breastfeeding & newborn screening

BREASTFEEDING

&

NEWBORN SCREENING

Presented by: Jocelyn B. Panzo

Ma. Kathrina T. Bunao

Marie Kris C. Manalo

Jocelyn.Kathrina.MarieKris

BREASTFEEDING


Breastfeeding or Nursing

is the feeding of babies and

young children with milk from a

woman's breast.

is the normal way of providing young

infants with the nutrients they need

for healthy growth and development.


WHEN TO START BREASTFEEDING?

Health professionals

recommend that

breastfeeding begin within the

first hour of a baby's life and

continued as often and as

much as the baby wants.

Breastfeeding

should ideally start soon after

your baby is born.

A baby is usually alert after

birth and will spontaneously

seek the breast if left

undisturbed in skin-to-skin

contact with their mother's

body. Research suggests that

a mother should allow her

baby to feed when the baby

shows it is ready.


Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn.

During the first few weeks of life babies may nurse roughly every two to three hours. The duration of a feeding is usually ten to fifteen minutes on each breast.

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.


BREASTFEEDING

INFANT HEALTH BENEFITS

COLOSTRUM

Small amount for the immature digestive system

Low fat for easy digestion

Contains mothers antibodies which boost infants’ immune system

Acts as a laxative to ease passage of meconium

Provides immunologic protection while the infant’s immune system is maturing

Antimicrobial agents

Anti-inflammatory agents

Immunomodulating agents


BREASTFEEDING


Lower risk of Diarrhea

Constipation

Infections

Ear, respiratory, meningitis, urinary tract

SIDS

Allergic diseases

Chronic digestive diseases

Juvenile onset diabetes

Acute leukemia

Adult obesity


BREASTFEEDING


Preterm Infants

Decreased necrotizing enterocolitis

Decreased ROP

Decreased infection rates

Better able to tolerate feedings

Increased IQ rates

Contains long chain polyunsaturated fatty acids

that help the infant’s brain develop – these are

normally provided by the mother in late

pregnancy, therefore preterm infants miss this


BREASTFEEDING

MOTHER HEALTH BENEFITS

Less postpartum bleeding

More rapid uterine involution

Weight loss

Decreased premenopausal breast cancer rates

Decreased ovarian cancer rates

Lactational amenorrhea

Should still use progesterone only contraceptives

Combined contraceptives dry up milk


BREASTFEEDING

PARENT BENEFITS

Saves money

Saves time

Better relationship


LACTATION

ANATOMY AND PHYSIOLOGY

Breast enlargement

During pregnancy and lactation indicates the

mammary glands are becoming functional

Breast size before pregnancy does not

determine the amount of milk a woman will

produce


LACTATION


Hormones during pregnancy

Estrogen stimulates the ductile systems to grow,

then estrogen levels drop after birth

Progesterone increases the size of alveoli and

lobes

Prolactin contributes to increasing the breast

tissue during pregnancy


LACTATION


Alveoli secrete milk and contract when

stimulated

Oxytocin stimulates milk secretion and is

released during the ‘let down’ or milk

ejection reflex

After let down, milk travels into the

ductules, then to the larger – lactiferous or

mammary ducts.


LACTATION


Hormones during breastfeeding

Prolactin levels rise with nipple stimulation

Alveolar cells make milk in response to prolactin

when the baby sucks

Oxytocin causes the alveoli to squeeze the

newly produced milk into the duct system


LACTATION


Latch On and sucking

Oxytocin Release

Releases Milk

Infant Empties Breast

Production Increases

Milk Production Occurs

Interference with this cycle decreases the milk supply.


BREASTFEEDING

BARRIERS

Early breastfeeding failures deprive infants

of the benefits.


BREASTFEEDING

BARRIERS

Lack of knowledge about breastfeeding.

Misconception that formula is equivalent.

Breastfeeding is not the social norm in many

communities.

Poor family and social support.

Embarrassment about feeding in public.

Lactation problems.

Returning to work and accessing supportive childcare.

Policies and practices by some health services and

health care providers.

Promotion and marketing of infant formula.


BREASTFEEDING

BARRIERS

Breast Pathology Flat/inverted nipples, breast reduction surgery that severed

milk ducts, previous breast abscess, extremely sore nipples (cracked, bleeding, blisters, abrasions)

Hormonal pathology Failure of lactogenesis, hypothyroidism

Overall health Smoking, anemia, poor nutrition, depression

Psychosocial Restrictive feeding schedules, mother without support

system, not rooming in with baby, bottle supplementing when not medically required

Other Previous breastfed infant who failed to gain weight well,

perinatal complication (hemorrhage, htn, infection)


BREASTFEEDING

COMPLICATIONS

Infants at risk for poor weight gain Premature (less than 38 weeks)

Difficulty latching on

Ineffective or unsustained sucking

Oral anatomic abnormalities (cleft lip/palate, short frenulum(tongue tie), receding chin)

Multiples

Jaundice

Cystic fibrosis

Infection

Cardiac disorders

Neurologic problems – downs, hypo or hypertonia

Poor apgars

Long labor

Sleepy, nondemanding, passive temperament

Separation from mother early after delivery

Infants less than 5 lbs


BREASTFEEDING

POSITIONS

The Cradle

Sit with baby

lengthwise across your

abdomen with your

elbow supporting his

head and your hand

supporting his bottom.

Your other hand

supports the breast.


BREASTFEEDING

POSITIONS

The Cross Cradle

Lay baby on her side,

well supported (consider

a nursing pillow) and

touching you. If you're

feeding on your left

breast, use your right

arm to support baby's

body and your right

hand to support her

head. Your fingers

support the left breast.


BREASTFEEDING

POSITIONS

Side-Lying Position

To feed on the left breast, lie on your left side with your back supported. Lay baby on his side facing you, his chest against yours. Your right arm will support his body, and your right hand will support his head, bringing him toward your breast. Some mothers are more comfortable with the baby supported in the crook of their arm.


BREASTFEEDING

POSITIONS

The Football Hold

Hold baby at your side

face up and lengthwise,

supported by pillows. If

nursing on your right

side, use your right arm

to support baby at your

side, and guide her

head to your breast.


BREASTFEEDING

POSITIONS

Football hold for

twins

Hold each baby at one

side, with your elbows

bent. Your baby's

backs will rest on your

forearms. For comfort,

put pillows on your lap

and use a chair with

broad, low arms.


BREASTFEEDING

THE RESULTS

Your baby's diapers are excellent indicators of whether your breastfed baby is getting what he or she needs. Because the first milk your newborn gets (known as colostrum) is concentrated, your baby may have only one or two wet diapers until your milk comes in, which is usually about 3 or 4 days after the birth.

After 4 days, here are some signs you should look for: six or more wet diapers per day, with clear or very pale urine

two or more yellow, seedy bowel movements per day, usually one after each feeding through 4 weeks of age. After about a month, breastfed babies usually have fewer bowel movements and many may not have one every day.


BREASTFEEDING

THE RESULTS

Your breastfed baby is also probably

getting enough if he or she:

seems alert and content

is steadily gaining weight

feeds between eight to 12 times per day(This is a good guideline to use early on, usually during about the first month because frequent feedings will help stimulate your milk production. Once your milk supply is established, breastfeeding should be on demand — when your baby is hungry — about every 1 to 4 hours. But remember, your infant may feed every hour for a stretch, then sleep a good 4 to 5 hours, if you're lucky.)


BREASTFEEDING

THE RESULTS

Baby gains weight

No more than 7% weight loss

Back to birth weight in 2 weeks

1oz per day weight gain for the first three months

If baby is still loosing weight on the 4th day of

life:

Get feeding evaluation

Remember to:

1. fed the baby

2. maintain the milk supply

3. continue breastfeeding


NEWBORN

SCREENING


NEWBORN SCREENING

1996 REPUBLIC ACT

9288

A public health program

aimed at the early

identification of infants

who are affected by

certain genetic/metabolic/

infectious conditions.


NEWBORN SCREENING

is a simple

procedure to find out

if a baby has a

congenital metabolic

disorder that may

lead to mental

retardation and even

death if left

untreated.


NEWBORN SCREENING

Most babies with

metabolic disorders look

normal at birth.

onset of signs and

symptoms.

irreversible.


NEWBORN SCREENING

is a simple procedure. Using the heel prick

method, a few drops of blood are taken from the

baby's heel and blotted on a special absorbent filter

card. The blood is air dried for 4 hours and sent to

the Newborn Screening Laboratory (NBS Lab).


WHEN IS THE NEWBORN SCREENING DONE?

Newborn screening is ideally done on the 48th

hour or at least 24 hours from birth..

The baby must be screened again after 2 weeks

for more accurate results.


NEWBORN SCREENING RESULT

Seven (7) working days from the time the newborn

screening samples are received.

Laboratory result indicating an increased risk or of a

heritable disorder (i.e. positive screen) shall be

immediately released, within twenty-four (24) hours

followed by confirmatory testing can be immediately

done.


WHO MAY COLLECT THE SAMPLES FOR

NEWBORN SCREENING?

A trained:

o Physician

o Nurse

o Midwife

o Medical Technologist


THE FIVE (5) METABOLIC DISORDERS BEING

IDENTIFIED BY NEWBORN SCREENING


THE FIVE (5) METABOLIC DISORDERS BEING

IDENTIFIED BY NEWBORN SCREENING


DISORDER APPEARANCE AT BIRTH

CAH Hyperpigmentation

Ambiguous Genitalia in

female infants

CH Normal

GAL Normal

PKU Normal

G6PD Deficiency Normal

THE FIVE (5) METABOLIC DISORDERS BEING IDENTIFIED BY

NEWBORN SCREENING (SIGNS & SYMPTOMS)


DISORDER GOLDEN PERIOD

CAH 7-14 days

CH 4 weeks

Gal 2 weeks

PKU 3 weeks

G6PD deficiency On exposure to specific

agents causing hemolysis

WHAT HAPPENS TO UNSCREENED AND

UNTREATED BABIES?


Disorder

Screened

UNSCREENED, UNTREATED

CAH Death

CH Severe Growth and Mental

Retardation

GAL Death or Cataracts

PKU Severe Mental Retardation

G6PD Deficiency Severe Anemia, Jaundice,

Kernicterus

CONGENITAL ADRENAL HYPERPLASIA (CAH)

Disorder present at

birth and

characterized by

abnormalities in the

production of certain

hormones of the

adrenal glands.



An endocrine disorder caused by abnormalities in specific enzyme of the adrenal gland that causes severe salt lose, dehydration and abnormally high levels of male sex hormones in both boys and girls.

If not detected and treated early, babies may die within 7-14 days.



CLINICAL MANIFESTATION:

SALT WASTING

Deficient aldosterone will start losing too much water and salt via

urine dehydration and very low blood pressure. This can be life-threatening if not treated right away.

Increased pigmentation

Ambiguous genitalia in female infants

Poor suck, weak cry

Vomiting, excessive urination

Irritability and seizures



IF NOT TREATED:

Severe dehydration leads to shock, a serious

situation in which not enough blood is getting to the

brain and other organs called the "adrenal crisis”.

The signs of an adrenal crisis include:

• Confusion

• Irritability

• Rapid heart rate

• Coma



Male GenitaliaAmbiguous clitoris


MANAGEMENT:

HORMONE REPLACEMENT

o HYDROCORTISONE a synthetic form of cortisol in

a pill form.• must be taken throughout life to prevent CAH effects.

o CUSHING SYNDROME

o For those with abnormal genitalia PEDIATRIC

SURGERY before 3 yrs. old to prevent

psychological and emotional problems.

CONGENITAL HYPOTHYROIDISM (CH)


is a condition in which

the person does not

make enough thyroid

hormone.

CAUSES OF CONGENITAL HYPOTHYROIDISM (CH)

Defective development of

thyroid gland

Development of thyroid gland

in an abnormal location

Maternal intake of anti-thyroid

medication or excess iodine

An inherent defect in

manufacturing the thyroid

hormone


CONGENITAL HYPOTHYROIDISM (CH)CLINICAL MANIFESTATION:

Jaundice

Poor muscle tone

Low body temperature

Long protruding tongue

Large anterior fontanel

Umbilical hernia


CONGENITAL HYPOTHYROIDISM (CH)

MANAGEMENT:

Thyroid Replacement before 2 weeks old

TREATMENT

o L -THYROXINE tablet form for babies with CH -

crushed into food or dissolved into a small amount

of formula, juice or other liquid.

NOTE: DO NOT GIVE

o Soy-based formulas and iron supplements - reduce

the amount of absorption.


GALACTOSEMIA (GAL)

is a condition in which

the body is unable to

process galactose, the

sugar present in milk.

Accumulation of

excessive galactose in

the body can cause

many problems,

including liver damage,

brain damage and

cataracts.


GALACTOSEMIA (GAL)

An inherited disorder

that lacks an enzyme

(galactose-1-phosphate

uridyl transferase/Gal-1-

PUT) which helps the

body break down the

galactose.


GALACTOSEMIA (GAL)

MANAGEMENT:

Avoid MILK and MILK PRODUCTS

• Substituted with LACTOSE FREE or GALACTOSE FREE

MILK such as SOY-BASED MILK FORMULA.

Galactose-restricted diet must be followed for life and

requires close supervision and monitoring.


PHENYLKETONURIA (PKU)

Is an autosomal

recessive metabolic

disorder in which the

body cannot properly use

one of the building blocks

of protein called

phenylalanine, an

essential amino acid that

converts into tyrosine

causing elevation of

phenylalanine in the

blood.



Phenylalanine is neurotoxic

Excessive accumulation of phenylalanine in the body causes brain damage.

“Phenylalanine hydroxylase” (PAH), is either missing or not working properly.



The first effects are usually seen around 6 months of age.

Untreated infants may be late in learning to sit, crawl and stand. They may pay less attention to things around them. Without treatment, a child with PKU will become mentally retarded



CLINICAL MANIFESTATION:

Severe intellectual impairment

Microcephaly

Eczema

Seizures

Hypopigmentation

Hyperactivity

Musty or mousy urine odor

Light hair and skin color

Autistic behavior



MANAGEMENT:

Should start as soon as possible but no later than 7

to 10 days.

Protein diet restriction


GLUCOSE-6-PHOSPHATE DEHYDROGENASE

DEFICIENCY (G6PD DEF.)

is an inherited condition in which the body lacks the enzyme glucose-6-phosphate dehydrogenase, or G6PD, which helps red blood cells (RBCs) function normally.

This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even infections.




is an X-linked hereditary disease, which means it is

caused by a defective gene and effects males almost

exclusively and is transmitted by the mother only to

son or daughter who will become another carrier.


Without enough G6PD to protect the blood , RBCs

can be damaged or destroyed.

Hemolytic anemia is a disorder in which the red

blood cells are destroyed faster than the bone

marrow can produce them.




G6PD DEFICIENCY

TRIGGERING FACTORS:

Kids with G6PD deficiency typically do not show any

symptoms of the disorder until their red blood cells are

exposed to certain triggers, which can be:• illness, such as bacterial and viral infections

• certain painkillers and fever-reducing drugs like aspirin

• certain antibiotics (especially those that have "sulf" in their names

like sulfamethoxazole -bactrim)

• certain antimalarial drugs (especially those that have "quine" in their

names like chloroquine)

• SOYA foods - taho, tokwa, soy sauce

• Red wine

• Legumes - munggo, garbanzos, abitsuelas


G6PD DEFICIENCY

TRIGGERING FACTORS:

VITAMIN K

Naphthalene (moth balls)

FAVA beans

Blueberries


G6PD DEFICIENCY

SIGNS & SYMPTOMS:

Paleness (in darker-skinned children paleness is

sometimes best seen in the mouth, especially on

the lips or tongue)

Extreme tiredness

Rapid heartbeat

Rapid breathing or shortness of breath

Jaundice, or yellowing of the skin and eyes,

particularly in newborns

An enlarged spleen

Dark, tea-colored urine


G6PD DEFICIENCY

PREVENTION/MANAGEMENT:

Limit exposure to the triggers of its symptoms

Folic acid

Phototherapy

BLOOD TRANSFUSION


MAPLE SYRUP URINE DISEASE (MSUD)

Is an aminoacidopathy secondary to an enzyme

defect in the catabolic pathway of the branched-

chain amino acids leucine, isoleucine, and valine.

Accumulation of these 3 amino acids and their

corresponding keto acids leads to encephalopathy

and progressive neurodegeneration in untreated

infants.



SIGNS & SYMPTOMS:

Feeding difficulties

Lethargy

Seizures

Urine that smells like maple syrup

Vomiting

Coma



IF NOT TREATED:

This disease can be life-

threatening if untreated.

Neurological damage

Coma

Death

Mental disability



MANAGEMENT:

Protein-free diet

For infants, the diet

includes a formula with

low levels of the amino

acids leucine,

isoleucine, and valine.

Remain on a diet low in

these amino acids for

life.


breastfeeding & newborn screening

Healthcare