Preventive Newborn Health and Care
Preventive Newborn Health and Care
Editor-in-Chief
Balaji Govindaswami MBBS MPH FAAP
Professor of Pediatrics and Associate Chair for Research, Department of Pediatrics Endowed Chair, Preventative and Addiction Medicine Professor, Department of Clinical and Translational Sciences Office of Research and Graduate Education Marshall University Joan C Edwards School of Medicine Division Chief, Neonatology; Director - NICU Hoops Family Children's Hospital at Cabell Huntington Hospital
Huntington, West Virginia, USA
Associate Editor
Robin Daughters Wu
Assistant Editor
Nisha Bedi Donley
Section Editors
Glenn Henry DeSandre
Kamakshi Devarajan
Matthew J Garabedian
Priya Jegatheesan
Rupalee Patel
Audra Pritt
Dongli Song
Illustrative Editor
Albert H Alhatem
Jaypee Brothers Medical Publishers (P) Ltd
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Preventive Newborn Health and Care
First Edition: 2021
9789352704736
Printed at:
- Ira Adams-Chapman MD MPH FAAP
- Associate Professor of Pediatrics
- Director, Developmental Progress Clinic
- Jennings Watkins Scholar in Neuroscience
- Emory University School of Medicine
- Department of Pediatrics/Division of Neonatology
- Children's Healthcare of Atlanta
- Atlanta, Georgia, USA
- Albert H Alhatem MD PhD
- Dermatopathology Fellow
- Department of Dermatology
- Saint Louis University School of Medicine Saint Louis, Missouri, USA
- Steven M Barlow PhD
- Corwin Moore Professor
- Associate Director
- Center for Brain, Biology and Behavior
- SECD and Biological Systems Engineering
- University of Nebraska
- Lincoln, Nebraska, USA
- Rebecca Barnett DO FAAP
- Attending Neonatologist
- Hoops Family Children's Hospital at Cabell Huntington
- Director, High Risk Infant Follow-up Marshall Pediatrics
- Assistant Professor of Pediatrics
- Division of Neonatology
- Marshall University Joan C Edwards School of Medicine
- Huntington, West Virginia, USA
- Robert M Bernstein MD
- Chief of Staff
- Shriners Hospital for Children
- Portland, Oregon, USA
- Medical Advisory Board
- Little People of America
- Pediatric Orthopedic Advisory Board
- Global Help
- Stephanie D Chao MD FACS FAAP
- Assistant Professor of Surgery
- Division of Pediatric Surgery
- Stanford University School of Medicine
- Stanford, California, USA
- Lily C Chen MD FAAP
- Attending Neonatologist
- Saddleback Medical Center
- Laguna Hills, California, USA
- John Patrick Cleary MD FAAP
- Associate Clinical Professor
- Department of Pediatrics
- University of California Irvine
- ECMO Director
- Associate Director, CVICU
- Children's Hospital of Orange County
- Regional Director of Neonatology
- CHOC Children's Specialists
- Orange, California, USA
- Noah Craft MD PhD
- CEO, People Science, Inc.
- Los Angeles, California, USA
- Glenn Henry DeSandre MD FAAP
- Attending Neonatologist
- Permanente Medicine
- Kaiser Permanente Oakland Medical Center
- Oakland, California, USA
- Kamakshi Devarajan MD FAAP
- University of California, Irvine
- Children's Hospital of Orange County
- CHOC Children's Specialists, Orange
- Chair of Pediatrics
- Director, Neonatal Intensive Care Unit
- Saint Francis Medical Center
- Lynwood, California, USA
- Nisha Bedi Donley BA MBA
- Los Angeles, California, USA
- Shannon Dralla MD FACOG
- Physician
- Department of Obstetrics and Gynecology
- The Permanente Medical Group
- San Jose and Gilroy, California, USA
- Gregory M Enns MB ChB
- Professor of Pediatrics
- Director, Biochemical Genetics Program
- Stanford University
- Stanford, California, USA
- Christopher Fink MD MPH FAAP
- Clinical Assistant Professor of
- Pediatric Gastroenterology
- Stanford University School of Medicine
- Pediatric Gastroenterologist
- Lucile Packard Children's Hospital
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Susan Flesher MD FAAP
- Associate Professor
- Interim Chair, Department of Pediatrics
- Director, Pediatric Hospital Medicine Fellowship
- Marshall University
- Huntington, West Virginia, USA
- Sharyn Frentner RNC MSN CNS NNP
- Clinical Nurse Specialist (Retired)
- Neonatal Intensive Care Unit
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Julie R Fuchs MD FACS FAAP
- Clinical Associate Professor of Surgery
- Stanford University School of Medicine
- Chief, Pediatric Surgery
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Matthew J Garabedian MD MPH FACOG
- Chief, Women's Health Subspecialties
- Kaiser Permanente
- Sacramento and Roseville, California, USA
- Zachary Max Goldstein MD
- Dermatopathologist
- Contra Costa Pathology Associates
- Pleas-ant Hill, California, USA
- Balaji Govindaswami MBBS MPH FAAP
- Professor of Pediatrics and
- Associate Chair for Research
- Department of Pediatrics
- Endowed Chair, Preventative and Addiction Medicine
- Professor, Department of Clinical and
- Translational Sciences
- Office of Research and Graduate Education
- Marshall University Joan C Edwards School of Medicine
- Division Chief, Neonatology; Director - NICU
- Hoops Family Children's Hospital at
- Cabell Huntington Hospital
- Huntington, West Virginia, USA
- Stephen Harris MD FAAP
- Clinical Professor (Affiliated) of Pediatrics
- Stanford University School of Medicine
- Department of Pediatrics
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Emily Altick Hartford MD MPH
- Assistant Professor of Pediatrics
- University of Washington
- Seattle Children's Hospital
- Formerly at UCLA Center for World Health
- Mozambique Partnership Director
- Maputo, Mozambique
- Francesca C Ianovich MD
- Resident (PGY-2)
- Department of Anesthesiology
- University of California San Diego School of Medicine
- La Jolla, California, USA
- Priya Jegatheesan MD FAAP
- Clinical Assistant Professor (Affiliated) of Pediatrics
- Neonatal and Developmental Medicine
- Stanford University School of Medicine
- Director, Neonatal Intensive Care Unit
- Chief, Division of Neonatology
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Korinne S Van Keuren DNP RN CPNP-AC PNP-BC
- Director of Advanced Practice Providers
- Clinical Assistant Professor of Nursing
- University of Virginia Medical Center
- Charlottesville, Virginia, USA
- Alganesh G Kifle RN BSN IBCLC
- Volunteer Faculty
- Tikur Anbessa Hospital
- Vermont Oxford Network, Addis Ababa, Ethiopia
- Lactation Program Coordinator (Retired)
- Neonatal Intensive Care Unit
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Rashmi Kirpekar MD FAAP
- Clinical Assistant Professor (Affiliated) of Pediatrics
- Stanford University School of Medicine
- Chief, Division of Pediatric Nephrology
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Yueh-Tze Lan MD FAAP
- Clinical Assistant Professor (Affiliated) of Pediatrics
- Stanford University School of Medicine
- Pediatric Cardiologist
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Sangeeta Mallik PhD
- Director, NICU Family-Centered Care
- Developmental Psychologist and
- Early Childhood Researcher
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Sonya Misra MBBS MPH FAAP
- Clinical Associate Professor (Affiliated) of Pediatrics
- Neonatal and Developmental Medicine
- Stanford University School of Medicine
- Attending Neonatologist
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Sudha Rani Narasimhan MD IBCLC FAAP
- Clinical Assistant Professor (Affiliated) of Pediatrics
- Neonatal and Developmental Medicine
- Stanford University School of Medicine
- Director, NICU, O’Connor Hospital
- Medical Director of Lactation
- Director, Well Baby Nursery
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Elizabeth M Nielsen CFRE
- Chief Executive Officer
- Youth on Their Own
- Tucson, Arizona
- Formerly Chief Development Officer
- Valley Medical Center Foundation
- San Jose, California, USA
- Matthew JR Nudelman MD MAS
- Pediatric Intern
- Marshall Pediatrics
- Marshall University Joan C Edwards School of Medicine
- Huntington, West Virginia, USA
- Adebola Olarewaju PhD(c) MS RNC-NIC CPNP
- Pediatric Otolaryngology and Head & Neck Surgery
- UC Davis Children's Hospital
- Sacramento, California, USA
- Rupalee Patel DNP MS BSN C-PNP RN C-PHN IBCLC
- Director, BRIDGE Home Follow-up Program
- Director, High Risk Infant Follow-up Clinic
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Valerie D Phebus PA-C
- Physician Assistant
- Envision Physician Services
- Joe DiMaggio Children's Hospital
- Hollywood, Florida, USA
- Audra Pritt MD
- Associate Professor of Pediatrics
- Director, Pediatric Residency Program
- Associate Director, PHM Fellowship Program
- Director, Pediatric Hospital Division
- Marshall University Joan C Edwards School of Medicine
- Hoops Family Children's Hospital at Cabell Huntington Hospital
- Huntington, West Virginia, USA
- Dechu P Puliyanda MD FAAP
- Professor of Pediatrics
- University of California, Los Angeles David Geffen School of Medicine
- Director, Pediatric Nephrology and Transplantation
- Cedars-Sinai Medical Center
- Los Angeles, California, USA
- Aarti Raghavan MD FAAP
- Director, Neonatal-Perinatal Fellowship Training Program
- Director, Master of Science in Patient Safety Leadership
- Attending Neonatologist
- Assistant Professor of Clinical Pediatrics
- Children's Hospital University of Illinois
- University of Illinois Hospital and
- Health Sciences System
- Chicago, Illinois, USA
- Ronald A Roiz MD CO
- Assistant Professor
- Division of Pediatric Orthopedics
- Department of Orthopedics
- Loma Linda University
- Loma Linda, California, USA
- Austin O Rosner PhD
- Senior Medical Writer
- Vertex Pharmaceuticals
- Boston, Massachusetts, USA
- Joseph Schulman MD MS FAAP
- Director
- NICU Quality Measurement and Improvement
- Associate Medical Director, Medical Policy and Operations Branch
- Integrated Systems of Care Division
- California Department of Health Care Services
- Sacramento, California, USA
- Christina T Sheridan MD FAAP
- Clinical Assistant Professor (Affiliated) of Pediatrics
- Stanford University School of Medicine
- Chair of Pediatrics
- Pediatric Cardiologist
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Augusto Sola MD FAAP
- Neonatologist
- General Director
- Ibero-American Society of Neonatology (SIBEN)
- Adjunct Professor of Epidemiology and
- Community Health
- School of Public Health
- New York Medical College
- Valhalla, New York, USA
- Antoine Soliman MD FAAP
- Associate Clinical Professor
- Department of Pediatrics
- University of California
- Irvine School of Medicine
- Division Chief, Neonatology
- Medical Director, Neonatal Intensive Care Unit
- Miller Children's and Women's Hospital Long Beach
- Long Beach, California, USA
- Dongli Song MD PhD FAAP
- Associate Clinical Professor (Affiliated)
- Department of Pediatrics
- Neonatal and Developmental Medicine
- Stanford University School of Medicine
- Eugene H Kim Chair, Newborn Research
- Department of Pediatrics
- Santa Clara Valley Medical Center
- San Jose, California, USA
- John Sum MD FAAP
- Clinical Associate Professor (Affiliated)
- Department of Neurology and Neurological Sciences
- Stanford University School of Medicine
- Chief, Pediatric Neurology
- Department of Pediatrics
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Cherry C Uy MD FAAP
- Clinical Professor
- Department of Pediatrics
- University of California
- Irvine School of Medicine
- Attending Neonatologist
- Medical Director, NICU
- University of California, Irvine Medical Center
- Orange, California, USA
- Arwin Valencia MD FAAP
- Attending Neonatologist
- Saddleback Medical Center
- Laguna Hills, California, USA
- Donna F Wallerstein MS
- Certified Genetic Counselor
- Silicon Valley Genetics Center
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Robert L Wallerstein MD FAAP
- Department of Pediatrics
- Division of Medical Genetics
- University of California San Francisco
- San Francisco, California, USA
- Laishuan Wang MD PhD
- Staff Neonatologist
- Department of Neonatology
- Children's Hospital of Fudan University
- Shanghai, China
- Robin Daughters Wu BA
- Research Associate
- Division of Neonatology
- Department of Pediatrics
- Santa Clara Valley Medical Center
- San Jose, California, USA
- Stacy Yadava MD FACOG
- Director of Maternal-Fetal Medicine
- Valley Perinatal and Genetics
- Stockton, California, USA
- Ki-Young Yoo MD
- Department of Dermatology
- Kaiser South Bay Medical Center
- Gardena, California, USA
Maternal, perinatal and newborn health should matter to all of us, and should be viewed from both a human rights and public health perspective. We are only beginning to comprehend the interplay of risk and protective factors, such as socioeconomic status, stress, toxic environmental exposures, and social, nutrition and health behaviors that are at play throughout our lifetime. The potential cumulative effects of these influences on health outcomes may be significant. As research continues to demonstrate the important role of early life events in shaping our health trajectory, we must learn and respond.
Through science, we have now been able to establish key links between early life events and the occurrence of many common chronic diseases that usually manifest in adulthood. A mechanism may be that early events are programed into the developing immune, cardiovascular, endocrine and other physiologic systems. For instance, fetal malnutrition can lead to long-term physiologic changes in lipid and carbohydrate metabolism, increasing the risk of obesity in adulthood with consequent diabetes, heart disease, hypertension and arthritis. Animal studies have indicated that epigenetic phenomena may be important mechanisms underlying programing, and that nutritional interventions may need to begin before conception. These new discoveries at the intersection of the biological, behavioral, and social sciences can now explain not only how healthy development happens, but where it may go awry and what we can do about it.
A broad new paradigm is emerging which can potentially address longstanding differences in health across populations. This “life course” approach to conceptualizing healthcare needs and services may be able to better discern the challenges and help improve the health and well-being of all women, children, youth and families in a transgenerational manner. Our efforts must be coordinated both across life stages and across the lifespan. However, we must be clear – the life course approach is not a one-size-fits-all model, but instead a perspective that should be incorporated into future research, programs, policies and partnerships to optimize health outcomes and reduce disparities across populations. If successful, we may be able to uncover early factors that influence infant mortality, including birth defects and preterm birth, leading to reduction in inequities in birth outcomes, and improved reproductive potential. We thus endeavor to improve the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs.
Rahul Gupta MD MPH MBA FACP
Chief Medical and Health Officer
Senior Vice-President
March of Dimes
Clinical Professor of Medicine
Georgetown University School of Medicine
Washington DC, USA
Preface
Every year approximately 140 million babies are born alive on this planet, a large proportion of whom die of preventable causes, including perinatal asphyxial injury, prematurity, infection, and severe birth defects. Maternal risk factors for infant morbidity are pre-existing maternal disease, disorders in pregnancy, and diseases of the placenta, cord and membranes. Recognition and optimum management of these predispositions will lead to better infant outcomes.
In this age of information, it is possible to search vast amounts of literature and data, giving us new perspectives on our experiences and the variation in disease burden in our own communities. Understanding disparities within and between populations may illuminate fundamental genetic disposition or healthcare delivery differences based on socioeconomic determinants of disease.
The impact of the environment and rapid shifts in climate are just beginning to be explored. Effects on our gametes, the early embryo, pregnancy, fetus, developing nervous system, and our entire life cycle are subjects of much-needed exploration. The effects of endocrine disruptive compounds and “forever chemicals” need to be studied with a sense of urgency. The same is true of the myriad new drugs on the market, many seeking to attenuate the way we feel and perhaps altering the way we are, by their effects on the adult central nervous system.
Mental health in general and infant mental health in particular are barely in the infancy of understanding. Sociological determinants of disease, especially adverse childhood experiences, have important consequences for an individual's lifetime, and may negatively impact the next generation. Both genetic code and zip code (i.e. place/circumstances at birth) are critically important to health and well-being; inequities of wealth in any society invariably lead to inequities in health. Addressing disparities in perinatal healthcare delivery will optimize maternal and neonatal outcomes.
It is estimated that the lifetime impairment rate of cognitive processes in our central nervous system is 47%. Thus, even a “perfect” newborn has a 1 in 2 lifetime risk of transient or long-term central nervous system dysfunction. Approaches to enhance neurocognition have critical windows of opportunity in early infant neurodevelopment and throughout childhood and adolescence. Conversely, exposure to the wrong agent at the wrong time can have devastating consequences. Early identification of at-risk infants and intervention programs aimed at enhancing function are essential to reducing long-term societal costs. A commitment to understanding differences in practice variations, both local and global, is fundamental to implementing pathways for minimizing risk of injury, else preventable morbidities often have consequences for a lifetime. Healthcare providers must carefully consider both big data and individual circumstance in order to deliver the most precise care. The instant availability of big data to providers no matter in what part of the world they practice, while fraught with inherent dangers if ill-understood or misapplied, generally holds great promise for the future of clinical practice.
Balaji Govindaswami
Acknowledgments
We would like to thank Mala Arora, editor of World Clinics: Obstetrics & Gynecology, for the inspiration, and Jaypee Brothers Medical Publishers for convincing us that there is a global need to provide transdisciplinary approaches to newborn care.
This book is truly the product of the ultimate devotion and fierce determination of Robin Daughters Wu, Research Associate extraordinaire with our Newborn division of medicine at Santa Clara Valley Medical Center, who has toiled effortlessly and ungrudgingly through a decade of collaboration among authors in different departments, institutions, states, and nations. It is her singular focus and catholic intent that brings this publication to its fruition.
Thank you to the many distinguished authors and faculty who have been incredibly patient and shared their knowledge and gifts with us selflessly, generously, and with private time taken from family and friends. To this group, our gratitude is eternal.
We would like to thank the Santa Clara Valley Medical Center obstetric residents and Stanford pediatric house staff for their questions, for their inquisitive participation, hard work, and feedback, which keep us vigilant. In addition, we thank our students – Sherwin Abdoli, Esther Belogolovsky, Kylie Burdsall, Tatiana Caine, Ashton Easterday, Bella Anderson Enni, Claudia Flores, Erica Flores, Ixtaso Garay, Keshav Goel, Ben Kifle, Melissa Ling, Pooja Rathi Shah, Maricela Vallejo, and so many others for their diligence, conscientious skepticism, and thoughtful work which has supported clinical investigation and made innovative learning fun.
The editorial support team has been ad hoc, extensive, and indispensable at every varied part of this journey. Their contributions to the final product cannot be under-emphasized. That said, any shortcomings, unwitting errors or failure on the part of being true to our stated mission, are mine, and mine alone.
This book would not have been possible without the support of Stacey D Stewart (President and CEO) and the March of Dimes Foundation, Arlington County, Virginia; Jolene Smith (CEO) and FIRST 5 Santa Clara County, San Jose, California; Santa Clara Valley Health and Hospital System, Santa Clara County, California; E Christopher Wilder (President and Executive Director) and the Valley Medical Center (VMC) Foundation, San Jose, California; Jeff Smith, MD, JD, County Executive Officer for the County of Santa Clara, California; Marshall Pediatrics, Huntington, West Virginia; Marshall University Joan C Edwards School of Medicine, Huntington, West Virginia; Hoops Family Children's Hospital at Cabell Huntington Hospital, Huntington, West Virginia; and Kristi Arrowood (Director of Development) and the Mountain Health Network Foundations, Huntington, West Virginia. Net proceeds will be administered through the VMC Foundation in San Jose for the ultimate benefit of disadvantaged women and children in need, anywhere, and with a sense of urgency to those with preventable morbidity and mortality.
The leadership of Dr Rajul Jain and her team at Jaypee Brothers Medical Publishers brought much needed momentum to us, in our eleventh hour. We are very grateful.
Finally, we would like to thank our patients, families, their advocates and caregivers, whose feedback over the years has been an invaluable gift helping to shape future, more civil approaches in healthcare. They remind us that health must be viewed through the eyes of the consumer, as we seek to do unto others as they would prefer to have done unto them, with the overall intent of enhancing “a state of complete physical, mental, and social well-being.”