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