Scott Webb (Host): Caring for a newborn and keeping them healthy can lead to sleepless nights and lots of worrying for parents, of course. And I'm joined again today by pediatrician, Dr. Nivedita More. She's here to discuss common newborn conditions and how we can keep our newborns healthy.

This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Dr. More, always a pleasure to have you on the podcast.

Nivedita More, MD: Thank you so much for having me, Scott.

Host: Yeah. It's great to have you here. It always just brings a smile to my face when I know I'm going to speak to Dr. More, and we're talking about something-- you know, my kids are much older, so I have different worries with a 17-year-old and 21-year-old, but I remember when they were newborns and those conditions, those dreaded conditions that newborns have. So, let's start there. What are some of the most common conditions in newborns?

Nivedita More, MD: A few common conditions or concerns that can affect newborns include jaundice, feeding issues, reflux, diaper rashes, other skin rashes, you know, delayed cord healing, cradle cap, and some gassiness just, you know, to give you a few of them here. These are some things that parents worry a lot about and we see them a lot in practice.

Host: Yeah. And those sleepless nights that I mentioned in my intro, some of that is because it's just, you know, listening to a baby sleep, listening to a baby breathe, watching this amazing little thing that you helped bring into the world, and then some of it is the conditions, of course, and the worrying. And that's why I want to ask you now about the symptoms, like what should we be on the lookout for?

Nivedita More, MD: Yeah. Parents should definitely monitor their newborns closely for any signs of illness or distress for that matter. They should be able to recognize symptoms that are normal from what are not normal or what are worrisome and definitely those that need attention from their doctor. Conditions like mild jaundice in the first few days or spit ups or, you know, even sleeping after they feed, some crying between feeds, wanting to be held a lot, these are all normal things, and we don't worry about them. But some of the times new parents don't know that they're not worrisome, and they will call us with these. Babies also startle, you know, with their hands like that when parents put them on their backs in the bassinets or in the cribs, and they have loose stools, they have mustard-colored poop. And these are all normal things in babies that are breastfed, and these are not concerning at all to us.

It is not uncommon for us pediatricians to see these parents worry about all these things all the time, and our job is to reassure these patients and parents at the first newborn visit within the first week of their life to tell them, you know, "See, these things are all fine. They're normal, not to worry." Yeah, just reassurance. A lot of reassurance is necessary.

Host: Yeah. It's one of all the many things that pediatricians do, all the wonderful things that pediatricians do. They get us not to worry so much. And definitely a difference between, you know, as you say, like if it's your first newborn versus your second or more, you know, by the time we had the second one, I knew not to worry about every little thing that most of what I was seeing and hearing was normal. Just wondering, Doctor, what do we do to keep them healthy? Like what can we do for our part as much as possible to keep our newborns healthy?

Nivedita More, MD: Absolutely. You know, first and foremost, parents need to ensure proper nutrition for all their babies. Whether it is breast milk or formula, babies need to be fed every two to three hours in the first month of their lives. I always tell parents, more than eight is great, and that kind of sticks with the parents. Sometimes they feel like, "Oh, they're, you know, just fair. They're sleeping a lot. Let them sleep." No, not okay with us. We need to wake those newborns, feed them every two to three hours, just so that they get the proper nourishment that they need in the first month. All newborns lose a lot of weight in their first few days of life and we want to make sure they spring back up appropriately with adequate nourishment.

Dressing the baby appropriately and maintaining the correct temperature at home is extremely important. We don't want the home set more than 70 or 72 degrees Fahrenheit. And that's the recommendation to prevent overheating the babies. it is advisable that babies wear an extra layer of clothing more than anybody else at home and that's to keep them warm enough, but not too warm, and definitely not get them cold. Otherwise, they'll be burning a lot of calories to keep themselves warm. And here we are struggling to gain, you know, an ounce a day after our first few days of life. And if they start burning calories to keep themselves warm, that doesn't go well with their weight and that doesn't go well with the growth of the baby.

They need to practice safe sleep habits along with maintaining adequate temperature. We're placing their babies on their backs on a very firm mattress, which is recommended by the American Academy of Pediatrics, in a crib or in a bassinet, not on the soft bed that the parents are sleeping, and also maintain a smoke-free environment. So, we recommend nobody in the house is smoking around the baby because that will prevent sudden infant deaths and this is really important that parents understand safe sleep for their babies to keep them healthy.

Maintaining good hygiene by washing hands before handling the baby, after changing the diaper, also before feeding the baby is important. Bathing the baby every two to three days. So, a couple of times a week after the umbilical cord has fallen off and keeping the skin moisturized with a lotion is recommended from the get go.

Staying up-to-date with vaccines which are recommended by the CDC and the American Academy of Pediatrics is important, and this is also important to protect them from serious vaccine-preventable diseases like whooping cough, polio, RSV, just to name a few.

Limiting their exposure to sick individuals, especially in the first few weeks, including their siblings for that matter, who are in daycare or in schools in the first few weeks and even in the first few months is important, because babies don't get all their vaccines, you know, at birth. They are based on their age. And getting airborne illnesses and airborne viruses is important in this age group. So, avoiding crowds, you know, when impossible and encouraging visitors and older siblings who are sick from handling this baby is important. It's important that visitors wash their hands really well before they touch this baby or even siblings when they're handling the baby need to be washing their hands to keep them from getting sick. Yeah, these are, you know, just a few guidelines in terms of how we can keep these babies healthy while they're growing.

Host: You're reminding me, bringing back fond memories, especially of our daughter and my patented method of wrapping her in the blanket, sort like a burrito was the approach my wife told me. Think of her like a burrito and you're wrapping a burrito. And I became very adept at it, Doctor. Are there any conditions that warrant immediate attention?

Nivedita More, MD: Yeah, absolutely. And, you know, this is important that the parents understand what is normal from abnormal to what is urgent. Any fever over 100.4 degrees-- a lot of parents, you know, prefer the rectal temperatures-- whether rectal or skin temperature, any temperature over 100.4 in the first three months of life is concerning to us. These can be conditions which get transmitted from the mother to the baby in the womb, and they can present as late as two or three months of age. So, we need to know if the fever, our temperature increases over 100.4 for any baby.

Any breathing difficulties where the babies are breathing really fast, they're breathing more like 60 breadths per minute. I mean, normal breathing rate is more than you and me, which is about 40 to 60 breaths per minute. But if babies are breathing faster than that, there is a concern in the lungs, and this needs to be brought to our attention immediately.

Severe jaundice, where the babies get really yellow or they start looking like a pumpkin, I say, that is a concern because, you know, a little bit of yellowing of the skin is not a huge concern for us. But if the baby is seriously looking super yellow, almost orange, that is a big concern for us because it's the byproduct called bilirubin or the metabolite called bilirubin, which happens only in newborns, can escalate to levels where it can get deposited in the brain and cause this serious disease called kernicterus and have, you know, deafness and other problems later on in life. So, it's really important that that gets picked up immediately and parents bring that to our attention.

Persistent vomiting where babies spit up here and there, I'm not so concerned. But if they are vomiting every feed, it's projectile, it's really hitting the wall, it could be some sort of obstruction in the stomach or somewhere else, and we want to make sure that that gets addressed immediately. If the babies are feeding poorly or they are very lethargic, then we start getting concerned and we need to know about it right away because babies are supposed to be eating every two to three hours. But if they're just being, you know, so lethargic that they can't be woken up or they are just not eating enough, they can get very hypoglycemic very, very quickly and that can be not good for them. So, we need to make sure we see those babies immediately.

Any bluish discoloration around their lips or mouth is a concern, and that can be a sign of a serious congenital heart disease. A lot of these heart diseases can manifest as, you know, a heart murmur or something else in the newborn period while they're in the hospital. But there are a few conditions which can show up after the baby goes home. So if the parents notice that there's any discoloration around their lips as well, especially looking like bluish color or what is called a cyanosis, we would like to know about that immediately.

Any abnormal movements, any jerky movements, you know, small ones are not concerns. But if they are almost looking like convulsions where the baby passes out or rolls their eyes upwards that can be a serious condition and we want to know about that immediately as well. If the poops or stools have blood in them or they have really dark stools, that can be a sign of bleeding inside the intestine, and we want to know immediately, and we need the parents to contact us immediately about those things.

Any redness or swelling around the umbilical cord, whether it is in the first week before it falls off or even after it falls off. It takes about a week after it falls off for it to heal completely. Sometimes the cord can get infected. And if it is looking red or swollen or it smells weird or funky, we want to know about that.

Any injury or trauma to the baby, newborns are wiggly, they are almost like a noodle. Sometimes it's hard for new parents to handle them. I've had parents drop them sometimes when they're trying to put them in a BabyBjörn or in a Kangaroo. It can happen. And any injury to the baby or to the head of the baby, we would like to know.

You know, if any of these symptoms that I just mentioned occur or happen, I definitely ask all parents call 911 and seek immediate medical attention. Acting quickly can prevent serious complications from any of these illnesses and will definitely ensure that the baby receives the necessary treatment and care. So, it's important that the parents understand what's urgent versus what can wait and, you know, be spoken to their pediatrician office the next morning.

Host: Let's finish up there, doctor. Let's talk about the things that can wait till the next morning, right? And of course, you know, first child, second child, we call the pediatrician a lot more the first one than we did the second one. So, you give us a sense there of the conditions, the things that would need immediate attention. So, when can we wait till the next morning to call, Dr. More?

Nivedita More, MD: Parents should talk to their pediatrician definitely during their routine visits which are normally scheduled around the third to the fifth day visit, is the first visit with us. Also at the one month, two months, four months, six months, nine months and the 12 months of age. That's the best time to bring up any concerns. But if there are any signs of illness that warrant a consultation, they can always make an appointment with us.

Some of these conditions include poor feeding, fewer than six wet diapers after the first week of life, any diarrhea or bloody stools or choppy stools, unusual irritability or excessive crying, dark urine or concentrated urine, any jaundice or yellowing of the skin lasting beyond first few weeks of life. We would like to know about any non-healing umbilical cord stump, with bleeding or any, you know, smelly umbilical cord stumps, we would like to know about that sooner as well. Any excessive bleeding or diaper rashes that are not healing from the diaper area. Those are concerns for us and parents should bring that to our attention.

Parents should also trust their own instincts at all times with their babies, as, you know, the parents know best for their own babies, and it's best if they think that something is off, it might be best to connect with their pediatrician.

Host: Yeah. When in doubt, reach out to pediatricians. They're the best. You're the best. You know, I mentioned, you know, like first child, we called a lot, a lot less with the second child. But if in doubt, you know, if you feel like it's an emergency, call 911, course. And if it's not an emergency, but something that the pediatrician should know, reach out, bring it up at the wellness visits. We certainly spent a lot of time there. That first year with a baby, you're there a lot. There's ample opportunity, right, doctor?

Nivedita More, MD: Yes, absolutely. There's ample opportunity with the baby.

Host: yeah. Well, it's always a pleasure to have you on. And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.