ENT care in the newborn

Prevention is the best cure.

If any condition is detected early then early treatment would mean a better outcome. This forms the basis for newborn screening the three main components of which are Blood tests, screening for Heart diseases and screening for Hearing Loss.

Herein below we will discuss some simple methods to monitor and manage the baby with a view to prevent common ENT problems. Also we will discuss about the Newborn Hearing Screening.

The first six months after birth the baby is protected by the immunity that is transferred from the mother. The baby's immune system develops by about one year of age. Therefore the age from six months to a year is critical as the baby can be prone to infections easily. Simple measures to keep the nose and throat clean go a long way in preventing infections in this crucial period.

NASAL CARE

Newborn babies are obligatory nasal breathers. This means that they do not know how to breathe through the mouth and if the nose is blocked with secretions they will struggle to breathe. Therefore it is very important to keep the nasal passages clear and this is done by using saline nasal drops regularly and using a dropper tip (or infant-sized nasal bulb syringe) to suck the secretions out of the nose if they are blocking the baby's nasal airway. It is a good idea to use saline nasal drops regularly in your child up to the age of five years to keep the nose clean and therefore less frequent nasal infections

Your paediatrician or ENT specialist will examine your baby to rule out any congenital blockage to the nose called Choanal Atresia. This is done by placing a cold flat steel instrument like a tongue depressor under the nose and look for fogging on the instrument. This is a rare condition and therefore most babies will have a clear nasal airway.

THROAT / ORAL CARE

The oral cavity is the route of entry of infections into the body as the baby tends to put most things into its mouth and these may be unclean or a source of infection. Therefore cleaning the tongue with a wet cloth atleast once a day is very beneficial. Also frequent sips of water improves the oral hygiene.

An uncommon finding in some babies is a Tongue Tie. This needs to be surgically released at the earliest especially if it is casuing feeding difficulties. In a small group of babies, a tongue tie may cause some speech problems and therefore early intervention is beneficial.

EAR CARE

It is very importatnt that the babies are always fed in a sitting or semi erect position (especially bottle feeding). The babies should never be fed in a lying flat position. This is because the Eustachian tubes (the tubes that connect the ears to the back of the nose) are more horizontal in position and milk can enter these tubes leading to ear infections.

The ear canals can be blocked with wax and using few drops of oils such as baby oil, coconut oil, almond oil or olive oil regularly can mimimise the wax and help clear it out naturally.

Rarely some babies can have congenital hearing loss due to genetic causes. It is very important to identify them early so they can be treated early or necessary support can be given early to prevent speech delay and help social interaction. If not actively tested and identified early, it is easy to miss the hearing loss and it may become difficult to prevent problems at a later date.

NEWBORN HEARING SCREENING

The Newborn Hearing Screening involves a test called OAE (Oto Acoustic Emmision) wherein a small probe like a ear plug is placed in the baby's ears and a computer is used to check the hearing. This test is done as soon as possible after birth and preferably within the first month after birth.

Most babies pass this test, In those babies that fail this test, a specialised test called AABR (Automated Auditory Brainstem Respone) maybe done. More diagnostic hearing tests are preferably done before three months of age if hearing loss is suspected and if needed hearing aids are given by 6 months of age to be beneficial and prevent speech delay

It is also a good idea to monitor hearing in the preschool and early childhood to pick up hearing loss from infections or other non genetic causes and if need intrevene early