Heart murmur

It is not uncommon for a baby to have a heart murmur, which is just the sound of turbulent blood flow. Sometimes a murmur is normal as the circulation transitions from the blood flow as a fetus to the normal blood flow for living in the real world. These usually go away after the first day. It is also relatively common for this transition to take a little longer, or for there to be a small hole in the heart which will close in a few months. Sometimes, of course, there are serious heart defects as well. Heart defects are the most common type of birth defect. Newborns are now screened for some of the most serious heart defects before discharge (see Critical Congenital Heart Disease Screening).

Babies also sometimes have abnormal heart rhythms, which are usually harmless. This will be heard as an irregular heart rate or rhythm.
If your baby has any of these, then a pediatric heart specialist (pediatric cardiologist) will see your baby before discharge. Your baby will also have an echocardiogram (ultrasound of the heart as it moves) and possibly an ECG (EKG).

Low blood sugar (hypoglycemia)

Some babies are at risk of low blood sugar (hypoglycemia), which can be harmful. Most healthy full-term babies have a low risk of hypoglycemia and are not tested. Babies at risk are tested until their blood sugar levels are stable, and are treated if necessary. Risk factors for low blood sugar include maternal diabetes, some maternal medications, being born large or small for gestational age, and premature birth.

If the level is low, usually the first treatment is feeding and checking again afterwards. Most healthy infants with low blood sugar respond well to more frequent feedings. A new treatment if feeding does not work well enough is to give sugar gel in the baby’s the cheek. Studies show this to be very effective. The great thing about this treatment is that it keeps babies with their parents, decreases anxiety, and also helps with breastfeeding since the baby is still there in the room with mom.

If feedings do not work and sugar gel does not work or is not used in that hospital, babies are usually admitted to the NICU for intravenous fluids with glucose added. The baby is slowly weaned off the extra sugar and usually do very well.

Infants with symptoms, such as jitteriness, tremors, poor feeding, seizures, lethargy, and irritability are also tested. Infants with symptoms are usually admitted to the NICU.

The most frustrating aspect of this problem for parents is the repeated heelsticks to draw blood, even though it only takes a few drops. Parents (and babies) don’t like the repeated pain, and the baby’s heels are often sore and bruised.
Your baby will stay for monitoring until the level is stable and safe for discharge.

Rapid breathing (transient tachypnea of the newborn, TTN)

One of the major changes newborns have to make is using their lungs and breathing on their own after birth. Sometimes, babies breathe a little faster than what we consider to be normal, likely due to remaining fluid in the lungs. This can go on for several hours to several days. If no cause is evident, it is called transient tachypnea of the newborn (TTN), which is completely normal and does not cause any problems.

Symptoms may also include grunting, nasal flaring, and skin sucking in around the ribs (retractions), which are signs of respiratory distress.
If it lasts longer than a few hours, the baby may be checked for more serious things that can cause rapid breathing, such as lung or chest problems, heart problems, or infection.

TTN is more common in babies born by c-section, with a very short labor, or to mothers with diabetes. It is also more common in late preterm infants (34-37 weeks).

Treatment is observation and maybe testing for any more serious causes. Occasionally, a baby needs a little bit of oxygen, or help feeding because babies cannot feed very well if they are breathing too fast. For babies that appear more serious, antibiotics are often given until the doctors are sure there are no bacterial infections like pneumonia.

Small for gestational age (SGA) babies

Babies who are small for their age (weeks of gestation) may have some challenges similar to that of late preterm infants. Small for gestational age is usually defined as weighing less than 10% of infants born at the same number of weeks of gestation. However, many of these babies are healthy and normal; it is more serious in infants who weigh less than 3% of other babies. It is also sometimes called low birth weight; however, this terms refers to any infant less than 2,500 grams regardless of weeks of gestation. It is often related to intrauterine growth restriction (IUGR), which refers to low weight of the baby during pregnancy. There are numerous causes; it is not usually investigated in healthy children while in the hospital. Many SGA babies are simply genetically small and it is normal for their family.

SGA infants are at higher risk of low blood sugar (hypoglycemia), difficulty maintaining body temperature, difficulty feeding and gaining weight, and having too many red blood cells at birth (polycythemia).

SGA babies, and babies who are normal weight but had IUGR usually have blood sugar and red blood cells checked after birth.

Large for gestational age (LGA) babies

Babies whose birth weight is more than 90% of babies of the same weeks of gestation are called large for gestational age. They are at risk of birth injuries such as fractured collar bone (clavicle) or nerve injury to the arm, C-sections, low blood sugar (hypoglycemia), low calcium levels, respiratory distress, jaundice, poor feeding, and elevated number of red blood cells (polycythemia). When maternal diabetes is the cause, they are also at higher risk of congenital abnormalities.

The hospital routinely monitors the blood sugar of LGA babies and checks the number of red blood cells to be sure that it is not too high.