Changes

|type=article

|type=article

}}

}}

 

The care of a newborn is termed as “Navajata shishu paricharya” in [[Ayurveda]]. ‘Navajata shishu’ is a newborn baby, and ‘paricharya’ indicates the care and necessary management protocols. The atmosphere and surroundings change from intrauterine dependent life to independent external life after birth. The child has to adapt to the new changes quickly. It is essential to take care of newborns until the body systems are well adopted and developed to survive in the new world. [[Ayurveda]] classical texts include the methods and practices followed for newborn care in ancient times. The ancient practices include use of available natural resources. Hence, they can be practiced with cost effectiveness and the least medical equipments. Though the principles of care are same, the contemporary practices have changed significantly with advances in medical technology. This article deals with the analysis of these practices along with their contemporary views.  

The care of a newborn is termed as “Navajata shishu paricharya” in [[Ayurveda]]. ‘Navajata shishu’ is a newborn baby, and ‘paricharya’ indicates the care and necessary management protocols. The atmosphere and surroundings change from intrauterine dependent life to independent external life after birth. The child has to adapt to the new changes quickly. It is essential to take care of newborns until the body systems are well adopted and developed to survive in the new world. [[Ayurveda]] classical texts include the methods and practices followed for newborn care in ancient times. The ancient practices include use of available natural resources. Hence, they can be practiced with cost effectiveness and the least medical equipments. Though the principles of care are same, the contemporary practices have changed significantly with advances in medical technology. This article deals with the analysis of these practices along with their contemporary views.  

 

{{Infobox

{{Infobox

|label1 = Section/Chapter/topic

|label1 = Section/Chapter/topic

|data1 = [[Sharira]] / [[Artava]] / Menstrual disorders  

|data1 = [[Sharira]] / [[Garbha]] /Neonatal care (Navajata shishu paricharya)  

|label2 = Authors

|label2 = Authors

|data2 = Karthik K.P.¹, Anagha S.², Deole Y.S.²

|data2 = Karthik K.P.¹, Anagha S.²  

|label3 = Reviewers  

|label3 = Reviewers  

|data3 = Bhinde S.³ Basisht G.²,  

|data3 = Bhinde S.³ Basisht G.²,  

|label4 = Editor

|label4 = Editors

|data4 = Basisht G.²

|data4 = Deole Y.S.² Basisht G.²

|label5 = Affiliations

|label5 = Affiliations

|data5 = ¹ Department of Kaumarabhritya, AIIA , New Delhi,

|data5 = ¹ Department of Kaumarabhritya, A.I.I.A. , New Delhi, India

²[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar,

²[[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar,India

³ Department of Kaumarabhritya, ITRA, Jamnagar.

³ Department of Kaumarabhritya, I.T.R.A., Jamnagar,India

|label6 = Correspondence email

|label6 = Correspondence email

|label7 = Date of first publication:

|label7 = Date of first publication:

|data7 = August 10, 2021

|data7 = August 10, 2021

|label8 = DOI

|label8 = DOI

|data8 = under process

|data8 = under process

4. A club or pestle is placed along the lower wooden beam of the door frame.

4. A club or pestle is placed along the lower wooden beam of the door frame.

5. Medicines like Acorus calamus (vacha), Saussurea lappa (kushta), Ferula asafetida (hingu), Brassica juncea (sarshapa), Linum usitatissimum  (atasi), and Allium sativum (lashuna) and other drugs that are capable of eliminating the surrounding morbidity factors (rakshoghna) are to be tied inside a cloth packet and suspended down from the upper beam of the door frame.

5. Medicines like Acorus calamus (vacha), Saussurea lappa (kushtha), Ferula asafetida (hingu), Brassica juncea (sarshapa), Linum usitatissimum  (atasi), and Allium sativum (lashuna) and other drugs that are capable of eliminating the surrounding morbidity factors (rakshoghna) are to be tied inside a cloth packet and suspended down from the upper beam of the door frame.

6. These packets are worn by the mother and child on their necks.

6. These packets are worn by the mother and child on their necks.

The drugs usable for fumigation include Hordeum vulgare (yava), Brassica juncea (sarshapa), Linum usitatissimum (atasi), Ferula asafetida (hingu), Commiphora mukul (guggulu,), Acorus calamus (vacha), Angelica glauca (choraka), Bacopa monnieri (brahmi), Nardostachos jatamamsi (Jatamamsi),  Saraca asoca (ashoka), Picrorhiza kurroa (rohini), and slough of snake mixed with ghee. [Cha. Sa. [[Sharira Sthana]] 8/61]

The drugs usable for fumigation include Hordeum vulgare (yava), Brassica juncea (sarshapa), Linum usitatissimum (atasi), Ferula asafetida (hingu), Commiphora mukul (guggulu,), Acorus calamus (vacha), Angelica glauca (choraka), Bacopa monnieri (brahmi), Nardostachos jatamamsi (Jatamamsi),  Saraca asoca (ashoka), Picrorhiza kurroa (rohini), and slough of snake mixed with ghee. [Cha. Sa. [[Sharira Sthana]] 8/61]

The drugs that are mentioned for fumigation and preventing infection have antimicrobial action (especially against Staphylococcus aureus) in vitro.  

The drugs that are mentioned for fumigation and preventing infection have antimicrobial action (especially against Staphylococcus aureus) in vitro.<ref>Manita Ahlawat et.al., In-vitro Evaluation of Antimicrobial Activity of Dhupana Drugs on Staphylococcus aureus, International Journal of Ayurvedic Medicine, 2019, 10(3), 289-292</ref>

</div>

</div>

=== Wearing of amulets ===

=== Wearing of amulets ===

Amulets made from pearls and other jewels end of right horns of rhinoceros, deer, or bull, drugs which have the property of promoting the growth of the child (prajasthapana).eg- Bacopa monnieri (aindri) are advised to be worn. [Cha. Sa. [[Sharira Sthana]] 8/62]  

Amulets made from pearls and other jewels end of right horns of rhinoceros, deer, or bull, drugs which have the property of promoting the growth of the child (prajasthapana).eg- Bacopa monnieri (aindri) are advised to be worn. [Cha. Sa. [[Sharira Sthana]] 8/62]  

Any scientific explanation regarding the action of talismans and amulets is not available. Even though it has been made an object of study in various research works. It is considered to be an element indicating emotional and psychological support. The concept of evil eye and measures to fend it off are prevalent in various forms all over the globe.  Even these spiritual tools shall be used with caution as they are also not completely free from adverse reactions, for instance some amulets have been identified to be potential chemical toxins (especially lead).  

Any scientific explanation regarding the action of talismans and amulets is not available. Even though it has been made an object of study in various research works. It is considered to be an element indicating emotional and psychological support. The concept of evil eye and measures to fend it off are prevalent in various forms all over the globe.  Even these spiritual tools shall be used with caution as they are also not completely free from adverse reactions, for instance some amulets have been identified to be potential chemical toxins (especially lead).<ref>Centers for Disease Control and Prevention (CDC). Lead poisoning of a child associated with use of a Cambodian Amulet --- New York City, 2009. MMWR Morb Mortal Wkly Rep. 2011 Jan 28;60(3):69-71. PMID: 21270744.</ref>

</div>

</div>

===Recommendations for selection of toys===

===Recommendations for selection of toys===

Toys for the baby must be diverse, sound-producing, attractive, light, devoid of sharp edges, non-swallowable, non-dangerous, non-frightening. [Cha. Sa. Sharira Sthana 8/63]  

Toys for the baby must be diverse, sound-producing, attractive, light, devoid of sharp edges, non-swallowable, non-dangerous, non-frightening. [Cha. Sa. Sharira Sthana 8/63]  

In those times, if the physical attributes of the toys were the primary area of concern, today, chemical aspects also are to be taken care. Phthalates, lead, and cadmium used in soft plastic or PVC toys, button batteries, and several other chemicals have posed dangerous threats to children. Cancer, kidney and reproductive dysfunction, and intellectual disabilities are the major diseases associated with these chemicals.  Most countries have safety regulations for toys. The toys also play a pivotal role in the child's development in all domains of creativity, intellect, problem-solving ability, and social behavior. Toys are to be judiciously selected, specifically according to the need of the child.  

In those times, if the physical attributes of the toys were the primary area of concern, today, chemical aspects also are to be taken care. Phthalates, lead, and cadmium used in soft plastic or PVC toys, button batteries, and several other chemicals have posed dangerous threats to children. Cancer, kidney and reproductive dysfunction, and intellectual disabilities are the major diseases associated with these chemicals.<ref>Pandve, Harshal T. “Selecting the Right Toys for Your child is Not a Child's Play.” Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine vol. 35,2 (2010): 367-8. doi:10.4103/0970-0218.66867</ref> Most countries have safety regulations for toys. The toys also play a pivotal role in the child's development in all domains of creativity, intellect, problem-solving ability, and social behavior. Toys are to be judiciously selected, specifically according to the need of the child.  

According to the utility, toys are of five categories:

According to the utility, toys are of five categories:

v. Gross motor (Tricycles, push and pull toys, large toy cars, etc.)

v. Gross motor (Tricycles, push and pull toys, large toy cars, etc.)

It is also important that the toys improve the interactions between the child and his caregivers, peers, and parents. Obesity, aggression, and poor social interactions are often observed as consequences of excessive indulgence in electronic toys and games).  

It is also important that the toys improve the interactions between the child and his caregivers, peers, and parents. Obesity, aggression, and poor social interactions are often observed as consequences of excessive indulgence in electronic toys and games).<ref>Aleeya Healey, Alan Mendelsohn, Selecting Appropriate Toys for Young Children in the Digital Era, COUNCIL ON EARLY CHILDHOOD, Pediatrics Jan 2019, 143 (1) e20183348; DOI: 10.1542/peds.2018-3348</ref>

</div>

</div>

==Approach to an unhealthy newborn==

==Approach to an unhealthy newborn==

<div style="text-align:justify;">

<div style="text-align:justify;">

- Site of origin and manifestation of the disease. [Cha. Sa. Sharira Sthana 8/64]

- Site of origin and manifestation of the disease. [Cha. Sa. Sharira Sthana 8/64]

===Evaluating a sick newborn===

===Evaluating a sick newborn===

<div style="text-align:justify;">

<div style="text-align:justify;">

A history comprising the age of neonate, antenatal and intrapartum events, delivery mode, Apgar score, neonatal resuscitation, feeding history, disease history is to be taken primarily. There are various scales that are used in neonatology:

A history comprising the age of neonate, antenatal and intrapartum events, delivery mode, Apgar score, neonatal resuscitation, feeding history, disease history is to be taken primarily. There are various scales that are used in neonatology:

I. Apgar Score : Apgar score is one of the most initial and relevant scores used in neonatology. It is primarily used to assess the basic condition of the child at birth.

I. Apgar Score<ref>https://pediatrics.aappublications.org/content/pediatrics/117/4/1444.full.pdf </ref> : Apgar score is one of the most initial and relevant scores used in neonatology. It is primarily used to assess the basic condition of the child at birth.

ii. Downe’s score : The score and Silverman and Anderson score are used to assess respiratory distress in neonates.  

ii. Downe’s score<ref>http://cghealth.nic.in/ehealth/2013/Training_Portal/pdf/FBNC/Chapter%2010.pdf </ref> : The score and Silverman and Anderson score are used to assess respiratory distress in neonates.  

iii.New Ballard’s score : This score calculates the gestational age of the child under two broad headings, physical and neuromuscular maturity.

iii.New Ballard’s score <ref>https://www.ballardscore.com/files/BallardScore_scoresheet.pdf </ref> : This score calculates the gestational age of the child under two broad headings, physical and neuromuscular maturity.

iv.Sarnat & Sarnat staging , Levene staging : Hypoxic-ischemic encephalopathy (HIE) is caused due to hypoxemia and/ or reduced cerebral blood flow due to a peripartum event. It is one of the significant causes of mortality and long-term morbidity in neonates. These two scales are used to stage HIE.

iv.Sarnat & Sarnat staging<ref>https://www.health.qld.gov.au/__data/assets/pdf_file/0014/140162/g-hie.pdf </ref> , Levene staging <ref>https://www.newbornwhocc.org/pdf/post_asphyxia_mangement.pdf </ref>: Hypoxic-ischemic encephalopathy (HIE) is caused due to hypoxemia and/ or reduced cerebral blood flow due to a peripartum event. It is one of the significant causes of mortality and long-term morbidity in neonates. These two scales are used to stage HIE.

v.CRIB score : Clinical Risk Index for Babies score is a UK based score that takes into consideration the birth weight, gestational age, congenital malformations, maximum base excess in the first 12 hours, and the minimum and maximum levels of inspired oxygen in the first 12 hours for evaluating the risk of mortality amongst low birth weight babies. It has been recently updated to CRIB II.

v.CRIB score<ref>Ezz-Eldin ZM, Hamid TA, Youssef MR, Nabil Hel-D. Clinical Risk Index for Babies (CRIB II) Scoring System in Prediction of Mortality in Premature Babies. J Clin Diagn Res. 2015 Jun;9(6):SC08-11. doi: 10.7860/JCDR/2015/12248.6012. Epub 2015 Jun 1. PMID: 26266178; PMCID: PMC4525567</ref> : Clinical Risk Index for Babies score is a UK based score that takes into consideration the birth weight, gestational age, congenital malformations, maximum base excess in the first 12 hours, and the minimum and maximum levels of inspired oxygen in the first 12 hours for evaluating the risk of mortality amongst low birth weight babies. It has been recently updated to CRIB II.

vi. SNAP score : The score for Acute Neonatal physiology was a USA-based score for assessing mortality and morbidity risk in a neonatal ICU. It considered 26 factors, which was simplified in its further generations, now in the form SNAPPE II (SNAP with Perinatal Extension II) considering six major factors.  

vi. SNAP score<ref>Harsha SS, Archana BR. SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension-II) in Predicting Mortality and Morbidity in NICU. J Clin Diagn Res. 2015 Oct;9(10):SC10-2. doi: 10.7860/JCDR/2015/14848.6677. Epub 2015 Oct 1. PMID: 26557585; PMCID: PMC4625304.</ref> : The score for Acute Neonatal physiology was a USA-based score for assessing mortality and morbidity risk in a neonatal ICU. It considered 26 factors, which was simplified in its further generations, now in the form SNAPPE II (SNAP with Perinatal Extension II) considering six major factors.  

</div>

</div>

===Fetal aspiration syndrome (ulbaka)===

===Fetal aspiration syndrome (ulbaka)===

<div style="text-align:justify;">

<div style="text-align:justify;">

Due to insufficient clearing of amniotic fluid or the mucus in the throat, the nutrient fluid derived from the consumed food gets vitiation due to interaction with them. This leads to the fainting of the child with clenched fists. The child also gets afflicted by various other diseases like heart diseases, convulsions, dyspnea, cough, vomiting and fever. It is called ulbaka or ambupurna. [A.S.Uttara Sthana 2/52]

Due to insufficient clearing of amniotic fluid or the mucus in the throat, the nutrient fluid derived from the consumed food gets vitiation due to interaction with them. This leads to the fainting of the child with clenched fists. The child also gets afflicted by various other diseases like heart diseases, convulsions, dyspnea, cough, vomiting and fever. It is called ulbaka or ambupurna. [A.S. Uttara Sthana 2/52]

'''Management:''' After immediate neonatal resuscitation, the disease should be treated with principles of purification of channels (srotoshodhana) followed by palliative therapy (shamana chikitsa)

'''Management:''' After immediate neonatal resuscitation, the disease should be treated with principles of purification of channels (srotoshodhana) followed by palliative therapy (shamana chikitsa)

Daily administration of goat’s urine is recommended in this condition. It is not practiced currently. Oil massage and bathing are strictly contraindicated. A medicated ghee preparation namely “Billvadi gritam” is indicated in this condition. [A.S.Uttara Sthana 2/52]

Daily administration of goat’s urine is recommended in this condition. It is not practiced currently. Oil massage and bathing are strictly contraindicated. A medicated ghee preparation namely “Bilvadi gritam” is indicated in this condition. [A.S.Uttara Sthana 2/52]

'''Meconium aspiration syndrome'''

'''Meconium aspiration syndrome'''

The fetus passes meconium (greenish to brownish black thick secretion containing gastric contents), which may be aspirated in utero, during birth, or after birth known as “Meconium aspiration syndrome”. The meconium that has been breathed in, due to its mechanical properties, result in trapping of air inside the alveoli, and with irritant nature and toxicity, causes the inflammation of lung parenchyma, deactivation or wash-out of the surfactant and pulmonary hypertension leading to further complications. The clinical features of the condition include apnea leading to respiratory distress, suprasternal, substernal and intercostal retractions, grunting, emphysema, atelectasis, and consolidation. The management of MAS includes stomach wash, oxygen supply, thermoneutral environment, and symptomatic management. Continuous positive airway pressure, specific antibiotics, inhaled nitric oxide, and surfactant therapy constitute other therapeutic considerations.  

The fetus passes meconium (greenish to brownish black thick secretion containing gastric contents), which may be aspirated in utero, during birth, or after birth known as “Meconium aspiration syndrome”. The meconium that has been breathed in, due to its mechanical properties, result in trapping of air inside the alveoli, and with irritant nature and toxicity, causes the inflammation of lung parenchyma, deactivation or wash-out of the surfactant and pulmonary hypertension leading to further complications. The clinical features of the condition include apnea leading to respiratory distress, suprasternal, substernal and intercostal retractions, grunting, emphysema, atelectasis, and consolidation. The management of MAS includes stomach wash, oxygen supply, thermoneutral environment, and symptomatic management. Continuous positive airway pressure, specific antibiotics, inhaled nitric oxide, and surfactant therapy constitute other therapeutic considerations.<ref>Meharban Singh, Respiratory Disorders, Care of Newborn, Revised Eighth edition (2017), CBS Publishers and Distributors Pvt. Ltd., Chapter 19, Page No: 353.</ref>

</div>

</div>

===Swelling on head ( upashirshaka)===

===Swelling on head ( upashirshaka)===

<div style="text-align:justify;">

<div style="text-align:justify;">

|Extent of resolution ||Spontaneous and complete || Spontaneous, very rarely leaves elevated margins and calcifications.

|Extent of resolution ||Spontaneous and complete || Spontaneous, very rarely leaves elevated margins and calcifications.

|-

|-

|Intervention || Not needed || Incision or aspiration in case of infection or hyperbilirubinemia.  

|Intervention || Not needed || Incision or aspiration in case of infection or hyperbilirubinemia.<ref>Meharban Singh, Care of the Normal Newborn, Care of Newborn, Revised Eighth edition (2017), CBS Publishers and Distributors Pvt. Ltd., Chapter 8, Page No: 163. </ref>

|}

|}

===Diaper rash (gudakuttaka) ===

===Diaper rash (gudakuttaka) ===

Due to increased sweating or adhesion of feces to the anal region, coppery-colored lesion associated with itching occurs. Gudakutta in Ayurveda is also popular by other names Matrkadosha, Ahiputana, Anamika (Diaper rash or diaper dermatitis). [A. Hr. Uttara Sthana 2/69-70]

Due to increased sweating or adhesion of feces to the anal region, coppery-colored lesion associated with itching occurs. Gudakutta in Ayurveda is also popular by other names Matrkadosha, Ahiputana, Anamika (Diaper rash or diaper dermatitis). [A. Hr. Uttara Sthana 2/69-70]

• Leech therapy (raktamoshana using jaloka) in cases of redness and itching. [ A.Hr. Uttara Sthana 2/71-75]

• Leech therapy (raktamoshana using jaloka) in cases of redness and itching. [ A.Hr. Uttara Sthana 2/71-75]

Diaper dermatitis is contact eczema that results from the cumulative effect of hyperhydration of the stratum corneum due to the stagnation of urine and feces within the diaper. The friction of the diaper on the skin leads to inflammation, skin barrier dysfunction and increased vulnerability to infections. Maceration of skin, fungal infection, etc. are also seen contributive to diaper rash. It is managed by educating the parents about diaper related hygiene and topical medications like Zinc Oxide, petrolatum, Aquaphor or rarely topical steroids.

Diaper dermatitis is contact eczema that results from the cumulative effect of hyperhydration of the stratum corneum due to the stagnation of urine and feces within the diaper. The friction of the diaper on the skin leads to inflammation, skin barrier dysfunction and increased vulnerability to infections. Maceration of skin, fungal infection, etc. are also seen contributive to diaper rash. It is managed by educating the parents about diaper related hygiene and topical medications like Zinc Oxide, petrolatum, Aquaphor or rarely topical steroids.<ref>Fölster-Holst R. Differential diagnoses of diaper dermatitis. Pediatr Dermatol. 2018 Mar;35 Suppl 1:s10-s18. doi: 10.1111/pde.13484. PMID: 29596730.</ref>

   

   

Some other diseases and symptoms mentioned in Ayurveda classics, prevalent in neonates and infants are:

Some other diseases and symptoms mentioned in Ayurveda classics, prevalent in neonates and infants are:

Diseases arising due to consumption of vitiated breast milk (Ksheeralasaka, Kumarashosha)

Diseases arising due to consumption of vitiated breast milk (Ksheeralasaka, Kumarashosha)

Affliction by evil forces named Grahas is described. These conditions are similar to the present-day infections and developmental disorders due to birth trauma and other perinatal factors.

Affliction by evil forces named 'Graha' is described. These conditions are similar to the present-day infections and developmental disorders due to birth trauma and other perinatal factors.

 

==General principles of management of diseases in newborns and children==

==General principles of management of diseases in newborns and children==

The pathophysiological factors of diseases in the infant are the same as that in an adult. The difference is that body components in the infant are very immature.[ A.Hr.Uttara Sthana 1/30-31] Hence, there are restrictions in administering medicines and therapeutic procedures in children.  

 

The pathophysiological factors of diseases in the infant are the same as that in an adult. The difference is that body components in the infant are very immature.[A.Hr.Uttara Sthana 1/30-31] Hence, there are restrictions in administering medicines and therapeutic procedures in children.  

The nature of medicines used in children must be decided after considering the following factors:

The nature of medicines used in children must be decided after considering the following factors:

==Related Chapters==

==Related Chapters==

[[Jatisutriya Sharira]]

[[Jatisutriya Sharira]]

==Abbreviations==

==Abbreviations==

•  A. = Ashtanga

• Sa. = Samhita,  • Cha. = Charak, • Su. = Sushruta, •  A. = Ashtanga, • Hr. = Hridaya, • S. = Sangraha,

• Hr. = Hridaya

<big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big>

• S. = Sangraha

==References==

==References:==

<div id="BackToTop"  class="noprint" style="background-color:#DDEFDD; position:fixed;

bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;