jlink
Wednesday, September 18, 2019

While working at Bellevue Hospital during my training in pediatrics, I was exposed to many dif­ferent cultures. I treated babies with parents from all around the globe and learned how different we all are and how similar we are. I heard many old wives’ tales, some founded on reason and later proven by science; some never worked and sounded ab­surd to my Western Medicine mindset. No mat­ter which culture the child is born into, there is a common link: newborns are not brought into the general community immediately. Roman Catholics will not go out with a newborn un­til that child is baptized, which generally oc­curs after two months. Orthodox Jews will first bring the child to the synagogue for a ritual cir­cumcision or a formal naming on the eighth day of life. The Chinese usually have a party at one month, and the child is not brought out before that time.

During pregnancy there is an intimate re­lationship between mother and child that comes to an abrupt end with birth. Everyone, especially the mother, needs time to adjust to this new status. Some time alone at home with no visitors gives both the mother and child some time to adjust. I prefer to believe that this period is actually founded on a more scientif­ic reason. Limiting the exposure of a newborn to other people may be a way of isolating the child and making it less likely to come into con­tact with germs.

A newborn has an immature immune sys­tem and is therefore more prone to infections. Some can be quite serious. Infant mortality has decreased over the past five decades because we are aggressive in admitting and treating newborns with antibiotics at the first sign that something is wrong. We routinely do a “sepsis workup” when a child less than two months old has a fever. This includes a urine analysis and culture usually obtained by bladder cath­eterization or a lumbar puncture, and blood tests with an intravenous catheter. The child is given antibiotics intravenously. This has pre­vented many newborns from becoming seri­ously ill or dying. As such, medicine has been able to decrease infant mortality from 29 per 1000 live births in 1950 to 6 per 1000 live births in 2010.

The majority of babies needing a work-up usually have a virus. It’s traumatic for a moth­er anticipating a prescription for an antibiotic to be told that her infant requires hospitaliza­tion to undergo a battery of tests. In general, work-ups are not necessary for most of the ba­bies we see, but they become life saving for the small number of children who would have died if this were not done. Since we cannot tell which child will get seriously ill, we have to treat them all. Luckily, the hospital stay has been greatly shortened and methods of test­ing are much more sophisticated so the pro­cess is simpler and fortunately the results more accurate.

As usual, prevention is the best treatment. How do we prevent a newborn from getting sick? One method is to limit the exposure to vi­ruses and bacteria that are transmitted to the child by contact with other people. Perhaps limiting a child from going out in the first two months of life—sometimes based on religious practices, sometimes on custom—now can be shown to have a scientific basis that prof­fers limiting the newborn’s exposure to infec­tions. This is not to say that we want to keep ba­bies from their family members, but it is wise to practice good hand washing prior to hold­ing a newborn.

If you have any questions you want an­swered please address them to Dr. Giuseppi­na Benincasa-Feingold at “[email protected]­ishlinkbc.com.”

By Dr. Giuseppina Benincasa-Feingold