Lesson 2

• Newborns, Infants and Children

  • Are the most vulnerable age group for common childhood illnesses
  • Risk of infection is HIGHER when they are not screened for metabolic disorder
  • Not exclusively breastfed
  • Not given vitamin supplementation
  • Not vaccinated
  • Not properly managed when sick

  
• Main Goal of Child Health Programs

  Reduce infant mortality to 15 deaths per 1000 live births (National Objective for Health 2017-2022)

  
• Different Child Health Programs

  • Newborn Package
  • Infant and Young Child Feeding
  • Micronutrient Supplementation
  • Child Health Injuries
  • Integrated Management of Childhood Illnesses (IMCI)
  • Expanded Program on Immunization (EPI)
• Garantisadong Pambata Services Package


  • Established during former President Noynoy Aquino's term
  • Includes services for ages 0-1 year olds and 1-5 year olds
• Newborn Care Package


  • A Philhealth benefit package for essential health services of the newborn during the first few days of life
  • Costs P2950
  • It covers Essential Newborn Care, Newborn Screening Tests, and Newborn Hearing Screening Tests

  
• Essential Newborn Care

  1. Immediate drying of the baby

  2. Early skin to skin contact

  3. Timely cord clamping

  4. Non-separation of baby and mother for early breastfeeding initiation

  5. Eye prophylaxis

  6. Vitamin K administration

  7. Weighing of the baby

  8. First dose of Hepatitis B vaccine

  9. First dose of BCG vaccine
• Comprehensive Newborn Screening (NBS) Program


  • Provided by R.A. 9288 or the Newborn Screening Act of 2004
  • All newborns should undergo mandatory screening for the detection of metabolic disorders
  • Screening is a blood test done on the newborn 24 to 72 hours after birth
  • Enables early detection and management of several congenital disorders which may lead to mental retardation and/or death if untreated
• Disorders screened in the NBS program

  • Congenital Hypothyroidism
  • Congenital Adrenal Hyperplasia
  • Phenylketonuria (PKU)
  • Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
  • Galactosemia
  • Maple Syrup Urine Disease (MSUD)
• Congenital Hypothyroidism

  • Low production of thyroid hormone = Deficiency of Thyroid function
  • The Thyroid plays a role in metabolism, temperature regulation, and heart rate
• Congenital Adrenal Hyperplasia


  • Overgrowth of tissue around the adrenal gland = Glands produce too little of cortisol, aldosterone, and excess androgens
  • Adrenal gland is found above kidneys and is important for the "fight or flight" response, digestion, blood pressure, and the immune system
• Phenylketonuria (PKU)


  • Defect in enzyme = Inability to process proteins into amino acid Phenylalanine
  • Proteins are thrown away as ketones in urine
• Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)


  • Problem releasing the enzyme G6PD
  • G6PD is needed for red blood cells and act as protection for these cells from damage caused by chemicals, food, infections
• Galactosemia


  • Lack of enzymes = Inability to process and break down Galactose (High levels of galactose in blood stream)
  • Galactose is a simple Carbohydrate (Macromolecule - Monosaccharide)
• Maple Syrup Urine Disease (MSUD)


  • ALL nutrients are not absorbed by the body
  • Urine comes out thick, dark, and aromatic, due to the concentration of nutrients
• Program Objectives of the NBS Program

  • By 2030, all Filipino newborns are screened
  • Strengthen quality of service and intensify monitoring and evaluation of NBS implementation
  • Sustainable financial scheme
  • Strengthen patient management
• Procedure for Newborn Screening

  1. A few drops of blood are taken from the baby's heel, and blotted on the special absorbent filter card

  2. The filter card will then be sent to the Newborn Screening Center (NSC)

  3. The collection of the blood sample may be collected by Physicians, Nurses, Medical Technologists, and Trained Medical Assistants
• Galactose


  A simple Carbohydrate (Macromolecule - Monosaccharide)
• Symptoms of Galactosemia


  • Difficulty in feeding
  • Yellow skin and eyes (jaundice)
  • Irritability
  • Cataracts
  • Low energy levels
• Galactosemia: KidsHealth
• Maple Syrup Urine Disease (MSUD)


  ALL nutrients are not absorbed by the body, urine comes out thick, dark, and aromatic, due to the concentration of nutrients
• Program Objectives of the NBS Program

  • By 2030, all Filipino newborns are screened
  • Strengthen quality of service and intensify monitoring and evaluation of NBS implementation
  • Sustainable financial scheme
  • Strengthen patient management
• Newborn Screening Procedure

  1. A few drops of blood are taken from the baby's heel, and blotted on the special absorbent filter card

  2. The filter card will then be sent to the Newborn Screening Center (NSC)

  3. The collection of the blood sample may be collected by: Physicians, Nurses, Medical Technologists, and Trained Midwives
• When are Newborn Screening Results Available

  • Normal NBS results are available by 7-14 working days
• Newborn Screening Results

  • Negative Screening - NBS result is normal
  • Positive Screening - There is a presence of a metabolic disorder, thus the newborn must be brought back to the health practitioners for a confirmatory test (To identify the metabolic disorder)
• EXPANDED NBS PROGRAM COVERS 28 DISORDERS, CYSTIC FIBROSIS is the MOST COMMON
• Newborn Hearing Screening Test


  A test done on the newborn to detect congenital hearing loss, a test that shows hearing impairment or unclear results is usually followed up with a detailed diagnostic assessment carried by an audiologist

  
• Republic Act No. 9709 paved way for the Universal Hearing Screening (UNHS) and Intervention Act of 2009, which established the universal hearing screening program for the prevention, early diagnosis, and intervention of hearing loss
• Early detection AVOIDS

  • Delay in language acquisition
  • Poor communication skills
  • Low educational attainment
  • Inadequate social skills
• Where does Screening take place

  • Done in a hospital or birthing facility
• When is the RIGHT TIME to screen

  • Performed as close to discharge as possible (1 week after birth), if the baby was not born in a hospital, they should be screened if they are not more than 3 months of age
• Who can PERFORM THE TESTS

  • Trained Audometrists
  • Trained Audiologists
  • Trained Licensed health professionals
• Automated Auditory Brainstem Response (AABR)


  Measures how the hearing nerve responds to sounds and can identify babies who have hearing loss, it is more comprehensive since it tests the entire auditory pathway including the auditory or vestibulocochlear nerve and brainstem via electrical activity

  
• Otoacoustic Emissions (OAE)


  Sounds are played and a response is measured, if a baby hears normally, an echo is reflected back into the ear canal and is measured by the microphone, it is the most commonly done procedure

  
• AABR Results

  • Positive - The newborn's auditory system has responded to the sounds appropriately

  Negative - Hearing or auditory issues

  
• OAE Results

  • Positive - Echo is reflected back upon hearing the sound played by device

  Negative - No echo
• Infant and Young Child Feeding


  Reduce child mortality and morbidity through optimal feeding of infants and young children, improve the health and nutrition status of infants and young children
• Key Messages of Infant and Child Feeding

  • Initiate breastfeeding within 1 hour of birth
  • Exclusive breastfeeding for the first 6 months of life (Just breast milk = No formula, water, and other foods)
  • Completed feeding at 6 months, with appropriate foods excluding milk supplements (Complementary feeding = Breast milk with solid food. Ex: Mashed veggies, fruits, porridge, mashed or cut pork or chicken, egg yolk)
  • Extend breastfeeding up to 2 years and beyond

  
• Benefits of Breastfeeding to Infant and Mother

  • INFANT: Provide nutritional complete food, Strengthen immune system preventing many infections, Safely rehydrates and provides essential nutrients to a sick child especially those suffering from diarrheal diseases, Increases IQ points

  MOTHER: Reduces risk of excessive blood loss after birth, provides natural methods of delaying pregnancies (Ex: Lactational Amenorrhea Method), Reduces the risk of ovarian and breast cancers and osteoporosis, Conservation of funds
• Kinds of Breastmilk

  • Colostrum
  • Transitional Milk
  • Mature Milk

  
• Colostrum


  Milk produced by the mammary glands in late pregnancy and a few days after giving birth (7 days), it is thick, sticky and yellowish, has high concentrations of nutrients (Proteins and Carbohydrates but in small quantities), is easy to digest (Low in Fats), and has a mild laxative effect to encourage passing of the 1st stool (Meconium), it contains antibodies to protect the infant and leukocytes to protect the infant from harmful viruses and bacteria