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Line 262: − Research works are being conducted on the topic of the administration of gold-containing medicines (“swarnaprashan”) to the neonates. Many clinical trials have shown its efficacy in improving the baby's immunity. A clinical trial was conducted in 102 infants to analyze the effects of gold nanoparticles (swarna bhasma) administered with ghee and honey compared to plain ghee and honey (ratio 1:4). The number of drops of medicine administered was equal to the age of the infant in months. The quantity of gold in the drops (in milligrams) was 0.2 times the age in months. The drops were administered for 4 weeks. No adverse drug reactions were observed. Even though both the groups showed considerable improvement in immunological parameters, there was significant normalization of immunoglobin G in the group administered with gold compared to the other group. − + + + + − + + + − + − + − + + Line 295:
Line 309: − + + + − With higher content of lactose, whey and lactalbumin, lower solute load, and osmolality compared to that of animal milk, human milk stands the best choice of diet for babies, at least up to 6 months. The substitution of breast milk with animal milk or formulas based on them is not recommended unless the situation demands. In such cases, goat milk or cow milk-based formula or liquid milk shall be provided. Goat milk-based infant formulae have been found to be resembling human milk than those of cow milk . All the substitutes for breast milk, their production, distribution, advertising, etc. are governed by the Infant Milk Substitutes Act 1992. Line 310:
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Line 416: + − + + + − ii. Downe’s score : 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.+ − 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.+ − 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.+ + − 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. − </div> − + − + − + + Line 457:
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{{CiteButton}}
{{#seo:
{{#seo:
|title = Neonatal care (Navajata shishu paricharya)
|title = Neonatal care (Navajata shishu paricharya)
|type=article
|type=article
}}
}}
<div style="text-align:justify;">
<p style="text-align:justify;">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.
</p>
</div>
{{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.<sup>1</sup>, Anagha S.<sup>2</sup>, Deole Y.S.<sup>2</sup>
|data2 = Karthik K.P.<sup>1</sup>, Anagha S.<sup>2</sup>
|label3 = Reviewers
|label3 = Reviewers
|data3 = Bhinde S.<sup>3</sup> Basisht G.<sup>2</sup>,
|data3 = Bhinde S.<sup>3</sup> Basisht G.<sup>2</sup>,
|label4 = Editor
|label4 = Editors
|data4 = Basisht G.<sup>2</sup>
|data4 = Deole Y.S.<sup>2</sup> Basisht G.<sup>2</sup>
|label5 = Affiliations
|label5 = Affiliations
|data5 = <sup>1</sup> Department of Kaumarabhritya, AIIA , New Delhi,
|data5 = <sup>1</sup> Department of Kaumarabhritya, A.I.I.A. , New Delhi, India
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar,India
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar,
<sup>3</sup> Department of Kaumarabhritya, I.T.R.A., Jamnagar,India
|label6 = Correspondence emails
|data6 = kpkarthik131@gmail.com, carakasamhita@gmail.com
|label6 = Correspondence email
|label7 = Publisher
|data6 = carakasamhita@gmail.com
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of first publication:
|label8 = Date of first publication:
|data7 = August 10, 2021
|data8 = August 10, 2021
|label8 = DOI
|data8 = under process
|label9 = DOI
|data9 = 10.47468/CSNE.2021.e01.s09.071
}}
}}
==Care of healthy newborn==
==Care of healthy newborn==
<div style="text-align:justify;">
<div style="text-align:justify;">
A normal newborn is born at term with birth weight between 2,500 g and 3500 g, without any breathing difficulty, major congenital malformations, or any birth injuries. The goals of neonatal care in all medical systems are uniform:
A normal newborn is born at term with birth weight between 2,500 g and 3500 g, without any breathing difficulty, major congenital malformations, or any birth injuries.<ref>B. Vishnu Bhat. Care of Normal Newborn, IAP textbook of pediatrics, 7th edition, Jaypee Publishers. Chapter 2.3, Page No. 46. </ref>
The goals of neonatal care in all medical systems are uniform:
a) Ensure successful transition from fetal to neonatal life.
a) Ensure successful transition from fetal to neonatal life.
In the classical literature of [[Ayurveda]], the immediate procedures similar to resuscitation methods are described as the measures to re-establish and maintain vital energy (prana). It is recommended for every newborn irrespective of their vital status at the time of birth. [Cha.Sa.[[Sharira Sthana]] 8/42].
In the classical literature of [[Ayurveda]], the immediate procedures similar to resuscitation methods are described as the measures to re-establish and maintain vital energy (prana). It is recommended for every newborn irrespective of their vital status at the time of birth. [Cha.Sa.[[Sharira Sthana]] 8/42].
In contemporary views, if the baby is born at full term with a good tone and normal respiration (or healthy cry), only routine care needs to be given. The baby is to be kept dry, warm, and with airways clear. If, the baby does not satisfy the criteria of term tone and breathing, he/she has to be in the the warmer area and subjected to a neonatal resuscitation algorithm.
In contemporary views, if the baby is born at full term with a good tone and normal respiration (or healthy cry), only routine care needs to be given. The baby is to be kept dry, warm, and with airways clear.<ref>https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/NSSK/NSSK-Flipchart.pdf</ref> If, the baby does not satisfy the criteria of term tone and breathing, he/she has to be in the the warmer area and subjected to a neonatal resuscitation algorithm. <ref>https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/NSSK/NSSK-Flipchart.pdf</ref>
</div>
</div>
=== Ancient resuscitation measures (prana pratyagamana vidhi)===
=== Ancient resuscitation measures (prana pratyagamana vidhi)===
<div style="text-align:justify;">
<div style="text-align:justify;">
Once the child starts breathing properly, cleaning the external orifices and bathing of the child is to be done. Cleaning of the orifices is done by wiping with cotton wrapped around the fingers. The nails of the caretaker shall be trimmed to prevent any skin injury to the newborn. While cleaning the oral cavity, the direction shall be from palate to lips. Then the buccal cavity shall be cleaned from throat to tongue. [Cha.Sa.[[Sharira Sthana]] 8/42]
Once the child starts breathing properly, cleaning the external orifices and bathing of the child is to be done. Cleaning of the orifices is done by wiping with cotton wrapped around the fingers. The nails of the caretaker shall be trimmed to prevent any skin injury to the newborn. While cleaning the oral cavity, the direction shall be from palate to lips. Then the buccal cavity shall be cleaned from throat to tongue. [Cha.Sa.[[Sharira Sthana]] 8/42]
In modern pediatric practice, the cleaning of the airway is done by inserting a laryngoscope. Clearing the mouth and posterior pharynx is done by using a suction catheter under direct vision in case of visible obstruction of the airway of the neonate with respiratory distress syndrome.
In modern pediatric practice, the cleaning of the airway is done by inserting a laryngoscope. Clearing the mouth and posterior pharynx is done by using a suction catheter under direct vision in case of visible obstruction of the airway of the neonate with respiratory distress syndrome.<ref name=Chadha>Chadha IA. Neonatal resuscitation: Current issues. Indian J Anaesth. 2010;54(5):428-438. doi:10.4103/0019-5049.71042</ref>
The patency of these orifices and the presence of any congenital abnormality are also examined while cleaning.
The patency of these orifices and the presence of any congenital abnormality are also examined while cleaning.
</div>
</div>
Administration of ghee mixed with rock salt to induce emesis is recommended. [Cha. Sa. [[Sharira Sthana]] 8/43]. This emesis is targeted to eliminate accidentally swallowed or aspirated amniotic fluid, especially meconium-stained (ulba).
Administration of ghee mixed with rock salt to induce emesis is recommended. [Cha. Sa. [[Sharira Sthana]] 8/43]. This emesis is targeted to eliminate accidentally swallowed or aspirated amniotic fluid, especially meconium-stained (ulba).
Currently, this procedure is not generally practiced. In the case of meconium aspiration, it is recovered by slow suction by a suction device connected with the endotracheal tube inserted into the trachea.
Currently, this procedure is not generally practiced. In the case of meconium aspiration, it is recovered by slow suction by a suction device connected with the endotracheal tube inserted into the trachea.<ref name=Chadha />
</div>
</div>
===Application of oil on head (shiro pichu)===
===Application of oil on head (shiro pichu)===
<div style="text-align:justify;">
<div style="text-align:justify;">
Application of cotton soaked in ghee or medicated oil with Sida cordifolia (bala) over the vertex of the newborn is practiced. [Su. Sa. Sharira Sthana 10/12] The covering of anterior fontanels (where there could be open intracranial sutures at birth) using oil or ghee smeared tampons act as a protective mechanism to the open sutures. It also optimizes the heat regulation mechanism. At this point, examination of fontanels is also performed.
Application of cotton soaked in ghee or medicated oil with Sida cordifolia (bala) over the vertex of the newborn is practiced. [Su. Sa. Sharira Sthana 10/12] The covering of anterior fontanels (where there could be open intracranial sutures at birth) using oil or ghee smeared tampons act as a protective mechanism to the open sutures. It also optimizes the heat regulation mechanism.<ref>Sharma S, Dangwal A, Pandey R. Navjata Shishu Paricharya (Neonatal Care) In Ayurveda: A Review. J Ayu Herb Med 2019;5(3):106-109.</ref> At this point, examination of fontanels is also performed.
</div>
</div>
===Cutting of umbilical cord===
===Cutting of umbilical cord===
<div style="text-align:justify;">
<div style="text-align:justify;">
The time of cutting and clamping the umbilical cord is crucial for the health of the newborn. In [[Ayurveda]], cutting of the umbilical cord is recommended only after the baby become stable in the external environment. [A.Hr.Uttara Sthana 1/5-6] World Health Organization recommends delayed umbilical cord clamping i.e., at least one minute after birth for better health and nutritional outcomes of the mother as well as the baby.
The time of cutting and clamping the umbilical cord is crucial for the health of the newborn. In [[Ayurveda]], cutting of the umbilical cord is recommended only after the baby become stable in the external environment. [A.Hr.Uttara Sthana 1/5-6] World Health Organization recommends delayed umbilical cord clamping i.e., at least one minute after birth for better health and nutritional outcomes of the mother as well as the baby.<ref>https://www.who.int/elena/titles/full_recommendations/cord_clamping/en/ </ref>
The cord is cut at a point 16 cm (eight angulas) away from the umbilicus. The cord is held gently and firmly on both sides of the point and carefully cut using scissors (ardhadhara) made up of gold, silver, iron, or similar metals. The proximal end of the cut umbilical cord is tied with a thread, and the other end of the thread should be tied loosely around the neck of the child. [Cha.Sa.[[Sharira Sthana]] 8/44] Tying a knot on the cord using a thread before cutting, and then attaching it to the neck after cutting the cord, is also desirable.[Su. Sa. Sharira Sthana 10/12], [A.Hr.Uttara Sthana 1/5-6] Now a days, umbilical cord clamp is used for this purpose.
The cord is cut at a point 16 cm (eight angulas) away from the umbilicus. The cord is held gently and firmly on both sides of the point and carefully cut using scissors (ardhadhara) made up of gold, silver, iron, or similar metals. The proximal end of the cut umbilical cord is tied with a thread, and the other end of the thread should be tied loosely around the neck of the child. [Cha.Sa.[[Sharira Sthana]] 8/44] Tying a knot on the cord using a thread before cutting, and then attaching it to the neck after cutting the cord, is also desirable.[Su. Sa. Sharira Sthana 10/12], [A.Hr.Uttara Sthana 1/5-6] Now a days, umbilical cord clamp is used for this purpose.
In modern obstetrical practices, early clamping and cutting of the umbilical cord was a practiced as a part of active management of third stage of labour. But recent studies suggest that it may be harmful to the baby. Delayed clamping helps in reducing incidence of anaemia, intraventricular haemorrhage, and the need for transfusion for hypovolaemia and anaemia, except in the case of growth restricted babies who are already at risk of hypoxia induced polycythaemia.
In modern obstetrical practices, early clamping and cutting of the umbilical cord was a practiced as a part of active management of third stage of labour. But recent studies suggest that it may be harmful to the baby.<ref>Weeks A. Umbilical cord clamping after birth. BMJ. 2007;335(7615):312-313. doi:10.1136/bmj.39282.440787.80</ref> Delayed clamping helps in reducing incidence of anaemia, intraventricular haemorrhage, and the need for transfusion for hypovolaemia and anaemia,<ref>Rabe H, Reynolds G, Diaz-Rossello J. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database Syst Rev 2004;(4):CD003248.</ref> except in the case of growth restricted babies who are already at risk of hypoxia induced polycythaemia.<ref>Van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ 2006;333:954-8.</ref>
</div>
</div>
• Anointment (lepana) of thick paste of medicines along with jiggery.
• Anointment (lepana) of thick paste of medicines along with jiggery.
• Pouring (parisheka) of the decoction or oil processed with Glycyrrhiza glabra Linn (yasti), Symplocos racemosa (lodhra), Curcuma longa (nisha), and Panicum frumentaceum (shyamaka) or dusting using the powder made out of the same drugs is done as per the clinical condition of umbilicus.
• Pouring (parisheka) of the decoction or oil processed with Glycyrrhiza glabra Linn (yashti), Symplocos racemosa (lodhra), Curcuma longa (nisha), and Panicum frumentaceum (shyamaka) or dusting using the powder made out of the same drugs is done as per the clinical condition of umbilicus.
• In nabhitundi, [[vata]] alleviating measures like oleation (sneha), sudation (sweda), application of poultice(upanaha) should be done.
• In nabhitundi, [[vata]] alleviating measures like oleation (sneha), sudation (sweda), application of poultice(upanaha) should be done.
• A combination of Symplocos racemosa (Lodhra), Glycrrhiza glabra (Madhuka), Aglaia elaeagnoidea (Priyangu), Cedrus deodara (Suradaru), and Curcuma longa (Haridra) shall be used as a powder for dusting and oil made of their pastes shall be used for pouring.
• A combination of Symplocos racemosa (lodhra), Glycyrrhiza glabra (madhuka), Aglaia elaeagnoidea (priyangu), Cedrus deodara (suradaru), and Curcuma longa (haridra) shall be used as a powder for dusting and oil made of their pastes shall be used for pouring.
General measures to alleviate [[vata]] and [[pitta]] are to be administered in cases of diseases due to improper cutting of the umbilical cord. [A.S.Uttara Sthana 2/51]
General measures to alleviate [[vata]] and [[pitta]] are to be administered in cases of diseases due to improper cutting of the umbilical cord. [A.S.Uttara Sthana 2/51]
In modern practices also, the umbilical cord is maintained clean and dry. Spirit is used for cleaning. No local antiseptics are used as routine care. The stump falls off in 7 to 10 days. Neonatal omphalitis, umbilical hernia, umbilical granuloma, umbilical polyp, umbilical cyst, etc. are common disorders of the umbilicus.
In modern practices also, the umbilical cord is maintained clean and dry. Spirit is used for cleaning. No local antiseptics are used as routine care. The stump falls off in 7 to 10 days. Neonatal omphalitis, umbilical hernia, umbilical granuloma, umbilical polyp, umbilical cyst, etc. are common disorders of the umbilicus.<ref>Disorders of the umbilicus in infants and children: A consensus statement of the Canadian Association of Paediatric Surgeons. Paediatr Child Health. 2001;6(6):312-313. doi:10.1093/pch/6.6.312</ref>
==Examination of newborn baby==
==Examination of newborn baby==
!Parameter !! Average value
!Parameter !! Average value
|-
|-
|Birth weight|| 3.35 kg (male) , 3.25 kg (female)
|Birth weight|| 3.35 kg (male)<ref name=boy>https://www.who.int/childgrowth/standards/chts_boys_p.pdf</ref> , 3.25 kg (female)<ref name=girl>https://www.who.int/childgrowth/standards/chts_girls_p.pdf</ref>
|-
|-
|Length || 49.9 cm (male) , 49.1 cm (female)
|Length || 49.9 cm (male)<ref name=boy/> , 49.1 cm (female)<ref name=girl/>
|-
|-
|Body Mass index ||13.4 kg/ m2 (male), 13.3 kg/m2 (female)
|Body Mass index ||13.4 kg/ m2 (male), 13.3 kg/m2 (female)<ref>https://www.who.int/toolkits/child-growth-standards/standards/body-mass-index-for-age-bmi-for-age</ref>
|-
|-
|Head circumference || 34.5 cm (male), 33.9 cm (female)
|Head circumference || 34.5 cm (male)<ref>https://cdn.who.int/media/docs/default-source/child-growth/child-growth-standards/indicators/head-circumference-for-age/boys-chart--head-circumference-for-age-birth-to-13-weeks-(percentile).pdf?sfvrsn=ee62691f_0 </ref>, 33.9 cm (female)<ref>https://cdn.who.int/media/docs/default-source/child-growth/child-growth-standards/indicators/head-circumference-for-age/girls-chart--head-circumference-for-age-birth-to-13-weeks-(percentile).pdf?sfvrsn=e82e64a0_0 </ref>
|-
|-
|Chest circumference || 2 to 3 cm less than head circumference
|Chest circumference || 2 to 3 cm less than head circumference
|}
|}
'''Vital parameters'''
'''Vital parameters''' <ref>B. Vishnu Bhat. Care of Normal Newborn, IAP textbook of pediatrics, 7th edition, Jaypee Publishers. Chapter 2.3, Page No. 46. </ref>
{| class="wikitable"
{| class="wikitable"
|-
|-
'''Urine and Stool Passage'''
'''Urine and Stool Passage'''
First urine is usually passed within 48 hours after birth. Delay of urine passage without abdominal distension is probably due to inadequate feeding. Bladder distension in male child indicates posterior urethral valve. The stool is normally passed within 24 hours. If there is constipation, the probable cause behind it should be identified. The major causes are, imperforate anus, prematurity, meconium plug, megacolon (congenital), meconium ileus and hypothyroidism.
First urine is usually passed within 48 hours after birth. Delay of urine passage without abdominal distension is probably due to inadequate feeding. Bladder distension in male child indicates posterior urethral valve. The stool is normally passed within 24 hours. If there is constipation, the probable cause behind it should be identified. The major causes are, imperforate anus, prematurity, meconium plug, megacolon (congenital), meconium ileus and hypothyroidism.<ref>https://pedsinreview.aappublications.org/content/15/8/319#:~:text=Passage%20of%20the%20first%20stool,virtually%20all%20by%2048%20hours.</ref>
</div>
</div>
==General care of the newborn==
==General care of the newborn==
<div style="text-align:justify;">
<div style="text-align:justify;">
<div style="text-align:justify;">
<div style="text-align:justify;">
Initially, the neonate shall be fed with ghee and honey and the chanting of Vedic hymns.[Cha. Sa. Sharira Shana 8/46]. Acharya Sushruta advises the addition of gold to the above mixture. [Su. Sa. Sharira Sthana 10/ 13].
Initially, the neonate shall be fed with ghee and honey and the chanting of Vedic hymns.[Cha. Sa. Sharira Shana 8/46]. Acharya Sushruta advises the addition of gold to the above mixture. [Su. Sa. Sharira Sthana 10/ 13].
An earthen pot filled with water is recommended to be placed near the head of the neonate. [Cha. Sa. Sharira Sthana 8/46] It was considered as auspicious during the ancient times. Its therapeutic effect in thermoregulation or in any means is a topic of evaluation by further research. In neonates who have undergone perinatal asphyxia, therapeutic hypothermia of the scalp via cooling caps, if induced as early as possible, prevents further damage to brain and neurons.The procedure of placing the water-filled pot near the head of the baby might be a precursor of the same.
Research works are being conducted on the topic of the administration of gold-containing medicines (“swarnaprashan”) to the neonates. Many clinical trials have shown its efficacy in improving the baby's immunity. A clinical trial was conducted in 102 infants to analyze the effects of gold nanoparticles (swarna bhasma) administered with ghee and honey compared to plain ghee and honey (ratio 1:4). The number of drops of medicine administered was equal to the age of the infant in months. The quantity of gold in the drops (in milligrams) was 0.2 times the age in months. The drops were administered for 4 weeks. No adverse drug reactions were observed. Even though both the groups showed considerable improvement in immunological parameters, there was significant normalization of immunoglobin G in the group administered with gold compared to the other group.<ref>Bhaskaran JK, Patel KS, Srikrishna R. Immunomodulatory activity of Swarna Prashana (oral administration of gold as electuary) in infants - A randomized controlled clinical trial. AYU 2019;40:230-6</ref>
An earthen pot filled with water is recommended to be placed near the head of the neonate. [Cha. Sa. Sharira Sthana 8/46] It was considered as auspicious during the ancient times. Its therapeutic effect in thermoregulation or in any means is a topic of evaluation by further research. In neonates who have undergone perinatal asphyxia, therapeutic hypothermia of the scalp via cooling caps, if induced as early as possible, prevents further damage to brain and neurons.<ref>Gunn, A. J., Gluckman, P. D., & Gunn, T. R. (1998). Selective Head Cooling in Newborn Infants After Perinatal Asphyxia: A Safety Study. Pediatrics, 102(4), 885–892. doi:10.1542/peds.102.4.885 </ref> <ref>S. Shankaran, Neonatal Encephalopathy: Treatment with Hypothermia, J Neurotrauma. 26 (2009) 437–443. https://doi.org/10.1089/neu.2008.0678.</ref>The procedure of placing the water-filled pot near the head of the baby might be a precursor of the same.
</div>
</div>
===Oil massage (abhyanga) ===
===Oil massage (abhyanga) ===
<div style="text-align:justify;">
<div style="text-align:justify;">
It is recommended to apply the oil processed with herbs like Sida cordifolia (bala taila) and gently massage the neonate. [Su. Sa. Sharira Sthana 10/13]
It is recommended to apply the oil processed with herbs like Sida cordifolia (bala taila) and gently massage the neonate. [Su. Sa. Sharira Sthana 10/13]
The process of oil application followed by massage on neonate (abhyanga) has been reported to be effective in gaining weight, reducing pain, enhancing immunity and accelerating healthy growth and development.
The process of oil application followed by massage on neonate (abhyanga) has been reported to be effective in gaining weight, reducing pain, enhancing immunity and accelerating healthy growth and development.<ref>Shrikrishna, Rajagopala & Raskar, Swapnil. (2015). Abhyanga in newborn baby and neonatal massage - A review. International Journal of Ayurveda and Pharma Research. 3. 5-10.</ref>
Neonatal massage is a genre of external therapy that has been widely discussed. There are internationally acclaimed methods and procedures for the procedure. Neonatal massage has been proved to improve weight gain, optimize energy and stress levels and has reduced the risk of mortality and infection. Recently, home-based infant massage protocols based on the consensus of various medical streams have also emerged.
Neonatal massage is a genre of external therapy that has been widely discussed. There are internationally acclaimed methods and procedures for the procedure. Neonatal massage has been proved to improve weight gain, optimize energy and stress levels and has reduced the risk of mortality and infection. Recently, home-based infant massage protocols based on the consensus of various medical streams have also emerged.
</div>
</div>
=== Bathing (snana)===
=== Bathing (snana)===
<div style="text-align:justify;">
<div style="text-align:justify;">
Bathing of the baby is advised to be performed using, the decoction of the bark of the five milky trees (Kshiri Vriksha), [namely Ficus bengalensis (Vata), Ficus glomerata (Udumbara), Ficus religiosa (Ashvattha), Thespesia populina (Parisha), and Ficus lacor (Plaksha)], and other fragrant drugs. The decoction of Limonia acidissima (Kapittha), mildly heated by dipping heated gold and silver. [Su. Sa. Sutra Sthana 10/13], [ A. Hr. Uttara Sthana 1/6]
Bathing of the baby is advised to be performed using, the decoction of the bark of the five milky trees (Kshiri Vriksha), [namely Ficus bengalensis (Vata), Ficus glomerata (Udumbara), Ficus religiosa (Ashvattha), Thespesia populina (Parisha), and Ficus lacor (Plaksha)], and other fragrant drugs. The decoction of Limonia acidissima (Kapittha), mildly heated by dipping heated gold and silver. [Su. Sa. Sutra Sthana 10/13], [ A. Hr. Uttara Sthana 1/6]
Recent studies regarding bathing the newborns opine that delaying the bath by 48 hours (from birth) was effective in preserving the body temperature of the infant. The apt technique to bath neonates is swaddled bath, which has been found better in maintaining body temperature. The temperature of water in which the baby is to be bathed is recommended to be kept just above the body temperature, around 37 to 38 degree Celsius.
Recent studies regarding bathing the newborns opine that delaying the bath by 48 hours (from birth) was effective in preserving the body temperature of the infant.<ref>Gözen, D., Çaka, S. Y., Beşirik, S. A., & Perk, Y. (2019). First bathing time of newborn infants after birth: A comparative analysis. Journal for Specialists in Pediatric Nursing, e12239. doi:10.1111/jspn.12239 </ref> The apt technique to bath neonates is swaddled bath, which has been found better in maintaining body temperature.<ref>Fernández, D., & Antolín-Rodríguez, R. (2018). Bathing a Premature Infant in the Intensive Care Unit: A Systematic Review. Journal of Pediatric Nursing. doi:10.1016/j.pedn.2018.05.002 </ref> The temperature of water in which the baby is to be bathed is recommended to be kept just above the body temperature, around 37 to 38 degree Celsius.<ref>https://www.healthline.com/health/baby/baby-bath-temperature </ref>
The cleansing agents used in infants while bathing influence the skin mostly by altering the pH level. The pH of a term neonate ranges from 6.3 to 7.5, falling to 5 by 2 weeks and is maintained below 5 throughout adolescence and adulthood. The acidic pH of skin is crucial in its barrier mechanism, repair processes, etc. Hence it is recommended that the pH of the soaps should be around 5.5.
The cleansing agents used in infants while bathing influence the skin mostly by altering the pH level. The pH of a term neonate ranges from 6.3 to 7.5, falling to 5 by 2 weeks and is maintained below 5 throughout adolescence and adulthood. The acidic pH of skin is crucial in its barrier mechanism, repair processes, etc. Hence it is recommended that the pH of the soaps should be around 5.5.
In a study, bar soaps were found to have higher pH levels than liquids and synthetic detergents (syndets), which showed the ideal pH level (acidic and close to neutral).
In a study, bar soaps were found to have higher pH levels than liquids and synthetic detergents (syndets), which showed the ideal pH level (acidic and close to neutral).<ref>Mendes BR, Shimabukuro DM, Uber M, Abagge KT. Critical assessment of the pH of children’s soap. J Pediatr(Rio J). 2016;92:290---5.</ref>
pH of baby shampoos is seen to be around 6.0 to 7.0. This is because there is a need to reduce ocular irritation and excessive lacrimation in infants resulting from the acidic pH of shampoo. This is called the “no tear concept”. Despite these observations, there are no international standards set in these respects.
pH of baby shampoos is seen to be around 6.0 to 7.0. This is because there is a need to reduce ocular irritation and excessive lacrimation in infants resulting from the acidic pH of shampoo. This is called the “no tear concept”.<ref>Gavazzoni Dias, M. F., Pichler, J., Adriano, A., Cecato, P., & de Almeida, A. (2014). The shampoo pH can affect the hair: Myth or Reality? International Journal of Trichology, 6(3), 95. doi:10.4103/0974-7753.139078</ref> Despite these observations, there are no international standards set in these respects.
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===Breast feeding (Stanapana)===
===Breast feeding (Stanapana)===
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Cow’s milk and goat’s milk are recommended in the absence of breast milk. The milk is recommended to be processed with drugs like Solanum indicum, Solanum xanthocarpum, Desmodium gangeticum, Uraria picta, and Tribulus terrestris. [A.Hr. Uttara Sthana 1/20]
Cow’s milk and goat’s milk are recommended in the absence of breast milk. The milk is recommended to be processed with drugs like Solanum indicum, Solanum xanthocarpum, Desmodium gangeticum, Uraria picta, and Tribulus terrestris. [A.Hr. Uttara Sthana 1/20]
As per the current view, breastfeeding must be started soon after the birth, and exclusive breastfeeding is to be continued up to 6 months. For the first few weeks, the baby shall be fed 7 to 8 times a day. A newborn normally loses weight up to 10% in the first week and regains its birth weight by the 10th day. But the loss of weight above 10% in first 4 days indicates either poor feeding or illness of the baby.
As per the current view, breastfeeding must be started soon after the birth, and exclusive breastfeeding is to be continued up to 6 months. For the first few weeks, the baby shall be fed 7 to 8 times a day. A newborn normally loses weight up to 10% in the first week and regains its birth weight by the 10th day. But the loss of weight above 10% in first 4 days indicates either poor feeding or illness of the baby.<ref>B. Vishnu Bhat. Care of Normal Newborn, IAP textbook of pediatrics, 7th edition, Jaypee Publishers. Chapter 2.3, Page No. 47.</ref>
With higher content of lactose, whey and lactalbumin, lower solute load, and osmolality compared to that of animal milk, human milk stands the best choice of diet for babies, at least up to 6 months.<ref>Meharban Singh, Feeding and Nutrition, Care of Newborn, Revised Eighth edition (2017), CBS Publishers and Distributors Pvt. Ltd., Chapter 14, Page No: 222.</ref> The substitution of breast milk with animal milk or formulas based on them is not recommended unless the situation demands. In such cases, goat milk or cow milk-based formula or liquid milk shall be provided. Goat milk-based infant formulae have been found to be resembling human milk than those of cow milk.<ref>Maathuis A, Havenaar R, He T, Bellmann S. Protein Digestion and Quality of Goat and Cow Milk Infant Formula and Human Milk Under Simulated Infant Conditions. J Pediatr Gastroenterol Nutr. 2017 Dec;65(6):661-666. doi: 10.1097/MPG.0000000000001740. PMID: 28968291; PMCID: PMC5704675.</ref> All the substitutes for breast milk, their production, distribution, advertising, etc. are governed by the Infant Milk Substitutes Act 1992.<ref>https://legislative.gov.in/sites/default/files/A1992-41.pdf </ref>
===Protective measures===
===Protective measures===
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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>
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=== 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>
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===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>
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==Approach to an unhealthy newborn==
==Approach to an unhealthy newborn==
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If a neonate is ill, the following is to be considered in him/her:
If a neonate is ill, the following is to be considered in him/her:
- Genetic constitution on the basis of [[doshas]] ([[Prakriti]])
- Genetic constitution on the basis of [[dosha]] ([[Prakriti]])
- Probable etiology
- Probable etiology
- 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===
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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<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 <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<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<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<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.
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==Diseases of the newborn ==
==Diseases of the newborn ==
There are a few diseases of newborn and their management protocols mentioned in classical texts of Ayurveda.
There are a few diseases of newborn and their management protocols mentioned in classical texts of Ayurveda.
===Fetal aspiration syndrome (ulbaka)===
===Fetal aspiration syndrome (ulbaka)===
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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>
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===Swelling on head ( upashirshaka)===
===Swelling on head ( upashirshaka)===
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<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:
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==Thesis Works done==
==Thesis Works done==
1. M. S. Kamath (1981) , “Response of Madhu and Ghrita in New born”, I.P.G.T.
1. M. S. Kamath (1981) : Response of Madhu and Ghrita in New born, I.P.G.T.
&R.A., Jamnagar
& R.A., Jamnagar.
2. Amruta Gaikwad, (2011) “A Comparative Pharmaco-Clinical study of the effect of Madhu-Ghrita and Swarna-Vacha-Madhu-Ghrita on Neonates”, I.P.G.T. &R.A.,Jamnagar.
2. Amruta Gaikwad (2011) : A Comparative Pharmaco-Clinical study of the effect of Madhu-Ghrita and Swarna-Vacha-Madhu-Ghrita on Neonates, I.P.G.T. &R.A.,Jamnagar.
3. Sital S Desai (2011), “Effect of Suvarnaamritaprashana in recurrent attacks of kasa”,RGUHS, Bangalore.
3. Sital S Desai (2011) : Effect of Suvarnaamritaprashana in recurrent attacks of kasa,RGUHS, Bangalore.
4. Aniket Patil (2012), “To Clinically Evaluate the effect of Suvarna binduprashan on immunity and intelligence quotient”,BMK Ayurveda Mahavidhyalaya,KLE,Belgaum.
4. Aniket Patil (2012), To Clinically Evaluate the effect of Suvarna binduprashan on immunity and intelligence quotient,BMK Ayurveda Mahavidhyalaya,KLE,Belgaum.
5. Vinamra Sharma (2012), “Toxicity study of Suvarna Binduprashana in albino rats”,KLE, Belgaum.
5. Vinamra Sharma (2012) : Toxicity study of Suvarna Binduprashana in albino rats,KLE, Belgaum.
6. Anupriya (2013), “Safety and efficacy study of Swarna Prashana drops prepared from Swarna Bhasma and Swarna Lavana” (Dept of RSBK), I.P.G.T.&R.A.,Jamnagar.
6. Anupriya (2013) : Safety and efficacy study of Swarna Prashana drops prepared from Swarna Bhasma and Swarna Lavana (Dept of RSBK), I.P.G.T.&R.A.,Jamnagar.
7.Jyothy.KB, (2013), “A Randomized Controlled Clinical Trial on Swarna Prashana in infants w.s.r. to its immunomodulatory activity”, I.P.G.T. &R.A., Jamnagar.
7.Jyothy.KB, (2013) : A Randomized Controlled Clinical Trial on Swarna Prashana in infants w.s.r. to its immunomodulatory activity, I.P.G.T. &R.A., Jamnagar.
8.Singh Kumari Poonam(2016): A Randomized Controlled Clinical Trial On Swarna Prashana And Its Immunomodulatory Activity in neonates, Department of Kaumarabhritya,IPGT &RA, Jamnagar.
==Related Chapters==
==Related Chapters==
[[Jatisutriya Sharira]]
[[Jatisutriya Sharira]]
==Abbreviations==
==Abbreviations==
• A. = Ashtanga
• Sa. = Samhita, • Cha. = Charak, • Su. = Sushruta, • A. = Ashtanga, • Hr. = Hridaya, • S. = Sangraha,
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==References==
==References:==
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