newborn assessment

Newborn Screening (NBS)

is a simple procedure to find out if your baby has a congenital disorder that may lead to mental retardation or even death if left untreated

expanded newborn screening

program increased the screening panel of disorders from six (6) to more than twenty-eight.

to detect even before clinical signs and symptoms are present. As a result of this, treatment can be given early to prevent consequences of untreated conditions

why ENBS is important?

24hrs from birth

When is ENBS is done?

few drops of blood are taken from the baby's heel

how ENBS is done?

4hrs

how many hours does the ENBS air dryed?

MEDICAL TECHNOLOGIST

in Philippine setting who is usually gonna take the ENBS?

physician, nurse, medical technologist or trained midwife.

who are the following mag get og ENBS? State the 4 professionals?

hospitals, lying-ins, rural health units, health centers and some private clinics.

where ENBS is available?

Newborn Care Package (NCP)

is a PhilHealth benefit package for essential health services of the newborn during the first few days of life. It covers essential newborn care, expanded newborn screening, and hearing screening tests.

Either of the parents are eligible to avail of the benefits,  Born in accredited facilities that perform deliveries, such as hospitals and birthing homes; and

 Services were availed of upon delivery.

What are the eligibility conditions for newborn to avail of the NCP?

7-14 working days

how many days does the results can be claimed?

Cagayan or in Zamboanga City

where does the result of newborn screening in Zamboanga del Sur will be sent out

7-14 working days

how many days to get result in zamboanga del sur?

means that the ENBS result is normal.

What is the meaning of the newborn screening result if it is negative screen?

means that the newborn must be brought back to his/her health practitioner for further testing.

What is the meaning of the newborn screening result if it is POSITIVE SCREEN

Babies with positive results must be referred at once to a specialist for confirmatory testing and further management

What must be done when a baby has a positive ENBS result?

the dried blood spot has been tested, it will be stored in a secure locked area

What happens to the dried blood samples after screening?

1750 and is included in the Newborn Care Package (NCP) for PhilHealth members.

How much is ENBS?

Metabolic Disorders

disorders that are inherited

Metabolic Disorders

an abnormal chemical reactions in the body that may alter the normal metabolic processes. These are the altered processing and the distribution of the macronutrients ( protein, fats, & carbohydrates).

Phenylketonuria (PKU)

A metabolic disorder concerning the phenylalanine, an amino acid. During metabolism, the phenylalanine will build up in the body and will affect intellectual ability of the newborn, there are also seizure or behavioral problems

Phenylketonuria (PKU)

The phenylalanine will not metabolized by the newborn’s body.

Galactosemia

Inability to use the galactose, part of the sugar, lactose, or the lactose intolerance

Galactosemia

This galactose accumulates in the blood, and will not be converted into energy

sickle Cell Disease

It is an inherited disease concerning the red blood cells.

sickle cell disease

The red blood cells becomes hard and sticky (unhealthy ang red blood cells

sickle cell disease

The shape of the RBC becomes crescent shape (naa nay deformation) that will cause delay in growth of the newborn and frequent infection.

liver

what affected organ in galactosemia?

Cystic Fibrosis

A genetic disorder. Affected system are the lungs and digestive system

cystic fibrosis

There are clogged mucus

cystic fibrosis

Exocrine glands is affected mainly the integumentary system.

 Lung infection, clubbing of the fingers and toes.

toxoplasmosis

Caused by a parasite, the Toxoplasma gondii (coming from feces, cats).

toxoplasmosis

This infection can cause headache, fever, and fatigue.  It can weaken the immune system.

Hemoglobinopathies

These are inherited diseases commonly affecting RBC, particularly the hemoglobin.  This disease will attack the oxygen carrying capacity.  Hemoglobin is responsible sa redness sa blood. The RBC or the erythrocytes contain the iron.

12.3 and up,

normal count of hemoglobin for girls?

14 - 17.5

normal count of hemoglobin for male?:

Core disorders

This are dominantly inherited disorder affecting the muscles and skeletal system

Secondary disorders

Consequences of the existing disease, comorbid.

Appearance

Pulse

Grimace

Activity

Respiratory effort

what does APGAR means?

APGAR

is a quick test performed on a baby at 1 and 5 minutes after birth.

1-minute score determines how well the baby tolerated the berthing process.

what does the 1 minute mean in APGAR

5-minute score tells the doctor how well the baby is doing outside the mother's womb

WHAT does the 5 minutes mean in APGAR?h

Should be performed 1 minute after the delivery, then 5 minutes post delivery of the newborn.

 Perfect is 10 (normal)

 If below 3, the newborn needs emergency treatment

CRITERIA FOR APGAR SCORING?

46 – 54 cm

NORMAL NEWBORN MEASUREMENTS for the length?

49 cm or 19.2 inches

NORMAL NEWBORN MEASUREMENTS for female?

50 cm or 19.6 inches

NORMAL NEWBORN MEASUREMENTS for male?

32 – 33 cm

NORMAL NEWBORN MEASUREMENTS in cc?

34 – 35 cm

ORMAL NEWBORN MEASUREMENTS in HC

97.6 – 98.6 F (36.5 – 37.0 C)

NORMAL NEWBORN MEASUREMENTS IN TEMPERATURE?

evaporation, conduction, convection, and radiation.

WHAT ARE THE Processes of heat loss?

110 to 160 bpm

In utero: HR normally IS if baby is out

120-140

In utero: HR normally

90

In utero: rr? if baby out

30-60

n utero: rr normally?

3.4 kg or 7.5 pounds

NORMAL NEWBORN MEASUREMENTS in weight for females?

3.5 kg or 7.7 pounds

NORMAL NEWBORN MEASUREMENTS in weight for males?

macrosomic newborn

It becomes unusual kung above 4.7 kg or 10 lbs ang newborn. It will be termed as

colostrum

the first form of breastmilk that is released by the mammary glands after giving birth)

2 pounds per month (6 – 8 oz per week)

All infants will begin to gain the weight of what?

9 – 18 months

Fontanelles Anterior – will be closed

will be closed 1 – 2 months

Fontanelles – will be closed Posterior

Dubowitz/Ballard Maturational Examination (Gestational Assessment)

evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first 2 hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery.

Lanugo

s is the soft downy hair on a baby's body. It is absent in immature babies, then appears with maturity, and then disappears again with postmaturity

Plantar creases

these creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity.

breast

he thickness and size of breast tissue and areola (the darkened ring around each nipple) are assessed.

Eyes and ears

whether or not eyes are fused or open, and the amount of cartilage and stiffness of the ear tissue are noted.

Genitals, male

the presence of testes and appearance of scrotum, from smooth to wrinkled, are assessed

Genitals, female

the appearance and size of the clitoris and the labia are assessed.

Posture -

 Square window -

 Arm recoil -

 Popliteal angle

 Scarf sign -

 Heel to ear

Six evaluations of the baby's neuromuscular system are performed. These include:

Posture

- how the baby holds his or her arms and legs.

Square window

how far the baby's hands can be flexed toward the wrist.

Arm recoil

- how far the baby's arms "spring back" to a flexed position

Popliteal angle -

- how far the baby's knees extend.

Scarf sign

- how far the elbows can be moved across the baby's chest

Heel to ear

- how close the baby's feet can be moved to the ears.

APGAR TESTING

a score of 7 to 10 is considered normal, while 4 to 7 might require some resuscitation measures, and a baby with an APGAR score of 3 and below requires immediate resuscitation

CREDES PROPHYLAXIS

instilling of ordered ophthalmic ointment --erythromycin -- into the newborns eyes to avoid damage and blindness due to conjunctivitis-- ophthalmia neonatorum -- brought about by Neisseria gonorrhea

-erythromycin

into the newborns eyes to avoid damage and blindness due to conjunctivitis-

ophthalmia neonatorum

- brought about by Neisseria gonorrhea

vitamin k

s required for the synthesis of coagulation factors, being essential for blood clotting; 1 mg (.5 ml) of Vitamin K 1 by IM- upper outer vastus lateralis muscle/ anterolateral thigh

IM

vitamin k is injected via what?

HEP B

vaccination within 24 hours of birth

Otoacoustic Emissions Test (OAEs)

A miniature earphone and microphone are placed in the ear, sounds are played and a response is measured.

baby hears normally

IF an echo is reflected back into the car canal and is measured by the microphone, what does it mean?

baby has a hearing loss,

if no echo or a reduced echo can he measured on the OAE test, what does it mean?

Auditory brainstem response (ABR)

the best test available for newborns and infants up to 6 months of age that can provide information about the softest level of sound the car can hear,

Auditory brainstem response (ABR)

Sounds are played to the baby's ears and band-aid like electrodes are placed on the baby's head to detect responses. Sounds are presented to the ears using small earphones. The electrodes pick up responses from the hearing nerve and à computer measures the responses to identify babies who have a hearing loss.

(8-10 cm) (.5-.7 inch)

, cord is clamp close to umbilicus how many cm?

Crede's Prophylaxis

Instillation of a prophylactic agent at the eyes of all neonate is mandatory as a precaution against opthalmia neonatorum

2,500-4,000 gm

Weight the newborn without any dress Appropriate Gestational Age (AGA)

= lower 10% of 2,500 gm (preterm)

Weight the newborn without any dress of Small for Gestational Age (SGA)

= higher 10% of 4,000 gm (postterm with diabetic mother)

Large for Gestational Age (LGA) =weight the newborn without any dress of

36.5 C (97.6 F) or core temperature stabilizes at 37 C(98.6 F)

Baby's bath is postponed until the infant's skin temperature stabilizes at

10 – 15 minutes only between 7 am to 10 am, do not exceed sun exposure to 30 min

Sun exposure of baby bath?

Vernix Caseosa

a greasy, cheese-like coating that covers babies' skin during their time in the womb. It's made up of shed skin cells and sebaceous secretions

Lanugo

downy & unpigmented hair that covers the body of some newborns

jaundice

yellow color of NB skin; caused by a buildup of a bilirubin in the blood

1.      Physiologic Jaundice –

Pathologic jaundice

two types of jaundice

Physiologic Jaundice

yellowish skin, within 24 hours newborns naturally turns yellow