Newborn baby

Prime on the minds of a newborn's parents is whether the baby is healthy and what they need to do to ensure child's good health.

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  • When a newborn is examined by a doctor immediately after birth, Apgar score is not the only thing checked.
  • Doctors also look for signs on the body that may indicate that the child must be examined further.
  • One such small sign is pre-auricular skin tags or sinus at birth which is often associated with renal disease.

A house can come alive with the sounds of a thriving baby. Everyone prays for their baby's health. The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.

The Apgar score measures five things to check a baby's health. Each is scored on a scale of 0 to 2, with 2 being the best score:

  1. Appearance (skin colour)
  2. Pulse (heart rate)
  3. Grimace response (reflexes)
  4. Activity (muscle tone)
  5. Respiration (breathing rate and effort)

But the Apgar score test is not the culmination of all investigation into the health of the newborn. According to the British Medical Journal, doctors check the baby's health to rule out childhood diseases. BMJ, in its research paper titled "Is ultrasonography required to rule out renal malformations in babies with isolated preauricular tags?", BMJ points out that the association between external ear abnormalities and renal malformation has been reported previously. There is a general consensus on the need to rule out urinary tract malformation in a child with gross ear malformation or when the isolated preauricular tag/pit is accompanied by other dysmorphic features.

Speaking on "When to suspect Kidney disease", Dr Kanav Anand, the Associate Consultant, Division of Pediatric Nephrology and Renal Transplantation at Sir Ganga Ram Hospital told Times Now, "Signs of kidneys disease can be so subtle that they may get unnoticed. There may not be any manifestations till the late stage. Hence it becomes necessary to know the signs of kidney disease so as to pick up the problems early, to initiate prompt treatment and avoid progression."

According to a research study carried out by the Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Alberta, Canada - it is recommended that renal ultrasonography be performed on all children with a preauricular sinus. The Canadian doctors base this conclusion on a study carried out on suspected cases due to the pre-auricular tags in neonates.

"Renal ultrasonography was performed on 69 children who had a preauricular sinus. Three children (4.3 per cent) were found to have a significant renal anomaly. Two children had hydronephrosis secondary to vesicoureteric reflux. One patient with the branchio-oto-renal syndrome had an absent left kidney and a hypoplastic right kidney associated with two dysplastic arteries. Renal anomalies were significantly more common in patients with a preauricular sinus than the 1 per cent incidence of renal anomalies reported in the general population," said the study authors.

A similar study was carried out at the Department of Pediatrics and Neonatology, Dr Ram Manohar Lohia (RML) Hospital in the Indian capital New Delhi. During the study period, there were 32 subjects with isolated preauricular tags, and two of the 657 neonates born in the hospital also had isolated PAT. Therefore, a total of 34 patients were enrolled in the study group. The study authors say that "Of the 34 patients with isolated PAT (41% right-sided, 35% left-sided, and 24% bilateral), urinary tract abnormalities were detected in 3 children (8.8%), as compared to none in the control group (P >0.05). Two male children, 4-year-old and 7-year-old had uni-lateral hydronephrosis. One 3-day-old female neonate had left-sided isolated PAT and left-sided double renal pelvis. None of the children had associated congenital anomalies or a positive family history of tags or renal anomalies."
Preauricular tags or sinuses as a sign of kidney disease
Preauricular tags or sinuses as a sign of kidney disease

Why are preauricular tags indicative of any renal health angle?

The RML paper says that "In general, preauricular tags and pits have only cosmetic importance, but associated malformations in the ear/face region and kidneys, and hearing impairment have been reported previously. As differentiation of both the renal tract and ears occurs at the same stage of embryonic development, disturbances at this time can give rise to coincidental abnormality."

Why is the screening of babies to rule out anomalies important?

Dr Kanav Anand, who has successfully treated thousands of young children at the paediatric nephrology department of New Delhi's renowned Sir Ganga Ram Hospital, told Times Now, that timely intervention can save the child's kidney disease from worsening. It is important to seek medical evaluation early and provide the child with proper treatment so that the disease does not progress to Chronic Kidney Disease (CKD).

"In the Indian scenario, in more than 50 per cent of patients, CKD is picked up in advanced stages where the only option left for the patients is dialysis or renal transplantation. In a country like India where a large number of patients are below the poverty line, this increases the financial burden on the state and family leading to sub-optimal outcomes.

"In the west where robust kidney disease screening programs are available, CKD is detected in early stages resulting in timely initiation of CKD progression retarding strategies which improve not only the quality of life but also the financial load on the family," Dr Anand added.

How to ensure kids have healthy kidneys?

Dr Kanav Anand suggests that we must encourage children to lead a physically active lifestyle. "A sedentary lifestyle of children with no physical exercise, plenty of junk food, less water, can play a key role in children being affected by kidney ailments. The increased amount of time spent in sedentary behaviours has decreased the amount of time spent in physical activity," Dr Kanav Anand said.

"Television viewing among young children and adolescents has increased dramatically in recent years. Each additional hour of television per day increases the prevalence of kidney disease by 2 per cent. Research which indicates the number of hours children spend watching TV and playing games on phones correlates with their consumption of the most advertised goods, including sweetened cereals, sweets, sweetened beverages, and salty snacks."

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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