cost.

Fetal echocardiography, a detailed examination of the heart using a specialized ultrasound device, may be done to detect certain heart defects.

Magnetic resonance imaging (MRI) Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more is now being used to further evaluate some abnormalities in the fetus that are first detected by ultrasonography. MRI may give additional information about an abnormality and can be useful in evaluating treatment options.

Fetoscopy is an invasive test in which doctors insert a small viewing scope (endoscope) into the womb. Early in pregnancy, the scope may be inserted through the mother's cervix. Later in pregnancy, the scope is inserted through a small incision in the mother's abdomen and then another incision in the uterus. The scope lets doctors take a direct look at the placenta and fetus to identify (and sometimes treat) disorders in the fetus.

After birth, nurses and doctors do a routine physical examination Physical Examination of a Newborn A newborn is usually given a thorough physical examination by a health care professional within the first 24 hours of life. The examination begins with a series of measurements, including weight... read more , measure oxygen levels in the blood, and do routine screening tests Newborn Screening Tests Screening tests are done to detect health conditions that are not yet causing symptoms. Many serious disorders that are not apparent at birth can be detected by various screening tests. Early... read more . Additional tests, including blood tests, x-rays, ultrasonography, and others, may be done when babies have specific problems or have abnormal findings on the routine tests.

Depending on gestational age Gestational age Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 9% of newborns need special care after birth due to prematurity, problems... read more , newborns are classified as preterm Preterm (Premature) Newborns A preterm newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, preterm newborns have underdeveloped organs, which may not be ready to function outside of... read more , full term, late term, or postterm Postterm Newborns A postterm newborn is a baby delivered after 42 weeks of gestation. Near the end of a term pregnancy, the function of the placenta decreases, providing fewer nutrients and less oxygen to the... read more .

Newborns are further classified into three groups by how much they weigh compared to other newborns of the same gestational age. The three groups are

The gestational age and weight classifications help doctors determine the risk of various complications. For example, preterm newborns are at increased risk of breathing problems because their lungs may not be fully developed. Large-for-gestational-age newborns may have more difficult births and be at increased risk of low blood sugar (glucose).

The NICU Neonatal intensive care unit (NICU) Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 9% of newborns need special care after birth due to prematurity, problems... read more is a specialized facility that brings together the medical team and technology needed to care for newborns (neonates) with various disorders. Newborns may need such specialized care because of

The NICU team is typically directed by neonatologists (pediatricians specially trained to manage the problems of newborns). Much of the care is delivered by specialized neonatal nurses. Other team members may include pediatricians, neonatal nurse practitioners (advanced-degree nurses specifically trained to manage newborns), neonatal physician assistants, respiratory therapists, social workers, pharmacists, physical and occupational therapists, speech-language pathologists, and other specialized personnel. Many NICUs also have doctors and students in training. Depending on the care required by the baby, medical and surgical subspecialist physicians are also often involved.

In the NICU, newborns are cared for in incubators or radiant warmers, which keep them warm while allowing staff to observe and treat them. Babies are usually connected to monitors that continuously measure their heart rate, breathing, blood pressure, and oxygen levels in the blood. They may have catheters placed inside an artery or in the vein running inside the umbilical cord to permit continuous blood pressure monitoring, to allow repeated blood sampling, and to give fluids and medications.

NICU facilities vary widely. Some NICUs have wards in which many babies share a large space, some have modules with a few babies in a space, and some have private rooms for a family and their baby. Regardless of the layout, NICU personnel are focused on meeting the parents’ need for time and privacy to become acquainted with their newborn; to learn the newborn’s personality, likes, and dislikes; and ultimately to learn any special care that they will need to provide at home. Visiting hours vary but are usually flexible so that families can spend as much time with their newborn as they wish. Some hospitals have sleeping facilities for parents on-site or nearby. Many NICUs have cameras, which allows parents to see their baby even when they cannot be present in the NICU.

Sometimes, parents feel that they have little to offer their newborn in a NICU. However, their presence, including stroking, speaking, and singing to their newborn, is very important. Newborns hear their parents' voices even before birth and are accustomed to them so they often respond better to their own parents’ attempts to calm them. Skin-to-skin contact (also called kangaroo care), in which the newborn is allowed to lie directly on the mother’s or father’s chest, is comforting to the newborn and enhances bonding.

Breast milk significantly reduces the risks of necrotizing enterocolitis Necrotizing Enterocolitis (NEC) Necrotizing enterocolitis is injury to the inner surface of the intestine. This disorder occurs most often in newborns who are premature and/or seriously ill. The abdomen may be swollen, stools... read more (a serious intestinal disorder that can occur in preterm infants) and infections in preterm infants, and has a wide range of health benefits for all infants (see Benefits of Breastfeeding Benefits of Breastfeeding Breast milk is the ideal food for newborns and infants. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend... read more ). NICU personnel strongly encourage mothers to breastfeed directly or provide breast milk in a bottle when their infant's condition permits. Depending on their gestational age and medical problems, infants in a NICU may not be able to breastfeed or drink breast milk from a bottle, but, in most cases, they can still receive breast milk through a feeding tube that is placed in their nose and goes to their stomach. Preterm infants are not able to suck adequately and are not able to coordinate sucking, swallowing, and breathing. Full-term infants in the NICU may have respiratory problems or other illnesses that make breastfeeding impossible. But, because breast milk is clearly the best food for newborns, mothers are encouraged to pump their breast milk so it can be given to their baby through a feeding tube or saved for later use.

NICU personnel understand that parents need to be kept up to date on their baby's condition and expected course, the care plan, and the estimated time of discharge. Regular discussions with the nurses and medical team are beneficial. Many NICUs also have social workers who help communicate with the parents and assist in arranging family and medical services.