Newborn babies are extremely fragile creatures and they may be suspected to numerous disorders. Congenital defects in the neonates, as well as acquired maladies, place the baby in an unstable condition and may lead to long-term morbidity or even mortality. Thus, it is essential for everyone in the medical community to be aware of unique diseases associated with the neonatal period of life. The cause of congenital defects is unclear. Some claim that genetic factors play a crucial role in the etiology of these disorders, while others attribute such diseases to maternal exposure to environmental or behavioral factors. Nevertheless, in most cases the reason why a baby suffers from a congenital defect is unknown.
According to the March of Dimes, the US organization aimed to improve the health condition of mothers and their children; congenital heart disease comprises the majority of all congenital defects in neonates. Congenital heart disease is an inborn disorder of the heart, when there may be an innocent murmur in the heart, which may carry numerous disadvantages for an individual. In the US, one out of 125 newborn has some kind of congenital heart disease. This is the leading cause of neonatal mortality; however, if properly managed, most of these babies will live to be socially active humans. Moreover, the last five decades succeed in providing neonates with adequate medical aid and the number of grown-ups with congenital heart defects is growing.
The Critical Congenital Heart Defect
A critical congenital heart defect is a disorder that leads to high mortality within the neonatal period if left untreated. Among them is transposition of great arteries, hypoplastic heart syndrome or coarctation of the aorta. In the past, mortality from these conditions had been unacceptably high. For example, Taussig stated, “The majority of cyanotic infants do not survive for more than a year and a half”. It was not until antibiotic invention in the 1940’s, mechanical ventilation advent in the 1950’s and prostaglandin therapeutic approach development in the 1970’s, that survival of critical infants improved. Surgical techniques evolved, too. The first attempt to palliate transposition of the great arteries dates back to the 1950’s and the first successful arterial switch operation was reported in 1983. This is the last half of the 20th century that made pediatric cardiology a wonderfully exciting and rewarding specialty. Today many of these fragile conditions can be adequately managed, thus giving a chance to bring up wonderful individuals to admire. Clinical and scientific advantages of the last decades made the practice of care of children with cardiac disease a neonatal specialty. Today, diagnosis of cardiovascular malformations of a fetal is routine. Either palliative or reparative surgery within the first weeks of life is commonplace today, which results in improving long-term prognosis.
The Genitourinary Defect
The second most widespread defect of a neonate is genitourinary defect, namely obstructive genitourinary and bladder exstrophy. The former is the narrowing of the urinary tract. One out of 350 babies carries the disorder. This malfunction may lead to renal impairment, kidney stones and sexual disability in the adult. On the other hand, proper ultrasound diagnostics and appropriate surgery result in excellent long-term results. When a part of the urinary bladder is outside, the abdomen bladder exstrophy is recognized. This is an ominous abnormality, even if successfully surgically treated, may result in the long-term disabilities, like incontinence or recurrent infections.
Neurological and Pulmonary Conditions
Neurological and pulmonary conditions must be mentioned among the acquired diseases. Neurological impairments and pulmonary disorders lead to neonatal morbidity. Cerebral palsy is the third most common defect among diseased newborn. It makes an important contribution to the total burden of neurocognitive disabilities. Immature brain being extremely sensitive to perinatal disturbances; newborns, especially those with low birth weight, preterm or after parturition asphyxia, may develop bad complications, such as intraventricular hemorrhage. To add congenital malformations, cerebral palsy ranges 1.5-3 per 1000 live births. The dominant feature of cerebral palsy lies in motor deficits, although mental retardation may be a common consequence. It is strongly believed that preterm birth, intrauterine retardation and perinatal asphyxia play a major role in neurological injury. This is the reason for which these etiopathological options need to be kept in mind. For example, intramuscular dexamethasone injections at the end of preterm pregnancy are beneficial for lung maturation, thus providing a baby with more sufficient oxygen supply.
The Respiratory Distress
Most grieving respiratory disorders in infancy result in respiratory distress. Many acquired conditions summarize this term – transient tachypnoea of the newborn (delayed clearance of fetal fluids from the lung), pneumonia, meconial aspiration syndrome, hyaline membrane disease (a common condition in the preterm babies). Respiratory distress represents the most frequent indication for re-evaluation of the young infant (Aly, 2004). Both maternal (diabetes, infections) and obstetrical (premature delivery, meconium sustained amniotic fluid) conditions may result in pulmonary neonatal disease. Although many diseases of the mentioned above are relatively benign today, some still lead to the pulmonary illness in the adult.
Care of a neonate with an acquired or congenital sickness must be a teamwork. It is a collaborative process shared by many physicians as well as nurses. There needs to be a free exchange of ideas and expertise on a daily basis. A non-interrupted educational process experienced by the neonatal team, no matter how difficult it may seem, is a noted thankful operation. It is the nurse who assists in contributing to the recovery of the diseased. The workload and its demands for a nurse are exceptional. She finishes one task with an infant just in time to start the next one, and when finished, she is ready behind to do the same task again on the first baby. In neonatology, mistakes may be inevitable, but every procedure is potentially lifesaving.
Developed countries now provide adequate medical support to challenging disorders. What was an irresolvable problem in the past may be more or less approached today. Infants suffering from acquired and congenital disorders survive much better today. Statistical data show that the number of these babies is substantial, which leads to the medical overwork, economical burden and potential socio-demographic changes. As medical policy shifted to more precise management of challenging newborns, numerous effects occur that the society will have to cope with.