Uncomplicated

Our new baby boy is an uncomplicated little man. Or at least, despite a high risk pregnancy, and an unassisted labour and delivery, his nursing care needs are relatively uncomplicated.

Born full-term, but very small, weighing just 3lb 14 oz, (5lb 8 ounces is the minimum birth weight that is considered normal in a baby born after 37 weeks), he arrived a matter of hours after his birth. He is the son of a severely disabled teenager, who lives at a large and poorly resourced orphanage, that is located less than a mile from God's Littlest Angel's main house.  His blood sugar was low and he was hypothermic. Like many low birth-weight babies, Maudlin did not have enough body fat to generate heat. I knew it was likely that he was using all of his energy in an attempt to create metabolic heat, and that he hadn't received enough milk to maintain normal blood sugar levels. There are other reasons though, that a high-risk newborn might have low blood sugars, and a low body temperature. I worried that he might have an infection. I worried that his blood supply might have been compromised during the birth process. If that had happened, he might certainly have low blood sugars and hypothermia, but seizures and organ failure were also a possibility. 

A few hours after he was admitted, Maudlin was in an incubator, and had taken a small milk feed. His temperature and blood sugar were both within the normal ranges. I had fully assessed him and the results of my nursing assessment were encouraging. 

As we warm hypothermic babies, we monitor them for breathing problems, for heart rhythm irregularities, and for blood pressure and blood sugar instability. Maudlin was stable and appeared healthy. His lungs were clear and his heart beat was strong. His muscle tone was normal, his abdomen was soft and there were no signs of infection or congenital abnormalities. I counted 10 fingers and 10 toes. He was sleepy, and he had a weak suck, but he was drinking.

So Maudlin wouldn't need CPAP, or an IV, or antibiotics or even a feeding tube. You are very red, I thought, I hope you don't have polycythemia - a condition in which a high concentration of red blood cells can make newborns blood viscous. Occasionally, this can cause breathing problems and seizures. More commonly, it causes newborn jaundice. The bedside test I ran suggested that Maudlin did have a high concentration of red cells, but not high enough to cause symptoms. Maudlin was unlikely to need any special treatment, we would just have to keep him warm, monitor him and make sure that he stayed well hydrated, so that his blood did not become too thick.

Two days after he arrived, Maudlin still has to be wakened for feeds every three hours, but he is drinking well from a bottle. Recently, we have admitted three infants with chromosomal abnormalities and we have cared for some extremely sick children. This has made me hyper vigilant. I can't help looking for problems. I am glad that in Maudlin's case I didn't find any serious or complex issues.