Hare Lip. The fissured lip, which is not infrequently seen in new babies, may consist merely of a small notch or it may amount to a deep cleft reaching up into the nostril. It is due to a non-union of the frontonasal plate with the lateral processes and may occur on one or both sides, thus forming a single or double hare lip. An extensive fissure will usually interfere with suckling and the nurse may need both ingenuity and patience in feeding such a baby, for the prospect of successful treatment, which is surgical, increases with the baby’s age and improved nutrition. The longer she can feed the baby successfully, therefore, the better his chance of recovery.
Cleft palate, a common congenital abnormality, consists of a fissure of the soft, and sometimes of the bony, palate; it may be on one or both sides and may be continuous with a hare lip. The problem of feeding the baby with a cleft palate is very grave since the fissure may make it impossible for him to form the vacuum in the back of his mouth which is necessary for suckling. He is sometimes fed with a medicine dropper or by gavage or by means of a special nipple provided with a flap which fits into the roof of the mouth and closes the opening into the nasal passages. Even more than in the care of the baby with a hare lip is it important to nourish the baby with a cleft palate, and build him up for as long as possible before he is subjected to the strain and shock of the inevitable operation.
Hernia. Umbilical and inguinal hernias are both seen in young babies.
Umbilical hernia is the commoner type and is not uncommon in thin babies and those with indigestion and distension and in babies who cry violently. Such hernias are not regarded as serious if prompt measures are taken to reduce them as they usually respond very readily to treatment. But since neglect may have serious consequences, the nurse should watch for protrusions and report them promptly. She will often be instructed to reduce the hernia and apply adhesive strapping, in which case the following observations by Dr. Griffith will be helpful:
“Usually it is quite sufficient to draw the skin into two folds, one on each side of the hernia and meeting over it; holding these in place by straps of adhesive plaster crossing over the navel, or by a broad horizontal band of adhesive plaster reaching to the lumbar regions. Another method is the following: A silver quarter of a dollar is laid upon the adhesive surface of a piece of rubber plaster about two inches square; over this is placed the broad strap referred to, with its adhesive surface next to that of the smaller piece. After reducing the hernia and pressing the sides of the abdominal walls slightly together the band is applied with the quarter dollar directly over the position of the navel. My own preference is for a simple adhesive band without the use of the coin. The dressing should be worn constantly, changing it from time to time as the old one loosens. The dressing must, of course, not be removed during the bath. Several months are required before the opening is permanently closed. Occasionally the plaster produces a great deal of cutaneous irritation, especially in the first few months of life. The employment of zinc oxid plaster tends to avoid this difficulty.”[[17]]
Inguinal hernia is less common in very young babies but it should be watched for since it usually may be easily reduced by the use of a truss, if discovered and treated early, but may be serious if neglected.
In general, the new baby who is ill, needs the same thoughtful, gentle, painstaking care that the nurse gives to the well baby, but these must be shaped to his immediate requirements and the doctor’s special instructions.
CHAPTER XXIV
A FINAL WORD
It will be well for us now to take a retrospective view of the various functions of the nurse which are associated with the phenomena of pregnancy, labor, the puerperium and the beginning of a new life. As we see these in perspective, our attention is fixed by a few important principles which stand out from the picture as a whole in clear and shining relief.
We see, for example, that no matter what else may become vague and unimportant, be changed or discarded, there remains the conspicuous, unalterable requirement that the nurse shall do clean work throughout this entire series of experiences. All maternity patients and all babies need scrupulously clean care no matter what else they may have or may lack.