Items in AFP with MESH term: Infant, Newborn
Universal Newborn Hearing Screening - Article
ABSTRACT: Congenital hearing loss is estimated to affect one in every 1,000 newborns. Causes of hearing loss can be conductive, sensorineural, mixed, or central. Known risk factors for congenital hearing loss include cytomegalovirus infection and premature birth necessitating a stay in the neonatal intensive care unit. However, up to 42 percent of profoundly hearing-impaired children will be missed using only risk-based screening. Universal newborn hearing screening is a way to identify hearing-impaired newborns with or without risk factors. Newborns with positive screening tests should be referred for definitive testing and intervention services. Whether early intervention in hearing-impaired children identified with universal screening improves language and communication skills has not been established by good-quality studies. However, universal screening has been endorsed by most national children's health organizations because of the ease of administering the screening tests and the ability to identify children who may need early intervention.
Respiratory Distress in the Newborn - Article
ABSTRACT: The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Respiratory distress syndrome can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy. Intervention with oxygenation, ventilation, and surfactant replacement is often necessary. Prenatal administration of corticosteroids between 24 and 34 weeks' gestation reduces the risk of respiratory distress syndrome of the newborn when the risk of preterm delivery is high. Meconium aspiration syndrome is thought to occur in utero as a result of fetal distress by hypoxia. The incidence is not reduced by use of amnio-infusion before delivery nor by suctioning of the infant during delivery. Treatment options are resuscitation, oxygenation, surfactant replacement, and ventilation. Other etiologies of respiratory distress include pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension, and congenital malformations; treatment is disease specific. Initial evaluation for persistent or severe respiratory distress may include complete blood count with differential, chest radiography, and pulse oximetry.
Outpatient Care of the Premature Infant - Article
ABSTRACT: An increasing number of infants in the United States are born prematurely, with current statistics estimating about 13 percent of all births. Although survival rates and outcomes for premature infants have dramatically improved in recent decades, morbidity and mortality are still significant. Infants born prematurely are at increased risk of growth problems, developmental delays, and complex medical problems. To account for prematurity, growth and development monitoring should be done according to adjusted age (age in months from term due date). Premature infants should gain 20 to 30 g (0.71 to 1.06 oz) per day after discharge from the hospital. Growth parameters may be improved in the short term with the use of enriched preterm formula or breast milk fortifier. Each well-child examination should include developmental surveillance so that early intervention can be initiated if a developmental delay is diagnosed. Routine vaccination should proceed according to chronologic age with minor exceptions, and respiratory syncytial virus immune globulin is indicated in preterm infants who meet the criteria.
Strategies for Breastfeeding Success - Article
ABSTRACT: Breastfeeding provides significant health benefits for infants and mothers. However, the United States continues to fall short of the breastfeeding goals set by the Healthy People 2010 initiative. The American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology have policy statements supporting breastfeeding that reflect recent advancements in understanding the mechanisms underlying the benefits of breastfeeding and in the clinical management of breastfeeding. Despite popular belief, there are few contraindications to breastfeeding. Providing maternal support and structured antenatal and postpartum breastfeeding education are the most effective means of achieving breastfeeding success. In addition, immediate skin-to-skin contact between mother and infant and early initiation of breastfeeding are shown to improve breastfeeding outcomes. When concerns about lactation arise during newborn visits, the infant must be carefully assessed for jaundice, weight loss, and signs of failure to thrive. If a work-up is required, parents should be supported in their decision to breastfeed. Certified lactation consultants can provide valuable support and education to patients. Physicians should educate working women who breastfeed about the availability of breast pumps and the proper storage of expressed breast milk. Physicians must be aware of their patients' lactation status when prescribing medications, as some may affect milk supply or be unsafe for breastfeeding infants. Through support and encouragement of breastfeeding, national breastfeeding goals can be met.
Newborn Skin: Part I. Common Rashes - Article
ABSTRACT: Rashes are extremely common in newborns and can be a significant source of parental concern. Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Infants with unusual presentations or signs of systemic illness should be evaluated for Candida, viral, and bacterial infections. Milia and miliaria result from immaturity of skin structures. Miliaria rubra (also known as heat rash) usually improves after cooling measures are taken. Seborrheic dermatitis is extremely common and should be distinguished from atopic dermatitis. Parental reassurance and observation is usually sufficient, but tar-containing shampoo, topical ketoconazole, or mild topical steroids may be needed to treat severe or persistent cases.
Newborn Skin: Part II. Birthmarks - Article
ABSTRACT: Birthmarks in newborns are common sources of parental concern. Although most treatment recommendations are based on expert opinion, limited evidence exists to guide management of these conditions. Large congenital melanocytic nevi require evaluation for removal, whereas smaller nevi may be observed for malignant changes. With few exceptions, benign birthmarks (e.g., dermal melanosis, hemangioma of infancy, port-wine stain, nevus simplex) do not require treatment; however, effective cosmetic laser treatments exist. Supernumerary nipples are common and benign; they are occasionally mistaken for congenital melanocytic nevi. High- and intermediate-risk skin markers of spinal dysraphism (e.g., dermal sinuses, tails, atypical dimples, multiple lesions of any type) require evaluation with magnetic resonance imaging or ultrasonography. Family physicians should be familiar with various birthmarks and comfortable discussing disease prevention and cosmetic strategies.
ABSTRACT: Family physicians treat an increasing number of children with metabolic disorders identified through newborn screening, and they are often the first line of defense in responding to an abnormal screening result. How the family physician chooses to interpret information from the screening and what he or she chooses to tell the family affects the parent-child relationship, as well as the infant's medical and developmental outcomes. Family physicians must, therefore, be familiar with the current state of expanded newborn screening to effectively communicate results and formulate interventions. They also must recognize signs of metabolic disorders that may not be detected by newborn screening or that may not be a part of newborn screening in their state. For every infant identified with a metabolic disorder, 12 to 60 additional infants will receive a false-positive screening result. One recommendation for communicating results to parents is to explain what the initial and follow-up findings mean, even if the diagnosis is not confirmed. For infants with true-positive results, long-term follow-up involves regular medical examinations, communication with a metabolic treatment center, and developmental and neuropsychological testing to detect possible associated disorders in time for early intervention. This article provides a description of metabolic disorders included in expanded newborn screening programs; a list of disorders screened for in each state; and resources for obtaining ACTion sheets (guidelines for responding to newborn screening results), fact sheets, and emergency and acute illness protocols.
Oral Health During Pregnancy - Article
ABSTRACT: Oral health care in pregnancy is often avoided and misunderstood by physicians, dentists, and patients. Evidence-based practice guidelines are still being developed. Research suggests that some prenatal oral conditions may have adverse consequences for the child. Periodontitis is associated with preterm birth and low birth weight, and high levels of cariogenic bacteria in mothers can lead to increased dental caries in the infant. Other oral lesions, such as gingivitis and pregnancy tumors, are benign and require only reassurance and monitoring. Every pregnant woman should be screened for oral risks, counseled on proper oral hygiene, and referred for dental treatment when necessary. Dental procedures such as diagnostic radiography, periodontal treatment, restorations, and extractions are safe and are best performed during the second trimester. Xylitol and chlorhexidine may be used as adjuvant therapy for high-risk mothers in the early postpartum period to reduce transmission of cariogenic bacteria to their infants. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and decrease infant caries.
ABSTRACT: Over the past few years, there have been many changes to the recommendations for children and adolescents by the Advisory Committee on Immunization Practices. These include dividing the immunization schedule into two parts (i.e., ages birth to six years and seven to 18 years, with catch-up schedules for each group); expanding the recommendations for influenza vaccine to children ages six months to 18 years without risk factors; expanding coverage for hepatitis A vaccine to include all children at one year of age; initiating routine immunization with oral rotavirus vaccine given at ages two, four, and six months; and adding a booster dose of varicella vaccine at four to six years of age. The tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap), quadrivalent meningococcal conjugate vaccine (MCV4), and quadrivalent human papillomavirus (HPV) vaccine are routinely recommended for adolescents 11 to 12 years of age. Tdap provides pertussis immunity in addition to the tetanus and diphtheria immunity provided by the tetanus and diphtheria toxoids vaccine (Td). MCV4 has improved immunogenicity compared with the older meningococcal vaccine. HPV vaccine protects against serotypes 6, 11, 16, and 18, and is given in three doses, ideally at 11 to 12 years of age; the effectiveness increases when the vaccine is given before the onset of sexual activity. Family physicians play an integral role in implementing new immunization recommendations and properly educating patients and families in the increasingly complex armamentarium of prevention.
ABSTRACT: When monitoring growth and development in the premature infant, physicians should make adjustments for the estimated due date. With minor exceptions, administration of immunizations is based on the chronologic age. Administration of hepatitis B vaccine should be delayed until the infant weighs 2,000 g (4 lb, 5 oz). Administration of influenza vaccine should be considered in infants with chronic medical problems, and the pneumococcal vaccine may be beneficial at age two in children with chronic problems, especially pulmonary disease. Premature infants should also be monitored to assure appropriate nutrition. Breast-fed infants should probably receive vitamin supplements during the first year. Supplemental iron should be initiated at two weeks to two months after birth and continued for 12 to 15 months. Office care includes screening for problems that occur more frequently in premature infants, especially vision and hearing problems. Because many of these infants require care from multiple medical disciplines, coordination of care is another important role for the family physician. The goals of this care are to promote normal growth and development and minimize morbidity and mortality.