Dr. Allen Cherer is an accomplished neonatal care specialist with decades of medical experience.

Cropped Allencherer Cover Final.jpg

Category: Child Health Care Page 1 of 2

Some Common Health Problems in Newborns

Most babies are vulnerable to health problems after they’re born. They may be born with a variety of conditions, and they can contract others easily. If you’re a new parent, it’s important that you know about the signs and symptoms of these conditions so that you can take the necessary steps to prevent or treat them. Here are some of the most common health problems seen in newborns today.

Jaundice

Jaundice is a common health issue that affects infants and children. It occurs when a baby has an excessive amount of bilirubin in their blood. This condition usually occurs because their liver is not mature enough to remove the excess bilirubin.

Although it usually disappears within 2 to 3 weeks of being born, it can still be a symptom of an underlying issue. Parents should consult their doctor if their baby’s jaundice persists longer than 3 weeks.

Respiratory Distress

This condition can occur when the baby’s nasal passage gets blocked, causing insufficient oxygen to enter the body. It can take a couple of hours for the baby to start breathing normally, and it can continue until the bluish coloration disappears. If the condition persists, it’s important that the child gets checked by a healthcare professional.

Abdominal Distension

Healthy infants and newborns are prone to experiencing abdominal distension. One of the most common causes of this condition is the baby’s swallowing of excess air. If the belly feels swollen or hard, this could be caused by constipation or gas.

As the baby’s body begins to adjust to eating, this condition should eventually resolve itself. However, if it persists, it can lead to a serious issue with the internal organs.

Colic

Although colic is very common in babies, it can be hard for parents to handle due to its nature. Although the exact causes aren’t known, it’s believed that it can be caused by various factors such as gas, hormones, overstimulation by light or sound, or even a growing digestive system.

Early signs of colic usually start to appear in 2 to 3 weeks and typically only last about 3 months. However, if it persists, it can be caused by an underlying health issue. It’s important to consult a doctor to diagnose the condition.

A Brief History Of Today’s Neonatal Intensive Care Unit

When a baby is born prematurely or has a critical illness, the neonatal intensive care unit is usually the place to go. It has the latest equipment and medical experts to give that child the best chance of survival. This hasn’t always been the case though.

 

Before the 1950s, most premature and low-risk newborns were sent home. They didn’t receive the specialized care they needed, and many of them would not live past their first birthday. the NICU has come a long way since those days, so let’s talk about its evolutions through the years.

 

In The Beginning…

Early in the 17th century, scientists and doctors began discussing the care of at-risk and premature infants. During the 19th century, various forms of special care were being developed for these infants. After World War II, hospitals started to create specialized units for these children, becoming what we know today as the NICU.

 

While many medical experts through time were involved in advancing neonatal care, three, in particular, are considered pioneers in the field:

 

French obstetrician Dr. Etienne Tarnier (1828-1897) is known for his work on the well-being of premature infants. He came up with the idea of using a heated isolette to help premature babies stay warm and grow. He was inspired by the French farmers who used similar equipment to hatch chicken eggs.

 

Dr. Pierre-Courcy Budin (1846-1907) was another French obstetrician that devoted his career to improving the care of at-risk infants. He helped educate mothers about proper hygiene and nutrition. He also advocated for the use of gavage, which is a feeding tube that can be inserted into the stomach.

 

Although it’s not exactly clear if he had any medical training, Martin Arthur Couney (1869-1950) became known as the incubator doctor after he studied under Dr. Budin in Paris. He learned about the importance of using incubators for premature infants.

 

He became known for displaying live infants inside incubators at various events, such as fairs and expositions. Through his work, he was able to raise awareness about the importance of using incubators for premature infants.

 

The Rise of the NICU

The increasing number of studies that discovered the importance of humidity and heat in the survival rates of at-risk infants prompted more hospitals to create special care units for premature newborns. One of the first innovations to be used was the Hess incubator, which was invented by Dr. Julius Hess at Chicago’s Reese Hospital.

 

Louis Gluck, a doctor from the US, was another pioneer in the field of neonatal medicine. His research highlighted the risks of infection in premature babies.

He learned that poor hand hygiene could lead to infections among the babies in the special care unit. He then came up with a series of protocols that were designed to improve the hygiene of premature infants, as well as how we approached the design of these special care units. This led to what we know as the first American NICU unit opening at Yale New Haven Hospital in October 1960.

 

Getting To Today

Jacqueline Kennedy, wife of President John F. Kennedy, gave birth to a boy in August 1963. Unfortunately, he only lived for a couple of days before dying due to respiratory distress syndrome. This incident became very significant due to the seriousness of the situation and how public it was made, prompting professionals all over the world to take a closer look at how we approach the health challenges of premature infants.

 

Advancements in medical technology during the 1960s into the 1990s allowed any baby born alive to have a better chance of survival. As a result, multiple births became more common. This also led to more coverage of the care provided to premature babies.

 

During the 1990s, the number of hospitals that provide intensive care for premature infants grew. These facilities were equipped with highly trained medical teams that were able to respond to the needs of these kids.

 

Today, the care and treatment of premature and at-risk infants continues to improve due to the advancements in technology and the dedicated staff members of the hospitals that provide these services. It is truly amazing to see how far medical science has come in the field of neonatal medicine.

What does Neonatal Care Entail?

Neonatal care is essential in helping many newborn babies thrive. When a child is born prematurely, has a low birth weight, or has health concerns after birth, they will be cared for in the neonatal care unit. This special care provides personalized treatments based on the individual needs of each newborn. There are different levels of neonatal care. The level of care provided depends on the baby’s needs and many infants may go through several different levels as their condition changes. 

 

Parents may feel anxious or fearful when hearing that their child will be taken to the neonatal care unit. This is understandable, but the medical care teams are experienced in helping parents understand procedures and providing information each step of the way. When a baby first arrives in the neonatal care unit, it will be assessed thoroughly so the medical team can come up with the best medical care strategy. The unit may be filled with many machines and devices that can look scary to a new parent. That’s why the staff takes great care in comforting parents and ensuring that they stay informed about their child’s health. 

 

Neonatal care may involve regular testing and scanning to keep track of blood sugar, platelets, and white blood cells. The neonatal care unit is also capable of performing x-rays, MRIs, and other essential scanning procedures. These tests allow the medical care team to better understand the needs of the baby so they can tailor treatments based on those needs.

 

The medical staff working in the neonatal care unit understand that parents may be quite scared about their child needing extra care after birth. They do everything possible to allow parents to hold and interact with their children. Parents are encouraged to ask questions, which can help them better understand the need for various procedures. In many cases, a parent can be present to comfort their child through holding or touch. 

 

The neonatal care unit provides specialized care for newborns that need additional attention after birth. Parents may be present during many procedures and are encouraged to actively participate in comforting their new baby when possible. While it may seem like a scary place at first, the neonatal care unit is designed to help babies heal and thrive.

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome (NAS) is a condition that occurs in newborns who were exposed to addictive substances in utero. When a pregnant mother uses drugs or alcohol, the baby can be born with NAS. This condition can cause various health problems for the infant, including seizures, feeding problems, and respiratory distress. In this article, we will discuss NAS’s causes, symptoms, and impact.

 

 Causes of Neonatal Abstinence Syndrome

 

Several substances can cause NAS in a newborn, including opioids, and marijuana. When an expectant mother uses any of these drugs, the baby is at risk for developing NAS. The use of prescription painkillers is a major contributor to the development of NAS. 

 

Symptoms of Neonatal Abstinence Syndrome

 

The symptoms of NAS vary depending on the mother’s drug during pregnancy. However, common symptoms include seizures, feeding problems, respiratory distress, and irritability. These symptoms can vary from mild to severe, and they usually develop within the first few days after birth. In some cases, NAS can lead to death.

 

Impact of Neonatal Abstinence Syndrome on the baby

 

The impact of NAS on the baby can be devastating. The symptoms can cause physical and developmental problems, and they can also lead to long-term health issues. Some of the complications that babies with NAS may experience include:

 

  • Respiratory problems
  • Feeding difficulties
  • Seizures
  • Developmental delays
  • Behavioral problems
  • Low birthweight
  • Jaundice.

 

How Neonatal Abstinence Syndrome is treated

There is no one-size-fits-all treatment for NAS. Treatment depends on the severity of the baby’s symptoms and the mother’s drug. Some common treatments include:

 

  • Medication: Medications are often used to help relieve NAS symptoms. The most common medication used to treat NAS is methadone, which is an opioid agonist.
  • Nutritional support: Babies with NAS often have trouble feeding, so they may need to be fed through a tube.

 

Prevention of Neonatal Abstinence Syndrome

 

The best way to prevent NAS is to avoid using drugs and alcohol while pregnant. If you are pregnant and you need help to stop using drugs or alcohol, there are several resources available to you, including counseling and addiction treatment programs. It is also important to get regular prenatal care so that your doctor can monitor your baby’s development. If you think you may have an issue with drugs or alcohol, talk to your doctor about it. Getting help early on can make a big difference in the health of you and your baby.

2

Neonatal Intensive Care Trends in 2021

Neonatal intensive care (NIC) is a term used to describe the care of premature, or very premature infants in an intensive setting. NIC is often necessary to save the infant’s life and provide long-term care for them. In 2021, there will be an increase in the number of babies born with significant medical conditions, such as heart disease and leukemia. To provide the best possible care for these infants, it is essential to understand the trends in NIC.

NICU admission and race/ethnicity

In the United States, several NICU admissions are racially, and ethnically diverse. In 2011, the NICU admissions of white babies were more than double that of black, and Hispanic infants. The NICU admission rates for black babies are still much less than that of white babies, but it is increasing faster. In 2011, the rate for Hispanic babies was three times the rate for white babies. This trend will continue to grow over time as more Hispanics become pregnant, and give birth in the United States.

Medication use

During the last few years, there has been a decrease in the number of premature infants’ medications. This trend is partly because there has been a decrease in the number of medications prescribed to infants during this period. The use of various pharmaceuticals has also decreased over time. The decrease in medication use is positive because it can help with other aspects of NIC care, and reduce potential side effects from medication use.

Newborn screening

The rate at which infants are screened for certain diseases increases over time. In 2011, newborn screening for Down syndrome was more than double that of 2001. This increase is likely because more people are becoming aware of Down syndrome, and are seeking out prenatal care. There is also an increased awareness of preconception screening for Down syndrome risks.

Conclusion

The above points are just a few of the many trends in NIC over the next few years. It is essential to understand these trends because they can help to shape the future of NIC. To provide the best care for all infants, it is essential to understand these trends and work together with other professionals to provide a high-quality NIC.

1

Understanding Vaccine Mandates

Vaccines have saved millions of lives over the years by preventing diseases like polio, measles, and diphtheria from spreading. But as more people refuse to vaccinate their children because of unfounded fears, those numbers could rise again. This post will explore the mandates of a vaccine.

Prevents diseases

Vaccines are typically thought to work by stimulating the body’s immune system to defend against disease-causing microorganisms, called pathogens. The weakened or killed virus in a vaccine cannot make you sick, but your body can develop the ability to fight the real thing. This is called immunity and the only way to build it is through vaccines.

Safe to use

Vaccines are tested extensively for safety and effectiveness before they come to market. In the United States, vaccines must be approved by the Food and Drug Administration (FDA). This means that vaccines have met strict scientific guidelines, proving them safe and effective. Most vaccine reactions are mild such as fever, redness or soreness where they were given, or temporary aches. Severe side effects are very rare but may include allergic reactions, a severe allergic reaction called anaphylaxis can occur within minutes after vaccination occurs in someone who is known to be allergic to certain vaccine components.

Prevent epidemics

If a critical number of people in a community are vaccinated against the same disease, the odds of outbreaks become very small. This is called ‘herd immunity. Even those who cannot be vaccinated because they have compromised immune systems or other conditions benefit from herd immunity. This is why it is so important for everyone to get vaccinated, especially when an epidemic is looming.

Protects future generations

When enough people are vaccinated, diseases stop spreading. This protects everyone, including future generations because many vaccine-preventable diseases have no cure. Preventing disease through vaccination is one of the most successful and cost-effective health strategies in history. It is crucial to maintain high vaccination rates to ensure that these diseases do not return. Vaccines were responsible for making our world what it is today with all the achievements we’ve had so far.

Vaccines have saved millions of lives over the years by preventing diseases like polio, measles, and diphtheria from spreading. We must keep vaccinating ourselves and our children to protect against outbreaks.

1

A Potential Universal Vaccine from Scientists at UVA

While many think that the COVID-19 pandemic is a thing of the past, dozens of scientists throughout the world are working to develop a universal vaccine against the contagion. As demonstrated by the recent rise of the Delta variant, the coronavirus, like any other type of virus, can alter itself to resist vaccines, ensuring its continued survival. A universal vaccine would protect people from any mutation of the coronavirus. Accomplishing this, however, is difficult as scientists must determine what part of the virus is constant throughout all of its variations. Doctors at UVA Medical Center in Virginia believe that they have determined what part of the coronavirus to target in a universal vaccine.

Speaking with reporters from Charlottesville Tomorrow, Dr. Steven Zeichner, an infectious disease specialist at UVA Medical Center, says that his team believes that the fusion peptide of the coronavirus can provide a powerful opportunity in a universal vaccine. Dr. Zeichner explains that the fusion peptide is the part of the virus that sticks to a host’s cells and transfers genetic material. The fusion peptide is present in all variants of COVID-19 and even exists in other types of coronaviruses, namely MERS and SARS. The experts at UVA Medical Center quickly developed a vaccine centered around the fusion peptide and tested it on pigs. Results from the study found that the test animals were immune to COVID-19.

Although Zeichner’s team was happy with the results, it came as a great surprise. Originally, Zeichner and his colleagues were attempting to develop an inexpensive alternative to the current COVID-19 vaccines. Zeichner explains that while the mRNA vaccines from Pfizer and Moderna provide excellent protection against COVID-19, the manufacturing process for them is highly intricate and not available in many parts of the world. Zeichner sought to develop a new vaccine against the coronavirus that would be easier to manufacture by infusing the virus with e-coli bacteria. In preparing to develop the new vaccine, Zeichner’s colleagues examined the genetic sequencing of COVID-19 and realized that the fusion peptide was universal throughout all of its variants.

While Zeichner is excited about the results, he explains that the vaccine is still in development and his team is still altering it to ensure that it offers maximum protection against the coronavirus. Furthermore, as a small lab, UVA Medical Center is not ideally suited to manufacture the vaccine and distribute it on a worldwide basis. To help with this problem, Zeichner has already reached out to the International Vaccine Institute of the World Health Organization.

1

Avoiding the Delta Variant While Outdoors

For the majority of the pandemic, it has been recommended that people gather outdoors if they must gather at all, but that appears to be changing a little. The Delta variant of covid-19 has changed the playing field even among the vaccinated. Initially, we were advised to take as much of our daily lives outdoors as possible in order to reduce transmission of the virus. Makes sense, right? Well, with how the Delta variant has changed things, we thought we should put together a list of measures people can take to reduce their risk of exposure to the Delta Variant.

Mask Up!

First and foremost, the easiest thing a person can do to reduce transmission, regardless of whether or not they’re indoors, is to wear a mask. Surgical masks, respirators, and N95 masks have all been shown to reduce transmission by limiting the number of aerosolized particles that spread in our breath, sneezes, and coughs.

Get Vaccinated

Vaccinated people are 25 times less likely to fall significantly ill with the delta variant. Getting vaccinated is simple, free, and absolutely encouraged right now. It is the best way we can help reduce transmission and do our part to flatten the curve. By bolstering our immune systems through vaccination, we can ensure that our bodies will be better equipped to fight off the virus more effectively, and thereby lowering our risk of infecting someone else.

Social Distancing

Beth K. Thielen, MD, Ph.D., is an assistant professor of pediatrics at the University of Montana has encouraged people to continue socially distancing even when outdoors. The Delta Variant has been shown to spread even when outdoors, which has some medical professionals, like Dr. Thielen, rightfully suggesting that we revert to older, more established, and cautious preventative measures.

Conclusion

The increase in both breakthrough cases and outdoor infections indicates that we might need to exercise a little more caution with the new prominence of the Delta Variant. Doing our part to minimize transmission of the virus has become our civic duty as citizens not of our countries, but of humanity itself. The tips and recommendations here aren’t comprehensive by any means, but all of them offer a good rule of thumb to go by.

Unraveling Fragile X Syndrome

In 1943, Julia Bell and James Martin first described the sex-linked heritable condition now termed Fragile X Syndrome (FXS). In their paper, “A Pedigree of Mental Deficit Showing Sex-Linkage”, they described a single kindred in which eleven males spanning two generations  exhibited mental deficiency. After detailed investigation, the researchers concluded that the condition was heritable, sex-linked, and involved abnormal brain development. Since their initial description, much has been learned about Fragile X Syndrome, and yet the odyssey to lessen its impact on affected individuals and their families as well as future generations remains challenging.

 

Fragile X Syndrome is considered the most common cause of inherited intellectual disability. Although disease estimates are probably not precise for a number of reasons, the incidence among males is considered 1/4000 and among females 1/8000. In the 1990’s, the molecular basis for the disease was identified and found to lie within the FMR1 (Fragile X Mental Retardation 1) gene on the long arm of the X chromosome. Since that time, a whole new class of molecular disease has been characterized based on the presence of unstable and abnormal expansions of DNA triplets (trinucleotides). The normal FMR1 gene has CGG (cytosine-guanine-guanine) trinucleotide repeats  in the range of 7-54 in the 5’ untranslated region. The gene codes for FMRP (Fragile X mental retardation protein) which is responsible for the regulation of a number of cellular processes, not the least important of which is the development of brain synapses and the relaying of nerve impulses. In FXS, the CGG repeat expands to over 200. It is this abnormally expanded and hypermethylated  CGG segment that turns off (silences) the FMR1 gene and halts the production of FMRP. The loss or shortage (deficiency) of FMRP disrupts nervous system functions and leads to the signs and symptoms of FXS. Identifying trinucleotide repeats as the basis for disease has brought about a greater understanding not only of FXS but also a complex set of neurological diseases, such as Huntington’s Disease, the spinocerebellar ataxias, and myotonic dystrophy.

 

Since the FMR1 gene is located on the X chromosome and expansions of the CGG repeat  can include greater than the normal but less than the over 200 with the full mutation, a  number of different phenotypes are described based on the affected sex and the number of CGG repeats. In males, the mutation (> 200 trinucleotide repeats) often results in the full spectrum of FXS  signs/symptoms, including intellectual disability, speech/language and developmental delay, facial characteristics ( long face, large ears, broad forehead, joint laxity, macroorchidism) which become more apparent with age, and behavioral disorders (social anxiety, ADHD, autism). In females with the full mutation, the symptoms are often less frequent and severe most probably due to females having two X chromosomes (as opposed to males having a single X chromosome) and skewing of X inactivation among females.

 

The males and females with lesser repeats of the CGG segment (55-200) but greater than normal are said to have an FMR1 gene premutation primarily because expansion to the full mutation can occur in succeeding generations (genetic anticipation). Individuals with the premutation typically are intellectually normal. However, they may have lower than normal amounts of FMRP and consequently exhibit milder versions of the physical features and emotional problems  seen with the full mutation. On the other hand, two related disorders due to the premutation of the FMR1 gene are FXTAS (Fragile X-associated Tremor/Ataxia syndrome), a Parkinsonian-like syndrome occurring mostly in older males, and POI (Premature Ovarian Insufficiency) in females.

 

It is apparent that the spectrum of symptoms in individuals with the full mutation and with the premutation is extremely broad. In addition, the behavioral and developmental symptoms have significant overlay with autism and may be compounded by other neurologic disorders such as seizures. These  features make the clinical diagnosis of FXS difficult and often time-consuming. Fortunately, Fragile X Syndrome can be diagnosed with the blood FMR1 DNA test using Southern Blot analysis or Polymerase Chain Reaction (PCR). Clearly, it is imperative that any child who presents with global developmental delay, autism, and/or intellectual disability be tested for FXS with the FMR1 gene test.

 

Despite advances in the molecular understanding of FXS and its pathophysiology, treatment remains for the most part symptomatic and includes special education, behavioral therapy, and medication specific for ADHD, seizures, and neuropsychiatric problems. Molecules  aimed at targets in pathways that are dysregulated in the absence of FMRP continue to be developed and tested in order to offer effective drug therapies, but thus far overwhelming satisfaction has not been achieved. In the future, it is intriguing to envision the role of genome editing and CRISPR technology in the cure of this single gene disorder.

 

Tackling Postpartum Issues

Tackling Postpartum Issues by Dr. Allen ChererWorking in the field of neonatal care, I know all too well the health risks that come with pregnancy and childbirth, especially among women who can’t readily access health care.  Some common (and serious) postpartum health conditions include diabetes, hypertension, and depression, all of which are more common among racial and ethnic minority women.  However, it’s hardly a lost cause, and doctors can do their part to connect women suffering in the pregnancy and postpartum period to healthcare.  I recently read an article by Elizabeth A. Howell, whose work creating an “intervention design” at Mount Sinai is based around providing postpartum care to women.  This was recently published in the Maternal and Child Health Journal.  

According to the Healthcare Effectiveness Data and Information Set (HEDIS), at least 80 percent of commercially-insured women in this country have a timely postpartum visit.  Yet among those insured by Medicaid, that percentage goes down to about 60.  This is due to various factors: transportation, child-care demands, money, and poor doctor-patient communication.  While there isn’t an “easy fix” to this problem, reducing the barriers between patient and doctor makes it much easier for women to receive the necessary postpartum care.  In the article, Howell outlines various ways that her design reduces that barrier: education about the risks and importance of postpartum care, community resources, and financial incentives for providers who help make sure women return for postpartum care.  Since such a large percentage of patients are Spanish-speakers, her interventions are available in both English and Spanish.  

So far, Howell’s program seems to be yielding some good results: the visit rate for Healthfirst patients at her hospital was up to 71 percent through 2016.  Patients, many of whom are socially isolated, have also expressed their appreciation.  Through my experience, I can tell you just how serious the postpartum period is for the health of mothers as well as children.  I’ve thought about the many positive benefits of assuring comprehensive postnatal care.  In the end, I think this may turn out to be the best way to improve prenatal care, and consequently newborn outcomes.

Page 1 of 2

Powered by WordPress & Theme by Anders Norén