To Panic or Not to Panic

Understanding Common Newborn Conditions

By Kelly Burgess

When Leslie Reynolds of Magnolia, Miss., took her 4-day-old son to the doctor for his first checkup, the pediatrician mentioned that the baby had a heart murmur. Overwhelmed with being a new mother on her first outing, Reynolds didn't think to ask any follow-up questions, but when she got home she began to worry.

"After the appointment, what he said about a heart murmur just started to stand out for me because it sounds so serious when you think about it, and I thought maybe I should have asked him if I should see a specialist," says Reynolds. "I ended up calling him back and asking about it, and the office told me that it was nothing to worry about and most likely will go away on its own."

Although Reynolds' doctor may have been a little too casual for her peace of mind, it is not unusual at all for a newborn baby to have a heart murmur. According to Dr. Henry H. Bernstein, associate chief of general pediatrics for Children's Hospital Boston and associate professor of pediatrics at Harvard Medical School, at least half of all newborns will have a murmur that's heard in the first few days of life. All it is, he says, is the sound of the blood rushing through the baby's heart and blood vessels near the heart and is usually nothing to be concerned about.

Dr. Bernstein says the baby's adjustment to living outside the mother's body is the cause of many of the conditions commonly seen in newborn babies. Some of these conditions are visible and some are not. Often, a parent only learns of them because the pediatrician mentions them in passing. Also, in Dr. Bernstein's estimate, the majority of children don't have many of these, but for those that do, the following guide may ease a few minds.

Like heart murmur, jaundice is a result of the baby's organs, in this case the liver, learning to work on its own. It's characterized by a yellowish tint to the baby's skin, which is caused by an excess amount of bilirubin in the baby's blood. It sounds alarming, but even adults produce bilirubin, which is a by-product of the normal breakdown of red blood cells.

Usually the liver processes the bilirubin, and it's secreted as bile. In the case of some newborns, the liver can't quite handle the excess bilirubin, and it builds up in the body. Because bilirubin has a yellowish-red pigment, it turns the skin and the whites of the baby's eyes the distinctive yellow tint of jaundice. It usually peaks in the first three to five days of life, and then often clears up on its own.

Dr. Kristin Hannibal, clinical director of the primary care center at Children's Hospital of Pittsburgh, says the American Academy of Pediatrics recently updated its recommendations for identifying and managing newborn jaundice. The new guidelines will base bilirubin levels on the infant's age in hours and can better identify infants that are at risk of developing jaundice in their first week.

"The good thing about this is that we can measure the bilirubin on the skin pretty reliably and don't have to do a blood test," says Dr. Hannibal. "If the baby does develop jaundice, many doctors and hospitals even have access to home treatment so we don't have to separate mother and baby."

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