• newborn

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    Congratulations, you are now a new mom! While you receive care from the hospital, so shall your new baby.

    The first few minutes are the most critical in a newborn baby’s life. From a compact, fluid-filled warm environment, baby is quickly expelled into a brand new, cold, noisy one. Let’s not forget that he is just learning to breathe!  

    The procedures done during childbirth are geared towards helping the baby transition to the external environment. However, while some of the old practices were convenient to the healthcare provider (midwife, nurse or doctor), they were not exactly baby-friendly since these involved separating the baby from the mother as quickly as possible so that the initial physical examination could be given within the first minute of life. It also entailed prolonged observation in the nursery by the doctors and nurses, but consequently hampered breastfeeding and bonding with the parents. Research done by the World Health Organization (WHO) revealed that the newborn death rate was high with these old practices, and they sought to change that.

    Essential Newborn Care
    The WHO launched the Essential Newborn Care protocol, a simple, concise and straightforward guideline that is backed by solid research in order to decrease newborn deaths. To align with this initiative, the Department of Health (DOH) launched the Unang Yakap campaign locally in December 2009. The protocol guidelines are categorized into time bound, non-time bound and unnecessary procedures, and emphasize a core sequence of four actions that are performed step-by-step.

    Time-bound procedures should be routinely performed first and they include:
    -    Immediate drying of the baby
    -    Skin-to-skin contact with the mother
    -    Clamping of the cord after 1-3 minutes
    -    Non-separation of the newborn from the mother, and
    -    Breastfeeding initiation

    After the first successful breastfeeding, which is anywhere from 30 minutes to 2 hours, post-natal care (non-time bound) is given, which includes:
        * Vitamin K injection -  to prevent Vitamin K deficiency bleeding
        * Eye prophylaxis – to prevent eye infections
        * Delayed bathing until 6 hours of life
        * BCG and the first dose of Hepatitis B Immunization
        * Newborn screening

    Lastly, the unnecessary procedures include:
    -    Routine suctioning
    -    Routine separation of newborn for observation
    -    Administration of prelacteals like glucose water or formula

    Based on studies, the first four time-bound steps are all important in the successful transition of the baby to the external environment. Immediate and thorough drying warms the newborn and stimulates breathing. The second step (early skin to skin contact between the mother and the newborn) and delayed washing for at least 6 hours prevents hypothermia, or a state when the body temperature gets too cold. Skin-to-skin contact also prevents infection and allows maternal-infant bonding. The third step is properly-timed cord clamping and cutting, which prevents anemia. Lastly, non-separation of mother and baby for early breastfeeding protects the infant from infection.  

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    Newborn Screening
    Newborn screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death, if left untreated. The Newborn Screening Study Group first introduced newborn screening in the Philippines in 1996 and is now included in the Philhealth Newborn Care Package. Five diseases are screened during the procedure: congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, and glucose-6-phosphate dehydrogenase deficiency.

    A newborn screening is important because most babies with one of these diseases will look normal at birth, and symptoms will only appear when the disease is already irreversible. This is a very simple procedure, ideally done on the 48th hour of life.  A few drops of blood are obtained from the baby’s heel and blotted onto a special filter paper, which is then sent to the NBS lab. Results are available between 1 to 4 weeks depending on the institution.  

    If all the results are negative, it means that baby is normal and does not have any one of the five diseases mentioned above. If one of the results is positive, you will be informed immediately by your doctor and will be asked to have a confirmatory test done. Results and treatment should be discussed with your pediatrician.

    The NBS and ENC are both potentially life-saving procedures. The ENC is being implemented in all government hospitals and is highly encouraged in private hospitals. Ask your OB-Gyn and Pediatrician if you wish to find out more about these procedures.  

    Sources:
    1. World Health Organization: http://www.wpro.who.int/philippines/sites/maternal/
    2. Department of Health: http://www.doh.gov.ph/faq/show/457.html
    3.  Philhealth Newborn Care Package: http://www.philhealth.gov.ph/members/employed/ncp_benefits.htm

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