In rare cases, a baby’s anus is sealed at birth, either because there is a thin membrane of skin over the opening or because the anal canal, which links the rectum with the anus, has not developed. The rectal pouch may be connected to the vagina, urethra, pr bladder, and surgery must be performed at once. This condition is routinely checked for at every birth, and is treated immediately if present.
In this condition, the pylorus, the passage that leads from the stomach into the small intestine, is narrow because of a thickening of the muscle. The cause is unknown, and it is more common in boys than in girls.
This is by far the most common of a range of conditions called trisomies, in which one pair of chromosomes has an extra chromosome, making three. In Down syndrome, there are three number 21 chromosomes. Affected infants characteristically have small features, a tongue that protrudes, and slanting eyes with folds of skin at their inner corners. They tend to be rather floppy infants and have short, wide hands. They may also suffer from congenital heart disease.
A cleft is a split or separation of parts. During the early part of pregnancy, separate areas of the baby’s face and head develop individually, than join together. When joining does not take place or is incomplete, the baby can be born with a cleft lip on one or both sides, with or without a cleft palate. Breastfeeding is sometimes possible, perhaps using a nipple shield; if not, special bottles and nipples are readily available. Some milk may return down the nose but this doesn’t matter.
The most common form of heart disease in newborns is a hole in the ventricular septum – the thin dividing wall between the right and left ventricles (pumping chambers). About four weeks after birth, blood will “shunt” from left to right through the hole and the oxygenated blood will flow to the lungs instead of to the body. Symptoms include breathlessness, particularly during feeding. In some cases, the hole seals spontaneously, but if it doesn’t, an operation will be necessary.
In a very small number of male babies – about 0.3 percent – there is an abnormality in the position of the urethral opening on the penis. In epispadias, the opening is on the upper surface of the penis, and the penis may curve upward; in hypospadies, the opening is on the underside of the glans (head), and the penis may curve downward. In rare cases, the urethral opening lies between the genitals and the anus, and the genitals may appear to be female. Surgery can be carried out in the preschool years to correct the defect, allowing normal passage of urine and, in later life, normal sexual intercourse. Neither of these conditions, even in the severe form, causes infertility.
Some infants – twice as many boys as girls – are born with the sole of one or both feet facing down and inward, or up and outward. The cause of club foot is not fully understood, but it may be inherited. It may be associated with spina bifida. The foot will be manipulated over several months, and braced or splinted is position between manipulations. If surgery is necessary, it can be carried out when the child is as young as 12-16 weeks.
Congenital handicaps are rare. Some are genetic, whereas others are due to the effects on the fetus of drugs, radiation, infections, or metabolic disturbances. The fetal tissues that are most actively growing at the time when the adverse factor operates are the ones most likely to be affected. An increasing number of defects can be defected before birth and successfully treated just after birth.
Most premature and low birth-weight babies do not have the strength to suck milk from a nipple or bottle, and their intestines may be too weak to absorb food. There are three alternative ways of feeding:
A baby with respiratory distress syndrome (RDS) may stop breathing for a short time. This is called apnea. Although it sounds very frightening, apnea is not uncommon, and most babies start breathing again after gentle stimulation such as a top or a stroke. Other respiratory problems can arise from fluid inhaled into the lungs or a lack of surfactant – a substance produced in the lungs that keeps them from collapsing. If a baby’s do not have enough surfactant coating, they don’t expand as well as they should. This can cause the smaller air sacs to collapse, leading to hyaline membrane disease, a condition common in babies born before 31 weeks.
Babies suffering from any of these complications can be given oxygen either by way of a face mask or by a small tube inserted directly into the windpipe and attached to a ventilator.
