BREASTFEEDING
&
NEWBORN SCREENING
Presented by: Jocelyn B. Panzo
Ma. Kathrina T. Bunao
Marie Kris C. Manalo
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
BREASTFEEDING
INFANT HEALTH BENEFITS
Lower risk of Diarrhea
Constipation
Infections
Ear, respiratory, meningitis, urinary tract
SIDS
Allergic diseases
Chronic digestive diseases
Juvenile onset diabetes
Acute leukemia
Adult obesity
Jocelyn.Kathrina.MarieKris
BREASTFEEDING
INFANT HEALTH BENEFITS
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
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
LACTATION
ANATOMY AND PHYSIOLOGY
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
Jocelyn.Kathrina.MarieKris
LACTATION
ANATOMY AND PHYSIOLOGY
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.
Jocelyn.Kathrina.MarieKris
LACTATION
ANATOMY AND PHYSIOLOGY
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
Jocelyn.Kathrina.MarieKris
LACTATION
ANATOMY AND PHYSIOLOGY
Latch On and sucking
Oxytocin Release
Releases Milk
Infant Empties Breast
Production Increases
Milk Production Occurs
Interference with this cycle decreases the milk supply.
Jocelyn.Kathrina.MarieKris
BREASTFEEDING
BARRIERS
Early breastfeeding failures deprive infants
of the benefits.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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)
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.)
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
NEWBORN SCREENING
Most babies with
metabolic disorders look
normal at birth.
onset of signs and
symptoms.
irreversible.
Jocelyn.Kathrina.MarieKris
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).
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
WHO MAY COLLECT THE SAMPLES FOR
NEWBORN SCREENING?
A trained:
o Physician
o Nurse
o Midwife
o Medical Technologist
Jocelyn.Kathrina.MarieKris
THE FIVE (5) METABOLIC DISORDERS BEING
IDENTIFIED BY NEWBORN SCREENING
Jocelyn.Kathrina.MarieKris
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)
Jocelyn.Kathrina.MarieKris
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?
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
CONGENITAL ADRENAL HYPERPLASIA (CAH)
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.
Jocelyn.Kathrina.MarieKris
CONGENITAL ADRENAL HYPERPLASIA (CAH)
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
Jocelyn.Kathrina.MarieKris
CONGENITAL ADRENAL HYPERPLASIA (CAH)
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
Jocelyn.Kathrina.MarieKris
CONGENITAL ADRENAL HYPERPLASIA (CAH)
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)
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
CONGENITAL HYPOTHYROIDISM (CH)CLINICAL MANIFESTATION:
Jaundice
Poor muscle tone
Low body temperature
Long protruding tongue
Large anterior fontanel
Umbilical hernia
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
PHENYLKETONURIA (PKU)
Phenylalanine is neurotoxic
Excessive accumulation of phenylalanine in the body causes brain damage.
“Phenylalanine hydroxylase” (PAH), is either missing or not working properly.
Jocelyn.Kathrina.MarieKris
PHENYLKETONURIA (PKU)
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
Jocelyn.Kathrina.MarieKris
PHENYLKETONURIA (PKU)
CLINICAL MANIFESTATION:
Severe intellectual impairment
Microcephaly
Eczema
Seizures
Hypopigmentation
Hyperactivity
Musty or mousy urine odor
Light hair and skin color
Autistic behavior
Jocelyn.Kathrina.MarieKris
PHENYLKETONURIA (PKU)
MANAGEMENT:
Should start as soon as possible but no later than 7
to 10 days.
Protein diet restriction
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
GLUCOSE-6-PHOSPHATE DEHYDROGENASE
DEFICIENCY (G6PD DEF.)
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.
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
GLUCOSE-6-PHOSPHATE DEHYDROGENASE
DEFICIENCY (G6PD DEF.)
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
Jocelyn.Kathrina.MarieKris
G6PD DEFICIENCY
TRIGGERING FACTORS:
VITAMIN K
Naphthalene (moth balls)
FAVA beans
Blueberries
Jocelyn.Kathrina.MarieKris
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
Jocelyn.Kathrina.MarieKris
G6PD DEFICIENCY
PREVENTION/MANAGEMENT:
Limit exposure to the triggers of its symptoms
Folic acid
Phototherapy
BLOOD TRANSFUSION
Jocelyn.Kathrina.MarieKris
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.
Jocelyn.Kathrina.MarieKris
MAPLE SYRUP URINE DISEASE (MSUD)
SIGNS & SYMPTOMS:
Feeding difficulties
Lethargy
Seizures
Urine that smells like maple syrup
Vomiting
Coma
Jocelyn.Kathrina.MarieKris
MAPLE SYRUP URINE DISEASE (MSUD)
IF NOT TREATED:
This disease can be life-
threatening if untreated.
Neurological damage
Coma
Death
Mental disability
Jocelyn.Kathrina.MarieKris
MAPLE SYRUP URINE DISEASE (MSUD)
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.
Jocelyn.Kathrina.MarieKris
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