NEWBORN SCREENS & EARLY INTERVENTION


STRAIGHT FROM THE SOURCE


DR. MELISSA M. CARBAJAL
Neonatologist, Texas Children's Hospital 
Assistant Professor, Department of Pediatrics, Baylor College of Medicine
  

Editor's Note: Straight from the Source is a ParentsPost.com series. These Question and Answer sessions allow readers access to the thoughts of Houston's top experts.

ParentsPost:  What are routine screenings for newborns and what conditions can they potentially catch?

DR. CARBAJAL:  In the state of Texas, it is required that all newborns (term and preterm) receive two newborn screens. In years past, the state would check for 7 major blood and metabolic disorders. Now that test has been extended to almost 30 disorders! Some of the conditions that can be found include Sickle Cell Disease, Congenital Hypothyroidism (CH), Congenital Adrenal Hyperplasia (CAH), Galactosemia, Cystic Fibrosis (CF), Phenylketonuria (PKU).

ParentsPost:  When are the screenings done and why are they important?
 
DR. CARBAJAL:  The first screen is drawn in the first 24-48 hrs of life before they leave the hospital. The second screen is drawn at 1 to 2 weeks of age by their pediatrician. The second screen is necessary because many of the disorders we screen for are metabolic disorders that result in a build-up of certain metabolites (or chemical byproducts of metabolic pathways). These metabolites can damage vital organs such as the brain and liver. Many of these metabolites are not found in the first 1-2 days of life because it takes some time after the baby begins to eat, and break down sugars, proteins, and fats in their milk, for these metabolites to be seen. The screening blood test is important because most of these disorders can be treated. In addition, early education from the medical community can teach families to understand their child's special need and give them strategies to avoid certain foods or conditions that may trigger a problem. Catching these conditions early and educating families results in improved outcomes.

ParentsPost:  Why is a hearing screen important?

DR. CARBAJAL:  A hearing screen is also offered to all newborns (term and preterm) born in Texas hospitals. Hearing loss is the most common birth condition in Texas. This loss can be due to a variety of causes from congenital infections to genetic disposition. In general, if found and intervention begins prior to 6 months of age, language development and learning potential can be preserved. There are two common screens done, the Auditory Brainstem Response (ABR) and Otoacoustic Emissions (OAE). The ABR is best done while the baby is resting/sleeping. The technician attaches small electrodes to the baby's head and introduces a quiet sound in the baby's ear. If the brain "hears" the sound the electrodes pick up the signal and results are produced at the bedside. Occasionally there will be a false reading secondary to fluid or debris in the baby's ear canal. If this happens the baby will be sent for a re-test. The other type of test is the Otoacoustic Emissions (OAE). For this test, the ear canal is sealed off with an ear tip that will emit a sound into the canal. The sound is received by the cochlea, the part of the ear that translates sound waves into electrical activity for the brain. If the cochlea works well, the ear tip will detect the electrical signal and a report can be generated.

ParentsPost:  If a hearing condition is caught, what is the next step?

DR. CARBAJAL:  If the results of the screen show that hearing loss is detected, the baby will be evaluated by an audiologist. The hearing process is divided into several areas that include the apparatus of the outer/middle/inner ear and the brain. A problem at any of these levels can cause hearing loss. An audiologist will be able to do more specific testing to find the source and the severity of the hearing loss detected on the initial screening test. Once that is identified, hearing aids can be fitted and placed immediately. There are two major programs, Early Childhood Intervention (ECI) and Deaf and Hard of Hearing Services (DHHS), which evaluate and ensure developmental follow up and intervention for children with hearing loss.

ParentsPost:  What are symptoms of an infection in the first few months?

DR. CARBAJAL:  The most common infection in the first few months (lasting for first few years) of life will be Otitis Media (OM) and depending on the time of year, possibly an upper respiratory infection (URI). In fact, a URI can result in an OM. The most frequent symptoms are fever, interrupted sleep schedule, poor eating, increased fussiness, and a general sense that the baby is not "his/her usual self." Both should be evaluated by your pediatrician because these types of infection can be caused by bacteria or a virus. Viral OM are very common and do not require antibiotics, only treatment of symptoms. If your child does have a bacterial infection, your pediatrician will prescribe an appropriate antibiotic based on your child's risk factors. Any prescription given should always be completed, do not stop giving the prescribed medication because the child seems to be improving. This common habit can lead to a repeat infection with resistant bacteria.

ParentsPost:  What are other infections new parents should be aware of?  

DR. CARBAJAL:  Another fairly common infection, although symptoms are not always specific in this age group, is a urinary tract infection (UTI). Children with a UTI will be generally fussy, may have concentrated or bad smelling urine, and will likely have a fever. This can be diagnosed by your pediatrician and is usually treated with antibiotics. Although less common than other infections, the most serious concern in the first few days/weeks is late-onset sepsis. This is a blood infection that is caused by bacteria and can cause the baby to become very ill, very quickly. Symptoms usually occur after 72 hrs (after the baby is usually home from the hospital), and include temperature instability, poor eating effort, limp muscle tone, lethargy, pale/change in complexion. These changes should not be ignored and should alert the parent to contact their pediatrician right away.

ParentsPost:  What nutritional advice do you share with new parents?

DR. CARBAJAL:  Breastfeeding is widely recognized as the optimal feeding regimen. Exclusive breastfeeding for a minimum of 6 months is supported and encouraged by the American Academy of Pediatrics (AAP). The World Heath Organization (WHO) also endorses breastfeeding as the preferred and best nutrition for newborns. Children who are exclusively breast fed have significantly fewer respiratory, ear, and gastrointestinal infections, as well as lower risk for obesity, than children who are not breastfed. In addition, breastfeeding has been associated with a decreased risk for Sudden Infant Death Syndrome (SIDS). There are also multiple benefits for the mother who breast feeds such as reduced risk of breast cancer, ovarian cancer, type 2 diabetes, and postpartum depression. During the first few days after delivery, the mother won't make very much milk, she will make small volumes of something called colostrum. Colostrum is high in protein, fat-soluble vitamins, minerals, and immunoglobulins. This means that moms are helping to protect their baby against bacteria and viruses as well as providing excellent nutrition even in the first few days of life. After the first 2-4 days, with sufficient stimulation from the baby, most moms will begin to produce increased volumes of milk, although some moms can take 7-10 days. Making sure your baby is having around 6 wet diapers per day and checking his/her weight can reassure you that your baby is getting plenty of milk.

ParentsPost:  Do you recommend any vitamins or supplements in the early months?
 
DR. CARBAJAL:  It is recommended that term infants who are exclusively breast fed receive an iron supplement starting at 4 months of age to prevent iron deficiency anemia. The AAP also suggest that exclusively breast fed infants receive Vitamin D supplementation beginning in the first few days of life. For the first 6 months of life, breast milk is sufficient to provide all the baby needs in the way of complete nutrition. Beyond the first six months, your pediatrician can guide you in choosing your baby's first simple solid foods (typically rice cereal) and beyond. Your pediatrician will keep a growth chart for your child, so regular visits are essential especially in the early years. Watching for any significant changes in your child's usual growth curve will be important during this time.

For a complete list of screened disorders go to the Texas Department of State Health Services website at www.dshs.state.tx.us/newborn/overview.shtm




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