Well-being of Newborn Babies

Dr Tom Lissauer answers your questions about the well being of newborn babies.

Claire Bishop: Whilst brining home the new born baby is a time of complete joy and happiness for most parents, it can also be a time of fear and worry for others. Looking after new baby is a huge responsibility and when you are a first time parent, you don't always know what to do or what to look out for. Tom Lissauer is a Consultant Neonatologist at St. Mary's in London and is here to answer some questions on newborns. First of all, Neonatologist, now that's one I have not come across, what does a Neonatologist do? Dr. Tom Lissauer: Well, we are Consultant Pediatricians, but we specialize in looking after newborn babies. Primarily, that's in Special Care Baby Units. So, it's sick newborns, particularly Intensive Care, but also well newborns as well. Claire Bishop: And let's go back to the Special Care Baby Units, when is a baby usually admitted and why? Dr. Tom Lissauer: Most babies who need to be admitted to a baby unit are admitted immediately after birth or shortly after birth and about one in ten babies get admitted. So, many parents will encounter the insides of a baby unit. One of the common reasons is because prematurity. But in fact, the majority of babies who are admitted to neonatal units, are term babies, so they are babies born at the right time, but they develop problems such as, breathing problems, shortly after birth. Claire Bishop: Now you talked about the newborn baby examination, what actually happens at one of these? Dr. Tom Lissauer: Well, newborn baby examination is something that happens to all newborn babies. And it occurs within the first 24 hours after birth, and it's really a general check up, it's an MOT for newborn babies. And what it does is it allows one to identify any particular problems simply from examining the baby; although severe problems would have been identified immediately after birth. But there are some special checks that are done at the same time. One of them is to check the hips, another is to check the eyes. And it's also a very good opportunity for parents to ask questions about whatever they are concerned about. And also to give advice to new parents. Claire Bishop: Now, if your baby is admitted to the Special Care Baby Unit, I would imagine that for most new, first time mothers, and even ones with children already, the alarm bells would ring. What is their to help parents, if your baby is admitted? Dr. Tom Lissauer: Well, I think the baby units are quite alarming. Although it's a lot less alarming now than it was in the past. I think with so many people watching 'ER' and so many programs about hi-tech medicine, coming into a neonatal unit is nothing like as awe-inspiring as it was in the past. But there are many things that we do to help parents. First of all, I think all the staff are very aware that this is a stressful thing for parents to encounter. So, they are welcoming, they explain everything that is going on. So, there is nothing hidden from parents. We also make sure that we show parents around, have facilities for parents where they can go and have a break away from the baby unit and of course, have some accommodation for parents near by, so that they can stay with their baby at all times. Claire Bishop: Now parents really do want to be with their baby all the time, but if your baby is in a small cot which is covered, that must make it very difficult for the mothers to bond with their babies. So, what you can do to help them with that? Dr. Tom Lissauer: Yes, it's interesting that you mentioned the word bonding because, there was a time when people thought that having a baby admitted to a baby unit would mean that mothers wouldn't bond with their babies. The term bonding actually comes from something that we observe with various, animals such as ducks or if you think of say, penguins, you see these thousands and thousands of penguins all on a beach, but the mother knows her newborn baby. And in order for her to do that, it's crucial that she and her baby are together immediately after birth. If they are not, then she wouldn't recognize the baby as being her own. And so, people thought that, if mothers were not with their babies in the immediate newborn period, then they wouldn't bond with their babies. And of course, we have come to realize that humans fortunately are much more complex than that. And yes it is more difficult because you are separated and there is the anxiety about your baby not being well, otherwise the baby wouldn't be in a baby unit. But parents do manage to overcome those problems and indeed even with the very tiny babies, parents are encouraged to touch them and to help with their care. So, if you go around the baby unit, you will find parents giving their babies feeds via tubes and so forth and actually they become very skilled, very quickly at many of the caring tasks for their babies. Claire Bishop: You mentioned tiny babies. Years ago, the outlook for tiny babies wasn't necessarily all that good, have things improved now? Dr. Tom Lissauer: There has been a huge improvement in the outlook for premature babies. That's being because of various medical advances. Some of it's because of drugs such as, steroids that are given to mothers, if we know that their babies are going to be born prematurely. Then there has been some new medication called Calfactant, which is used to treat the lining of the lung, which is often deficient in very premature babies. And that has really transformed the outlook for premature babies. So whereas, about 10-15 years ago, we were worrying and struggling with babies who were born about say, 8 weeks premature, now we are struggling with babies at the limit of viability and that's between about 23 and 28 weeks of pregnancy. So, that really is very, very early. Claire Bishop: You mentioned about the importance of bonding, but does the actual touch of parents improve the baby's outlook, when they are that tiny, or is it just purely from the parent's point-of-view, does it help the baby? Dr. Tom Lissauer: Oh! I think that it does help babies and babies are calm when parents talk to them. And the interesting thing is that they quickly become accustomed to their parent's voice and their parent's touching. Claire Bishop: Now, I know you mentioned the routine examination you do when babies are first born, but you mentioned just then hearing, is that really something you can tell at that early an age? Dr. Tom Lissauer: Well, that's being one of the exciting new developments actually and that is that we now can test hearing of newborn babies. It's usually done in hospitals using special equipments, but if it's not done in hospitals, it's done in community clinics after the baby has gone home. And the great thing about the early detection of hearing problems is that it means that we can provide assistance with hearing. And that improves markedly the speech of hearing impaired babies. So, that really has been a dramatic new development. Claire Bishop: But also, are there some things you discover that maybe a baby has a hearing problem, but it will right itself anyway. It's not necessarily the most tragic news a parent will get. Dr. Tom Lissauer: That's the case, but the ones what we are detecting in the immediate newborn period are severe problems. Most of the problems that are minor ones are ones that develop during childhood or in adult life. Claire Bishop: Now the other area around though, where you must have to get involved is in cot death and that is a thing that scares a lot of new parents. What can parents do to reduce the risks of cot death? Dr. Tom Lissauer: Well, cot deaths of course are always very tragic when they happen, and they have been in the news very much recently. But fortunately again, the number of babies dying from cot deaths or Sudden Infant Death Syndrome, as it's called medically, has reduced dramatically over the last ten or so years. And that's because we discovered that actually if babies were put down to sleep, to lie on their backs, that reduces the incidents markedly. So, we advise all parents now, to put their babies on their backs when they put them to sleep. There is also other advice, which is not to smoke near one's baby. Then there is also advice to put the baby with a feet at the bottom of the cot and not to overheat babies. The temptation is to put lots and lots of baby grows and lots of blankets on babies and they get overheated. Claire Bishop: It must be very difficult for new parents though to work what the right temperature is, I think everybody's fear is that their baby is going to get cold, so that's why they layer them up. Dr. Tom Lissauer: Well, there is good advice now given to all parents, of every baby, from the Department of Health. And the best guide is to do what's comfortable for yourself. So, if your room is what's comfortable for you, that's going to be comfortable for your baby. One of the tendencies in the past is that parents have made the rooms of their babies very, very hot, and then put lots of clothes on them as well. And then especially, if they become ill, then they have become overheated. So, the recommendation now is not to put too many layers, and certainly just to keep the room temperature the same as you would in any other room. Claire Bishop: Now I know a lot of mothers have been very worried, because they have not been prepared for the way a newborn baby looks. Some told me that their babies looked a little blue, is this normal? Dr. Tom Lissauer: Well, the thing that most parents notice is the hands and feet look blue and that is standard for virtually all babies. They don't usually, otherwise their tongues are pink and remain pink, although sometimes they can very briefly become dusky during feeds, but recover very quickly afterwards. Claire Bishop: But if a baby turns blue, that is obviously a cause of concern? Dr. Tom Lissauer: Then the baby should be checked. Claire Bishop: And I know the breathing is also another big worry for new mothers. If a baby stops temporarily breathing, is that a normal instance of growing up, or is this another cause for concern? Dr. Tom Lissauer: Yes, babies do breathe in their own way and then do periodically, just momentarily stop breathing and then they start breathing again. Claire Bishop: It must be very worrying for mothers though? Dr. Tom Lissauer: It does sometimes cause worries. Fortunately babies are very resilient and they do soak themselves out in such instances. And in fact, parents become very expert at recognizing the no breathing patterns of their babies and they really are the best judges and become the best judges very quickly. Claire Bishop: So, there is no normal pattern of breathing, each baby is different, are they? Dr. Tom Lissauer: They are similar, but they are a bit different. And parents become very used to their particular baby and that's why, altogether when babies become unwell, parents are very good judges, they realize that their baby isn't right, usually before anybody else does. Claire Bishop: And colic is the other one that really scares parents. What is actually happening when a baby has colic? Dr. Tom Lissauer: Well, of course, we don't really know exactly what's happening when babies have colic, because they can't tell us. But it does look as though they are getting stomach cramps and it's uncomfortable for them, and the thing to do really is to comfort them and of course, most parents do that naturally and they will walk around and pat their babies on the back and that generally soothes the babies. Claire Bishop: And is that just a passing phase usually? Dr. Tom Lissauer: It's a passing phase and it's very much around the age of six weeks to three months and then it gradually improves. Claire Bishop: Some parents are not sure whether they should have the baby in bed with them or in a separate cot, which his preferable? Dr. Tom Lissauer: Well, the current recommendation is that, for sleeping, parents and babies should be in separate beds and cots. Of course, that doesn't stop one from having baby in your bed to feed, to play with, and to have his company. But when you actually go down to sleep, then put the baby in a cot, next to one's bed, in one's bedroom, for the first few months and not to have the baby in the same bed as you. Claire Bishop: I know a lot of mothers quite like the idea of bonding with their child, with it in the bed, that's just not a good idea or is it? Dr. Tom Lissauer: Well, that's the current recommendation, just the worry is that if parents have been having a bit to drink or are very heavily asleep, in case they roll over, or could hurt their baby in anyway. So, that's currently what's recommended. Claire Bishop: Now, I know, there are a lot of anxious mothers out there with a new baby, no instructions, don't know quite what to do, they haven't quite worked out what the regular breathing pattern is. Do babies need to be watched at night? Because I know a lot of parents think, oh! Gosh this is when trouble is going to be here, I am not here to watch. Should they be watched every hour, every two hours, what's the advice, I mean they are going to be exhausted of course. Dr. Tom Lissauer: Yes, I don't think that there is any need to watch babies breathing. Because there is probably very little to be gained by doing it. But parents naturally are anxious about their babies and will observe them and to make sure that they are alright and that's fine. There is certainly no recommendation or rule to do it every hour and get up and keep observing your baby. Because there is no evidence that that actually makes any difference. Claire Bishop: And you will be a better parent when you have got some sleep inside you. Dr. Tom Lissauer: I think you are right. Claire Bishop: Tom, thank you very much for joining us. Dr. Tom Lissauer: My pleasure!