By Clay Jones
A significant part of my job as a pediatric hospitalist involves caring for newborns. It is arguably the best thing that I get to do as a physician, even if I do at times prefer the increased intellectual stimulation of the ill hospitalized child. While seeing newborns, I am almost always surrounded by happy and appreciative parents, grandparents and whoever else is invited to meet and greet the new arrival because the babies are almost always healthy. In fact, and not that I really care (sniff, sniff), the parents of newborns are with rare exception the only caregivers that ever thank me at discharge.
Unfortunately, sometimes I am called upon to assist babies that are having difficulty transitioning into the outside world for a variety of reasons. These reasons can range from the fairly minor and transient to the catastrophic. And despite our advances in the understanding of neonatal pathophysiology and in medical technology, there remain newborn infants that cannot be saved or who have severe lifelong deficits caused by their illness or injury. This will likely always be the case, especially if unqualified professionals continue to involve themselves in either the delivery or the care of babies.
Over the course of 11 years of practice, and after having seen thousands of both perfectly healthy and severely ill newborns, I have acquired a skill set which allows for the recognition of a baby in trouble and the ability to respond appropriately. All pediatricians and family doctors strive to develop this, particularly if they see patients in the newborn nursery, although I imagine none, including myself, would claim to have perfected this “art”. Newborn medicine can be very challenging for many reasons, not the least of which is the significant overlap of the presenting signs and symptoms of many serious conditions, with even normal baby behavior sometimes mimicking potentially life-threatening pathology.
Take a fussy or jittery baby for example. These are common symptoms often experienced as part of normal newborn behavior or related to environmental insults such as hunger, overstimulation, or a wet diaper. Frequently babies are fussy for no apparent reason at all, and normal newborn findings like the Moro reflex and startle can be exaggerated but within the wide range of what is normal. But fussiness or jitteriness can be the presenting symptoms for hypothermia, hypoglycemia, hypocalcemia, opioid withdrawal, meningitis, pneumonia, sepsis, necrotizing enterocolitis, a collapsed lung, a broken clavicle, hemorrhaging into the brain, a twisted testicle and much more.
While it is true that there are often historical clues or additional exam findings that can help differentiate the many possible causes of a newborn’s signs or symptoms, it isn’t always the case. Sometimes helpful clues develop over time, but time isn’t always a luxury we have. Waiting for a blood culture to become positive or for a baby to develop hypothermia and seizures before starting antibiotics would result in some very poor outcomes.
Healthcare professionals who care for newborns are trained to deal with most of the complications that can arise in the immediate period after a baby is born. We are qualified in neonatal resuscitation and regularly maintain our skills by attending classes and taking part in simulated cases. And again, we see actual sick babies. Some of us, particularly neonatologists, see a lot of them.
I tell you all this to provide some insight into my utter revulsion at the concept of chiropractors taking part in the care of any newborn infant, let alone one that might require medical intervention to save their life or prevent long-term complications. I realize that readers of Science-Based Medicine are almost certainly aware of the push by many practitioners of so-called alternative medicine to be accepted as a primary care provider or PCP. There are a number of posts that discuss their legal tactics by Jan Bellamy, for instance. And several that point out the absurdity of it all considering the lack of a fund of knowledge and appropriate training that could even remotely qualify them to successfully prevent or treat real medical problems, as opposed to their litany of fictitious ailments.
Read more here.