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.

Symptoms usually first appear at two to four weeks, though they can appear earlier or later. The stomach contracts powerfully in an attempt to force a buildup of food through the narrow pylorus. This is impossible, however, and the contents of the stomach are vomited up so violently that they may be propelled up to 3 feet (1 meter) – projectile vomiting. The baby may also suffer constipation and dehydration. Ultrasound and a barium swallow may be used to confirm the diagnosis. A simple operation to widen the pylorus can be performed, curing the condition completely.

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.

Down syndrome babies usually mentally handicapped, though the degree of handicap varies widely; many are near normal. They are usually affectionate and happy children. With careful attention and early education, they often do very well, and some manage to live independently as adults.

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.

A cleft lip can be surgically closed soon or some weeks after birth. The palate can be closed from about six to nine months. Further operations may be necessary for some children.

Affected children are looked after by a cleft-palate team which will monitor speech, hearing, and teeth and will intervene should this become necessary. Support for parents is available.

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:

• Intravenous feeding is used for babies who are very ill or so premature that they cannot swallow or digest food for themselves. It may continue for weeks and subsequent feeding will be through a stomach tube.
• With nasogastric feeding, a tube is passed through the baby’s nose and into the stomach or intestine. Because the tube is very fine and soft, the baby hardly knows it’s there, so it’s a very comfortable way to feed.
• When your baby is older, a combination of breast or bottle and tube feeding will suffice; the baby feeds as much as he can from breast or bottle, and the feeding tube supplies the rest. Combination feeding can be used once the rooting and sucking reflexes are established and will continue until the baby is strong enough to feed from breast or bottle only.

Progress

The development of a premature baby can be slow and erratic. It is often a great shock to see just how tiny a premature baby is but he will have a great will to live.

For a premature baby every day can be an uphill battle. Periods of improvement may be followed by setbacks, and this constant uncertainty can make you and your partner feel anxious, moody, and restless. It is encouraging to know, however, that most babies born after 32 weeks will develop normally. Of those babies born at 27 weeks (three months early), six out of seven will survive.

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.