Hello and a very warm welcome to our series – Virtue Baby. How we have understood many aspects of parenthood The foundation begins when the baby is in the womb itself. We have received a emails with questions from the audience To discuss them we have senior neonatologist and pediatrician Dr Poonam Sidana. Welcome, doctor. Thank you. We have understood several aspects of the baby’s journey and the fears and anxieties of the mother. During pregnancy, when the mother goes for an ultrasound, she gathers certain information What does neonatology cover? Pregnancy is a very healthy event for the mother. Even if you check across medicine Pregnancy is a time when you are not a patient. You come with a lot of hope and excitement. But sometimes parents can get very upset and sad when they get to know that There are some issues with the baby inside. They don’t know whether it’s a small issue or big. A lot of people start giving advices. So the obstetrician sends them to us So we need to work out what systems are involved and how major the issue is. We need to convey to the parent in a way that they don’t feel hopeless. We need to be careful and involve the family also. Some parents are very mature. What does neonatology comprise of? In very simple terms New means new and natle means anything, so we are talking about a new birth. So it’s about the baby about to be born. There is another branch perinatology. It also means a new born specialist but your role Begins even before the delivery. If a complication is detected during pregnancy Then the obstetrician sends them to us. We need to study the case and counsel the parents. We need to explain what is the problem with the baby. What are the chances in future. We need to do all this very gently. They would have come in a very happy mood and will be waiting for a happy event. So suddenly they feel that everything has changed. So we need to counsel and support them Even if the situation is bad we need to present it in a positive way. And we have to carry on with the pregnancy. It involves arrangements With a paediatric surgeon Or a genetic specialist. The mother may need certain investigations. But the beauty of it is In today’s times we detect a lot of things initially itself Initially it may feel complicated So many cases that will eventually have a happy ending. If you get proper care and timely intervention Then the outcome in most babies Will be nice in the long run. When it comes to premature babies today The fear in world about it and then the baby is separated from the mother initially. Does it affect the child and the mother? What is the scenario overall? Prematurity is not a new thing. It was there in earlier times too. If the baby was too premature, they would let go of it earlier. Be here about stories where the child was kept in cotton bed and nurtured and the child would eventually be fine. Worldwide about 10% to 12% of the babies were premature even in earlier times. Even now it’s the same percentage. It can be very traumatic for the family. Because you will never imagine that there can be a problem with your child. 85% to 90% of the pregnancies are normal. 10% to 15% of them will have different issues. Prematurity is one of them. Such babies need specialised care. It is like plucking a unripe fruit from a tree. It depends on how unripe it is Accordingly the baby is kept in NICU, which is an ICU for the newborns. There are different levels. Extreme preterm means less than 1 kg or 700 grams Such babies need a different kind of care. Lungs may not be fully developed, so baby maybe on ventilator. They cannot take the feeds by themselves. There are ways like intravenous methods through which fats, proteins and all nutrients are given. They will help the baby to grow well. Although baby is separated from the mother we try to involve her as much as possible. After the mother recovers, we encourage her to sit with the child everyday. For as long as she can be there. When a child is at home, parents keep talking to him. We ask parents to record everyone’s voices in the family Or even based on their religious or spiritual beliefs, we ask them to record what they wish and give it to us. We play it all for the baby. So that the simulation which the baby was supposed to get from the mother’s womb. Or when the baby is at home We try to maintain that continuity. Once the child becomes stable What is called Kangaroo Mother Care – KMC. The mother Kangaroo carries its baby all the time So there is skin to skin contact. Primarily with the mother. Otherwise father or grandparents Anyone who is willing to do, we ask them to sit in the ICU. We try to keep the bonding of the baby with its family, to the maximum. And the separation level should be at the minimum. It is a very taxing and tiring period. Does it have a long term effect on the child? If it’s a very premature baby, then you carry certain risks even into the long term. But that risk needs to be taken. Having said that We monitor a lot of parameters There are ultrasounds taken To check if there has not been any bleeding. We continuously observe the baby’s activities. We protect the baby from infections. If at any point we feel that the outcome in the long-term may not be good There is a small percentage especially when the baby is too premature We try to be honest with the family. We can’t make a decision but we help them to arrive at a decision themselves. That in the long term the baby could have so and so issues. From our side we provide factual information Again in a very gentle way. Thereafter, acceptance varies from person to person. Some people readily accept and say they will go with whatever God has given. Other parents will have a different reaction. After the baby is born We say that nature helps to a great extent. They say that it is important for the child to cry. Or the baby is made to cry. What is the significance? When the baby is inside the mother The breathing, circulation, functioning of Kidneys Practically a lot of things happen through the mother. The lungs are not yet breathing, they are like sponge. Filled with fluid The cry basically means a deep breath. When it cries the fluid gets displaced And air fills up the lungs. Therefore crying of the baby at birth is very important. It means that the baby’s lungs have started functioning. When the circulation has started. The first 1 to 2 minutes after birth So many changes happen that you can’t even imagine. From being a completely dependent individual Now each and every system needs to switch over. If air or oxygen is not entering your lungs It means your body parts do not get oxygen for that duration. That can be very dangerous. The biggest factor is how it will affect the brain. Today the organisations related to newborn babies We conduct a lot of training programs where we try to Ensure that each birth has a trained attendant. Exclusively to care for the baby. When we plan where the delivery need to take place The mother is taken care by any doctor. People often forget about who will take care of the baby. It is very important that When you book a hospital for delivery Make sure that there is a specialist available to care for the baby God forbid if there is a problem If you come under that 10% to 15% category Again if you get timely care Everything will be fine. If you don’t get timely care then things can be bad. It can have long term implications, and this is a major issue with newborns. If you don’t get the timely care Generally the entire focus is on the mother or the delivery It is not that people don’t bother. As a society we don’t think of adverse situations, because we don’t expect to be in that 10% to 15% category where things can go wrong. Out of all the babies who run into trouble Only 1% of such babies will need massive care. It needs high-end care where breathing and circulation need to be established In other cases, if someone gives them for example timely artificial breathing It is a very simple thing. Only thing is to pick up a place Where there is someone exclusively for the baby, with sensitivity that baby is a separate individual. As soon as the baby comes out, it needs care. Its temperature is to be maintained, the baby needs to be kept dry. It should be protected from infection, there should be hygiene. Sheets should be clean and warm. Small things which will have a long term effect. The umbilical cord of the baby which breaks There can be complications like infection. Umbilical cord is the lifeline of a baby before birth. It will be cut at the time of birth. Since it will not be dry yet, there are chances of infection. There are many myths and beliefs about it In olden times they would apply mud or manure Even turmeric as an antiseptic. Actually you don’t need to do anything to it. Just keep it clean and dry. Nothing needs to be applied. If you see any redness or any problem, cancel the doctor. Don’t do anything yourself. Because babies catch infection very quickly. So that can become a source of infection. So even if you see a little redness around the navel Contact your doctor immediately. Little things like clothes for the baby, applying a teeka The mother may not be able to do much so it is up to the family It is said that a lot of precaution is necessary. What are the precautions? Gutti which is a herbal concoction for babies, is given in many families of the educated, and even doctors. They bring honey. They want us to feed a few drops to the baby. But nothing is better than mother’s milk. Honey is of course very sweet. It can also be contaminated. It can cause problems to the baby. It’s not a good practice. We have a lot of good traditions in our society. We can follow those. But with time we need to drop some of the practices, and this is one of them. So we should not give Honey to the baby. Mother’s milk is the best. If the baby and mother are doing fine, the baby should be fed breast milk at the earliest. Nothing else can be better than it. Applying the Tilak out of Kajal is probably okay. We sometimes ask them to applied to the feet of the baby. But certainly not to the baby’s eyes. We have a tradition the newborn baby should wear used clothes. It is actually very scientific. New clothes are usually stiff. And they have many chemicals. Used clothes means there will be no Chemicals because of repeated washings. It will be soft and hence suit the babies skin. So it’s not advisable to put new clothes. If the tradition in your family is to use old clothes for 40 days As long as there clean and washed, it doesn’t matter. Basically the cloth has to be soft. There are other things related to child care Whether to feed water or not Doctors have an opinion but family advises differently. In the first two to three days, what aspects should the family keep in mind, especially when relatives come with flowers or gifts? There are very few conditions where the mother and the child are separated. Even if it is a cesarean Within two or three hours the mother is with baby. In fact in today’s concept Is to deliver the baby and place it on the mother’s abdomen. If it is not required, we don’t even take the newborn to the warmer, resuscitation station We put a clean sheet on the Mother’s abdomen and place the baby on it The doctor will be working on the mother. The mother gets busy with the baby. In the first one hour the baby will be awake. That is the best time to start breastfeeding. So give a good diet to the mother. Take care of the mother’s hydration. In many families they don’t give water to the mother. They fear that the stomach gets bloated. There is no connection between water and the stomach bloating. Water has no calories. So whatever the baby needs, feed it to the mother. If the mother is well hydrated The water requirement of the baby is fulfilled through breast milk automatically. If the baby is urinating around 6 to 7 times a day It means there is no deficiency of water in the baby. After the baby is discharged There could be problems like colic, vomiting They don’t know why the baby cries. The anxiety related to this few things in nuclear families Because there is no one else to guide the couple at home. Should I go to the hospital each time or can they manage at home? Baby needs regular feeding Most important is calm and prepared parents. The preparation should begin during pregnancy itself. Antenatal classes, literature available on the subject, or talking to friends. These are normal things where most of the time there is no danger. Every parent has a different anxiety level. If the baby is crying excessively If it is colic, babies generally curl up and cry. Put them on the shoulder and pat. Place them on your thighs and pat. Some babies are comfortable with one position and some are comfortable with another. Gradually you will get used to them. Traditionally they apply Hing on the abdomen of the baby. It’s a counter-irritant. Like how we apply a balm The pain sensation or irritation in the baby That gets overridden. So it can be used. But if it is acute and baby is repeatedly spitting You can talk to the doctor But if you feed the baby at regular intervals If you carry the baby across your shoulder for 15 to 20 minutes and make sure the baby burps There should not be a problem. Another thing is the restrictions on the mother’s diet. Scientifically there is no restriction. That the mother eats certain foods, baby will have an upset stomach. Mother should have a healthy and balanced diet. Vegetables and fruits. Most of the times these things are manageable. But it is important to remain calm. Generally anxiety level is very high Especially for nuclear families, attending the antenatal classes can play a big role. When the child gets jaundice Although it is said to be natural and can happen It becomes difficult for the parents to accept. Jaundice is normal 80% of the babies will have some degree of Jaundice. It’s basically transition from within the mother The red blood cells there in the womb, which will contain hemoglobin is of a different type. Because for the baby to suck oxygen from the mother, a different mechanism is needed. When the baby comes out it is getting a lot of oxygen. So they change into a different kind of cells. So the red cells are broken The end component is bilirubin Which is the yellow component of Jaundice. 80% of the babies have jaundice, and only 20% of such babies will need help. Other babies will recover by themselves. But it is very important that Today they are discharged 24 hours or 48 hours after normal delivery. So early follow up, which means you need to show the baby to the doctor within 24 hours to 48 hours. In many families mother is kept in a room where there is not enough ventilation or light. It is important to observe the skin colour of the baby under light. Again the main thing is about being timely. If you diagnose it in time There are special lights and you might have to keep the baby in the hospital for one or two days. The baby will be fine. But if parents miss noticing it, it can have lifelong implications. If jaundice increases beyond a certain limit Then it can affect brain development. So the message I want to convey is that Most of the time it is benign. You will not need to do anything. It might increase for 2 to 3 days. After that it reduces. But observation and awareness are very important. If your child looks yellow. You have to consult your doctor immediately. There is no need to fear. Breast feed the baby frequently. The more frequently baby passes stool And if the hydration is good The baby will recover very quickly. The biggest casualty of tension is that breastfeeding comes down. So we need calm and composed parents. Maybe if you have spiritual inclination or religious beliefs In my experience, when babies are in NICU I tell the parents to come and sit near the baby If you can sing any bhajan or Mantra Sit near the baby and recite it. The aim is to keep parents as relaxed as possible. But they need to be aware, it’s very important. You mentioned timely intervention is very important. That is about simpler complications What are the other complications which parents need to be aware? When is vaccination and they are given all the details. What are the other things parents should be aware of? Traditionally they say a lot of attention is needed for the first 40 days, which is a very good concept. Medically we call it Postpartum period which is 6 weeks, or roughly 40 days. During this duration there is a restriction at home normally. There won’t be many visitors, no functions, and no huge gatherings It is a way to allow the baby and the mother to bond, uninterruptedly. The family members can focus only on the care of mother and baby. Outsiders should not come with infections or dirty hands You mentioned about visitors bringing flowers. There is an interesting tradition that money is put into an envelope, and kept on the baby as blessings. We don’t know from where the baby can catch an infection. So it is important to have minimum visitors. There should not be an interruption to the mother and baby The mother’s sleep time should not be disturbed. Wash your hands before touching the baby. If someone has a skin infection Or if they have cold or cough As far as possible, keep them away from the mother and baby. If the mother has slight cold or cough, she can wear a mask. But we don’t interrupt breastfeeding. Because the benefits of breastfeeding They are much more than and everything else. The mother should feed the baby as many times as possible The child gets a lot of immune factors through the milk. The child will have the power to fight infections. So we don’t interrupt breastfeeding. Keep visitors to the minimum. Give maximum rest to the mother. Give them maximum time to be together and to get attached to each other. Another important aspect is about colostrum There is not enough awareness about it in our society. The tradition is that the aunt needs to wash the mother’s breast Until then the mother should not breastfeed the baby. They give other milk. Not a good idea. The first milk which is colostrum should never be discarded. It is not puss. It is thick and yellow, and is full of antibodies. It is very important for the child’s immunity and is very nutritious. I think this was the point we had not touched upon It is the first milk and there is no need to give the baby anything else before it. There is no need for water or anything else. 6 months of exclusive breastfeeding as far as possible. If the mother feels that it is not sufficient and their child is still hungry How to make out if the baby is full? The child may be crying because of some other reason. How to understand this? Nature’s arrangements are excellent. For the first two days Kidneys don’t function well, so the baby passes less urine. Accordingly the mother’s milk will be thick. It will have less water and more nutrients. As and when the system picks up and all organs begin to function well Mother’s milk starts getting diluted. The quantity of water in it increases. How to decide if it is sufficient or not? Baby doesn’t know anything other than crying. If an ant bites, the baby cries. If the baby feels over full (overfed), even then he cries. If he is unable to burp, he cries. They cry before passing urine or potty. If you don’t clean up immediately, they cry. So their crying is not a sign that they need milk. If the baby urinates for 6 to 7 times in a day And passes stool once or twice a day Sleeps for 1.5 to 2 hours in between feeds You are in touch with your pediatrician When you go for follow up visits If the baby is gaining as much weight as he should Those are the parameters we go by. That the milk is sufficient. Otherwise you can try rocking the baby or help him burp. Change his position It does not necessarily mean insufficient milk. If the baby is passing urine, it means that enough milk is going in. We focus on other aspects of pregnancy We didn’t have enough information about this, so thank you so much for sharing your knowledge and experience. Thank you. We had understood a lot about the phase of pregnancy. We have now understood the importance of early intervention after delivery, in case of issues. The things to take care soon after the child is born. We can think of other things like welcoming the baby. Someone exclusively for child care is needed soon after birth. And how to handle certain complications in the first few days. The whole family needs to understand it. Because they can have a long term implication on the child. If you have any message or question for us, please send an email. That’s all we have for today. Let’s meet again. Namaste.