Nursery

Today I started in the nursery / neonatal care. What is this entail? It is like its own specialty within pediatrics. The nursery has specialized physicians and nurses who work in and run the nursery. Given that neonates require different treatments and interventions than older children. A regular pediatrician is certainly trained to work in the nursery, but often hospitals will have neonatal specialists that regularly work in the neonatal ICU (NICU). Basically the nursery houses the newborns until they are ready to go home. The NICU houses the newborns with major health problems. 

Today I had 2 new admissions that I was assigned. The first infant was girl with jaundice. I placed the infant in the phototherapy unit. There are many things that can cause jaundice in a newborn. Often it is benign, however when it occurs in the 1st 24 hours and or comes with high bilirubin levels then there can be some complications that require aggressive treatment. In this infants case the jaundice was present at birth which is not a good sign and the bilirubin level was elevated beyond physiologic jaundice. If high bilirubin levels go untreated and continue to rise the infant is at risk for kernicterus which is basically brain damage caused by the bilirubin. I ordered a variety of test with the help of my attending physician. Ultimately a test that indicates ABO blood incompatibility came back positive which means that the mothers blood makes anti-bodies against the babies blood attacked the infants blood in utero causing hemolysis which releases bilirubin leading to hyperbilirubinemia manifested with jaundice. 

How is this treated? We continually monitor the bilirubin levels while keeping the infant in the phototherapy unit. The UV-B lights help rid the body of the bilirubin and treat the jaundice. Usually this is all the baby will need and often a baby with ABO incompatibility may not even need phototherapy. Once the baby is born the mother's blood no longer has access to attack the babies blood. Other times if it is severe the infant can require exchange transfusions to clear the bilirubin.

My second admission was a child born prematurely to a mother that was a heroin addict and tested positive for THC (marijuana). So this child was withdrawing and in a bad state.