Newborn Care Key to Babys SurvivalDepartment of Health By Dona Pazzibugan Philippine Daily Inquirer Published: 11/25/2009 MANILA, PhilippinesThe

current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the country. Doctors are introducing a new way of caring for newborns in the first few minutes of life, which could cut by almost half the number of newborn deaths estimated at 40,000 each year. This is a paradigm shift, was how Director Honorata Catibog, head of the Department of Health (DOH) task force on the rapid reduction of maternal and neonatal mortality, described the new program introduced by the DoH and the World Health Organization. Proponents of the Essential Newborn Care (ENC) are changing the protocol currently observed by childbirth practitioners. The ENC protocol prioritizes drying the newborn and initiating skin contact with the mother before clamping and cutting the umbilical cord. It prescribes a proper sequence of interventions that even a single health worker could perform and calls for initiating breastfeeding within the first hour of life. What should be done [immediately] after birth is to dry the baby because hypothermia can lead to several risks, Dr. Aleli Sudiacal of the DoH explained at a forum held at the Quirino Memorial Medical Center in Quezon City Tuesday. She said delaying the cord clamping two to three minutes after birth (or waiting until the umbilical cord has stopped pulsing) has been shown to increase the babys iron reserves. It also reduces the risk of iron-deficiency anemia and improves blood circulation. Instead of immediately washing the newborn, the baby should be placed on the mothers chest or abdomen to provide warmth, increase the duration of breastfeeding, and allow the good bacteria from the mothers skin to infiltrate the newborn. Delaying the start of breastfeeding is harmful, Sudiacal stressed. She said a delay of one day could make the newborn 2.6 times more prone to infection. Washing should be delayed until after six hours because this exposes the newborn to hypothermia and removes the vernix (skin covering) which is a natural protective barrier against bacteria. Washing also removes the babys crawling reflex, she said. The ENC protocol is being practiced in three hospitals so farQuirino Memorial Medical Center in Quezon City, and Fabella Memorial Medical Center and Philippine General Hospital in Manila.

Authors and Disclosures Tammy P. McConnell, MSN, RN Connie W. Lee, EdD, ARNP, IBCLC Mary Couillard, PhD, RN, CS, FNP, Windsor Westbrook Sherrill, PhD, MBA, MHA Greenville Technical College, School of Nursing, Greenville, University, USA 2005 W.B. Saunders

SC; Clemson

Current Cord Practice Today, cord care practices vary greatly from institution to institution in the United States. According to the AAP, no single method of cord care has proven superior in limiting bacterial colonization and disease. Methods of cord care that are currently used include triple dye, alcohol, antibiotic ointments, povidone-iodine (Betadine), soap and water, or no treatment at all. In general, the umbilical stump is expected to be kept clean and uncovered to promote healing, drying, and cord separation. For decades, the use of alcohol daily and as often as each diaper change has been recommended to decrease infection and shorten cord separation time. However, there is an absence of studies that show the benefits of using alcohol. It is important to note that the exposed necrotic tissue of the umbilical stump is readily colonized and infected by pathogenic bacteria. Ready access of the bacteria into the systemic circulation places neonates at high risk for infection. In developing countries, hygienic umbilical care is believed to reduce umbilical colonization, infection, tetanus, and sepsis, but the role of antiseptic cord care in reducing infections is unclear. Although studies in these less developed countries addressing cord care are lacking, historical controls and studies have demonstrated the decrease in infection during epidemic outbreaks in the 1950s. Recurrent epidemics of streptococcal infections have also been reported with the use of dry treatment or the use of alcohol alone, suggesting these regimens are insufficient. In the United States, the incidence of omphalitis (inflammation or infection of the umbilical stump) is rare. This has been assumed to be related to hand washing, standard precautions, knowledge of transmission, and antiseptic treatments of the umbilical stump. The thought that bacterial colonization of the umbilical stump is beneficial to the healing process and cannot necessarily be correlated with infection is also being explored by some investigators. These investigators have compared cleaning solutions and natural healing, and all recommend that no treatment at all may be more beneficial than the routine and historic use of topical antimicrobials.

Latest Trends about Maternal, Newborn and Child ENC Training held in Marikina
World Health Organization Representative Office in the Philippines 2009 Published: 22 December 2011

A total of 78 people participated in two training sessions; the first organized for City Health Office (CHO) staff and Barangay Health Center (BHC) physicians, and the second for private lying-in facilities and BHC staff. The first training session was held last April 27 and was attended by 23 participants, including five CHO staff members, nine City Health Center (CHC) physicians representing 11 of the 16 CHC, seven CHC staff members ,and two DOH-CHD-MM staff members. This session aimed to inform the CHO and BHC physicians on the evidence-based protocol for essential newborn care as developed and implemented by the Department of Health and World Health Organization. The second session was held on April 28 with a total of 55 participants. This included 24 midwives representing 19 different private lying-in centers, 23 health center midwives representing 13 of the 16 CHC, five midwives from the CHO, two independent midwives and a representative from the City Womens Council. This session was meant to with pregnant women. As Dalumpines from NCR-CHD used to convey the be a more hands-on training for the midwives and providers working such, in addition to lectures and informative speeches by Dr. Rein and Dr. Mariella Castillo from WHO, role play and demonstrations were important new steps included in the ENC protocol.

Data from the role playing was used as baseline to indicate where change is necessary in current practice. After the lectures, five participants volunteered to stay for the return demonstration. To indicate the change in knowledge, a pre- and post-test was conducted among 49 participants. The cut-off was at 70% since the examinees were licensed professional and practicing midwives. A 20-item questionnaire used before and after the session was identical to ensure comparability of outcome. Test scores were analyzed using SPSS (Statistical Package for Social Science) version 17 software for the inferential statistics. Descriptive statistics were also used in the data analysis. Only 4% of the participants passed the pre-test while after the seminar, 90% of the participants passed. The low passing percentage only affirms the wide variability in the interventions used for newborn care health providers. T-test for paired samples was done to determine the significance of a difference in the knowledge before and after the seminar. One of the criteria for the use of the T-test is when measurements are taken from the same subject before and after some manipulation, in this case the seminar conducted. T-test was set at 95% level of significance. Results suggest that there is a significant increase in the knowledge of the participants after the training (p=0.00<0.05). Results also revealed that that the mean score of the post-test was twice of the pre-test with a mean score of -8.31 (-7.39,-9.22, 95%CI). This suggests that there was an improvement in the knowledge of the participants after the training as evidenced by the result of the T-test. Moreover, participants had improved twice on their knowledge as evidenced by the difference of mean score from 7.37 to 15.67 after the post-test. To determine a change in skill level we would have liked to have conducted direct observations. However, this was not feasible since Marikina has no public lying-in clinics and paying patients who deliver in private clinics are not as open to participate in a direct observation study.

Issues in Newborn Screening Anita Saxena. Genetic Testing. June 2003, 7(2): 131-134. Published in Volume: 7 Issue 2: July 6, 2005 Anita Saxena Department of Medical Genetics, Sanjay Gandhi Post-Graduate Institute of Medical Science, Lucknow 226014, India. Newborn screening aims at the earliest possible recognition of disorders so that intervention with effective treatment can prevent the most serious consequences of the disorder. However, of several thousand known genetic disorders, therapy is presently available for only a small proportion of them. Newborn screening was first applied to phenylketonuria (PKU). Presently, newborn screening programs have been implemented in 26 countries for different diseases. However, potential problems in newborn screening programs that make implementation of newborn screening programs difficult include quality assessment, concerns about professional and technical competence, and ethical considerations. It has been shown that in the process from sampling the newborn to reporting of the screening results most errors are made in the pre- and post-analytical phases. It appears that much more could be done for the fetus if genetic screening and diagnostics could be accomplished early in pregnancy rather than after birth. Newborn Screening Pushed By PHOEBE JEN INDINO October 19, 2009, 6:25pm CEBU CITY The Region 7 Office of the Department of Health (DOH) is pushing for the enforcement of Republic Act 9288, or the Newborn Screening Act of 2004, particularly as there are a number of hospitals, birth centers and the like that are not compliant with such laws mandate. Dr. Naida Bautista, DOH7 Medical Coordinator for Child Health and Nutrition bared that although the region has registered 125 newborn screening facilities, only 70 percent of these are active while some birthing centers do not practice the said test. From January to June this year, DOH 7 has only reached 12 percent compliance on the implementation of newborn screening, which is way far from the 35 percent target, Bautista admitted. She explained that of total deliveries during the first quarter of the year, only 12 percent of babies have undergone newborn screening, which is a simple yet important procedure which would detect congenital metabolic disorder on the new born infant. However, Bautista pointed out that in order to compel concerned facilities on the implementation of the newborn screening policy, those that are not compliant are expected to be meted appropriate sanctions. Since health facilities are obliged to undergo licensing process in the DOH, those not practicing the newborn test will find it hard to renew their permits, as we will recommend sanctions against them, she said. Meanwhile, Bautista stressed that in order to spare children from possible illnesses like severe mental retardation, cataracts, severe anemia, among others; parents are urged to have their new born babies undergo appropriate tests. The DOH 7 official disclosed that through newborn screening five disorders will be detected early like congenital hypothyroidism and phenylketonuria that may lead to severe mental retardation, congenital adrenal hyperplasia which causes death among new born children.

Latest Trends of BCG According to World Health Organization WHO 2011

Safety After extensive tests in animals, BCG was first used as a vaccine in 1921. It was given orally to infants. Since this time the vaccine has been widely used. Today, it is estimated that more than 1 billion people have received BCG. BCG is widely used and the safety of this vaccine has not been a serious issue until recently. There is a concern that use of the vaccine in persons who are immune compromised may result is an infection caused by the BCG itself. Also, even among immune competent persons, local reactions, including ulceration at the site of vaccination may result in shedding of live organisms which could infect others who may be immune compromised. The early use of BCG was marked by a tragic accident. In Lubeck more than 25% of the approximately 250 infants who received a batch of the vaccine developed tuberculosis. It was later recognized that this batch was accidentally contaminated with a virulent strain of M. tuberculosis. BCG production and substrains The BCG vaccines that are currently in use are produced at several (seven?) sites throughout the world. These vaccines are not identical. To what extent they differ in efficacy and safety in humans is not clear at present. Some differences in molecular and genetic characteristics are known. What is not known is if the "BCG" from one manufacturer is "better" than one produced at another site. Each BCG is now know by the location where it is produced. For example, we have BCG (Paris), BCG (Copenhagen), BCG (Tice) and BCG (Montreal) among others.