Newborn screening is the practice of testing every newborn for certain harmful or potentially fatal disorders that aren't otherwise apparent at birth. Many of these are metabolic disorders, often called "inborn errors of metabolism," which interfere with the body's use of nutrients to maintain healthy tissues and produce energy. Other disorders that may be detected through screening include problems with hormones) or the blood.

1.PKU (phenylketonuria)2. Congenital Hypothyroidism3. Galactosemia4. Sickle cell disease5. HIV (human immunodeficiency virus)

PKU (phenylketonuria)People with PKU lack an enzyme needed to process the amino acid phenylalanine. This amino acid is necessary for normal growth in infants and children and for normal protein use throughout life.

with PKU experienced in the past. By following certain dietary restrictions, these children When babies with PKU are put on a special diet right away, they can often avoid the mental retardation that children can lead normal lives.

Management:Dietary restrictions CHON restrictions or eliminationFood low in phenylalanineRefer parents for genetic counselingIf planning to be pregnant, 3 months before

conception, mother must start to have phenylalanine free diet

Have a adequate supply of amino acids

congenital hypothyroidism Congenital Hypothyroidism (CH) is a

disease that is caused by the under activity of the thyroid gland.  This under activity results in underproduction of thyroid hormones.  These hormones play an important role in proper body metabolism.  In growing children these hormones are essential for normal physical growth and mental development.

Affected infants who are treated within the first few weeks of life will have normal or near-normal intelligence.

Delayed treatment can cause mental retardation, growth failure, deafness, and neurological problems.

Treatment for hypothyroidism is by drug therapy.

An infant born with this condition will have to take the drug thyroxine throughout his/her lifetime.  Thyroxine is usually taken orally.

galactosemia Is a hereditary disease that is caused by the lack of a liver enzyme required to digest galactose

Inheritance and FrequencyThe gene defect for Galactosemia is an

autosomal recessive genetic trait and is unknowingly passed down from generation to generation.

This faulty gene usually emerges when two carriers have children together and pass it to their offspring.

For each pregnancy of two such carriers, there is a 25% chance that the child will be born with the disease & a 50% chance the child will be a carrier for the gene defect.

• If not

detected immediately, it results in liver disease, cataracts, mental retardation & even death

cataract in galactosemia

As galactosemic children get older they may encounter delays in speech, and females may suffer from ovarian failure.

Nevertheless, children who are diagnosed early have very good long – term outlooks for leading normal, healthy lives

Treatment for galactosemia is the elimination of galactose and lactose from the diet throughout life

A person with galactosemia will never be able to properly digest foods containing galactose.

An infant diagnosed with galactosemia will simply be changed to a soy – based formula that does not contain galactose.

Galactosemia is often confused with lactose intolerance, but please keep in mind that galactosemia is a disease.

Presence of an abnormally shaped RBC (abnormal cell)

Normal hemoglobin is partly or completely replaced by the abnormal sickle cell hemoglobin (Hb S)

Occurs most frequently in blacks

Sickle Cell Anemia

Heterozygous people have both normal hgb (Hb A) and the abnormal hgb (Hb S). They are said to have the sickle cell trait.

Homozygous people are those who have predominant Hb S and suffer from sickle cell anemia

When both parents have the sickle cell trait, there is 25% chance that they produce an off – spring with the sickle cell anemia.

Sickle cell disease is an inherited blood disease in which red blood cells stretch into abnormal “sickle” shapes and can cause episodes of pain, damage to vital organs such as the lungs and kidneys, and even death

Young children with sickle cell disease are especially prone to certain dangerous bacterial infections, such as pneumonia (inflammation of the lungs) & meningitis (inflammation of the brain & spinal cord).

Studies suggest that NEWBORN SCREENING can alert doctors to begin antibiotic treatment before infections occur and to monitor symptoms of possible worsening more closely.

The screening test can also detect other disorders affecting hemoglobin ( the oxygen – carrying substance in the blood).

H I V (human immunodeficiency virus)

APGAR SCORE 0 1 2

Heart rate Absent Slow (≤100bpm)

Normal (≥100bpm)

Respiratory Effort

Absent Slow, irregular Good cry

Muscle tone Flaccid Some flexion ActiveReflexes No response Weak cry Vigorous cryColor Blue, pale Body pink,

extremities blue

Completely pink

total : __________

Apgar Score ( performed at 1 – 5 minutes of age

SCORING INTERPRETATIONS:

0 – 3 : POOR4 – 6 : FAIR7 – 10: EXCELLENT

Expanded Program of Immunization (EPI) for Infants

Vaccine Disease prevented Dose Route/Site Schedule Booster

BCG (1 dose) Primary Complex, PTB 0.05ml Intradermal/ right deltoid

At Birth School entrants (left deltoid)

DPT (3 doses) Diphtheria

Pertusis

Tetanus

0.5ml Intramuscular/ anterior lateral thigh

Start at 6 weeks, then give at 4 weeks interval

OPV (3 doses) Poliomyelitis 2 drops Oral Start at 6 weeks, then give at 4 weeks interval

1 month

Hepatitis B

Vaccine (3 doses)

Hepatitis B 0.5ml Intramuscular/ anterior lateral thigh

Start at 6 weeks, then give at 4 weeks interval

Measles Vaccine (1 dose) Measles 0.5ml Subcutaneous/ deltoid 9 months

BCGDosage: Infant – 0.05ml, School Entrants – 0.1mlSOA: Infant – Right, S.E – LeftROA: Intradermal (ID)Side Effects:•Wheal 10mm (it will disappear)•1st week soreness and inflammation•2nd week abscess and ulceration•12th week (2months) healed scar

DPTDosage: 0.5mlSOA: Thigh (VL)ROA: Intramuscular (IM) Z-trackSide Effect:•High grade fever (SOP give Paracetamol every 4 hours RTC for 2 days)

OPVDosage: 2-3 gttsSOA: MouthROA: OralS.E: None (NPO 20-30 minutes after receiving the vaccine)

HBVDosage: ≤ 10 yrs old – 0.5ml , 10 yrs old up – 1.0mlSOA: Thigh (VL)ROA: plain IMSide Effects:•Soreness and Inflammation (give Paracetamol)

MVDosage: 0.5mlSOA: Posterior Deltoid ROA: SQSide Effect:•Fever (give Paracetamol every 4 hours RTC for 2 days)•Rashes ( give Antihistamine) dipenhydramine (Benadryl), Caladryl or Calamine oinment

HEALTH PROMOTION GUIDELINES FOR INFANTSHEALTH EXAMINATION

Screening of newborns for hearing loss; follow-up at 3 months and early interventions by 6 monthsAt 2 weeks and at 2, 4, 6 and 12 months.PROTECTIVE MEASURES

IMMUNIZATIONSFluoride supplements if there is inadequate water fluoridation (less than 0.7 part per million)Screening for TuberculosisScreening for PKUPrompt attention for illnessesAppropriate skin hygiene and clothingINFANT SAFETY

Importance of supervisionCar seat, crib, playpen, bath, and home environment safety measures.Feeding measuresProvide toys with no small parts or sharp edges.Eliminate toxins in the environment (e.g., chemicals, radon, lead, mercury)Use smoke and carbon monoxide (CO) detectors in home.

NUTRITION

Breast-feeding to age 12 monthsBreast-feeding and Bottle-feeding techniquesFormula preparationFeeding scheduleIntroduction of solid foodsNeed for iron supplements at 4 to 6 monthsELIMINATION

Characteristics and frequency of stool and urine eliminationDiarrhea and its effectsREST/SLEEP

Establish routine for sleep and rest patternSENSORY STIMULATION

Touch: holding, cuddling, rockingVision: colorful, moving toysHearing: soothing voice tones, music, singingPlay: toys appropriate for development

B – BEST MILK (BEST FOR BABY)R – REDUCES INCIDENCE OF ALLERGYE – ECONOMICAL (NO WASTE)A – ANTIBODIES PRESENTS – STOOL INOFFENSIVET – TEMPERATURE ALWAYS IDEAL

F – FRESH MILK ALWAYSE – EMOTIONAL BONDINGE – EASY ONCE ESTABLISHEDD – DIGESTED EASILYI – IMMEDIATELY AVAILBALEN – NUTRITIOUS (NUTRITIONALLY OPTIMAL)G – GASTROENTERITIS GREATLT REDUCED SUCH AS DIARRHEA (LESSENED OR MINIMAL)

LACTATION PRINCIPLES

BREAST CARE ANTEPARTUM AND POST PARTUM

INITIATING BREAST FEEDING

Soap on nipples should be avoided during bathing to avoid dryness.

Nipples can be “prepared” antepartum by exposure to sun, air and loose clothing.

Redness or swelling can indicate infection and should always be investigated.

Relaxed position of mother is essential – support dependent arm with pillow.

Both breasts should be offered at each feeding.

Five minutes on each breast is sufficient at first teach proper way to break suction.

Most of the areola should be in infant’s mouth to ensure proper sucking.

AGE STAGEBirth to 18 months Infancy

18 mos to 3 yrs Toddler

3 to 6 yrs Preschool

6 to 12 yrs School-age

12 to 20 yrs Adolescence

20 to 45 yrs Young Adulthood

45 to 65 yrs Middle Adulthood

65 + yrs Late Adulthood

TYPES OF PLAY

Solitary Play (birth to 18 mos) infant

alone but enjoys presence of others, interest centered on own activity (infancy)

Parallel Play (18 mos to 3 yrs) toddler

Play alongside, not with, another; characteristic of toddlers, but can occur in other age groups (toddler)

Associative Play (3 to 6 yrs) pre-schooler

No group goal; often allows leader (preschool)

Cooperative Play (school age 6 to 12 yrs)

School age

Organized, rules, leader/follower relationship established (school age)

TYPES OF TOY

INFANT Sensory stimulation

TODDLER Something will display their anger

PRESCHOOLER Creativity and boost imagination

SCHOOLER Competition (sports and board games)

ADOLESCENT Body image