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Newborn Screening tests for disorders that, if left untreated, may lead to mental retardation, healthcomplications, or even death.An affected baby looks healthy at birth because symptoms do not begin to show until a much later age.Once the signs and symptoms set in, the ill effects are often already permanent. Early detection of thesedisorders is crucial. Diagnosed children can continue to live normal and healthy lives as long as they aregiven treatment on time and consistently follow up with a specialist.The Philippine Newborn Screening Project says that 33,000 children out of the 2 million Filipino babiesborn yearly are at risk from the disorders that NBS addresses. Currently, NBS tests for five disorders:• Congenital Hypothyroidism - A lack or absence of thyroid hormone, which is necessary for growth of the brain and the body. Treatment is required within the first four weeks to prevent stunted physicalgrowth and mental retardation. One out of 3,369 babies are at risk.• Congenital Adrenal Hyperplasia - An endocrine disorder that causes severe salt loss, dehydration, andabnormally high levels of male sex hormones. Left undetected and untreated, a baby may die withinseven to 14 days. One in 7,960 newborns are at risk.• Galactosemia - A condition in which babies are unable to process galactose, which is the sugar present in milk. Increased galactose levels in the body lead to liver and brain damage, and to thedevelopment of cataracts. One in 82,250 may be affected.• Phenylketonuria - The inability to properly utilize the enzyme phenylalanine, which may lead to braindamage. One in 109,666 may be at risk.• Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD) - A condition where the body lacks theenzyme called G6PD, which may cause hemolytic anemia resulting from exposure to oxidativesubstances present in certain drugs, foods and chemicals. Parents of G6PD-positive babies are given alist of these substances. While this is the mildest disorder that is covered in NBS, one out of 55 babiesmay be affected.
APGAR Score
Introduction
 
Your baby?s first exam in life that she needs to pass with flying colours is theApgar Test. Developed by Virginia Apgar, an anesthesiologist, it is performedoneminute after birthand then repeated after five minutes. Dr. Apgar has identified certain critical signs that are measured and rated immediately after birth. Theresults reflectthe baby?s general condition and help the doctors to determine thenature of the baby?s post-delivery care.
 
The rating scale
 
The baby is rated on a scale of zero to two on the following five signs:
 
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Appearance or colour
 
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Pulse or heart rate
 
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Grimace or reflex irritability
 
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Activity or muscle tone
 
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Respiration
 
The babies are rated in the following manner:
 
 
Appearance: If the baby is pink all over, she will get the maximum score of 2. If the body is pink with the exception of thearms and legs, which are blue, thebaby will score 1. She will get a minimum score of 0, if her body is blue all over.
 
Pulse: The baby scores 2 if her pulse rate is above 100 beats a minute. If herpulse rate is below 100, she will score 1 and if it not detectable, she will score 0.
 
Reflex irritability: The doctor will slap the baby on the soles of her feet. If shecries lustily in response, she will score 2. A grimace or slight cry will get her ascore of 1. If she does not respond at all, she will score 0.Activity: A baby that flails its arms and legs or otherwise displays a lot of activityat birth scores a two in this category. If the baby moves her limbs slightly, shewill receive a score of 1. If the baby is limp and flaccid, and shows no activity,she will score 0.
 
Breathing: Strong efforts to breathe, accompanied by crying are a sign that thebaby?s lungs are in good working order. She will receive a score of 2. Slow,irregular breathing rates a 1. No respiration gets the lowest score of 0.
 
What the scores mean
 
The baby?s scores in these five categories are added up to give the Apgar score.(The maximum score is 10). It has been observed that most babies scorebetween 7 and 10 points one minute after birth, indicating that the baby isgenerally in good health and will require only routine post-deliver care. Babieswho score between 4 and 6 are in fair condition, though they may require help tobreathe. They may be put on oxygen or if there is mucus in the throat it will haveto be removed to prevent any obstruction in the baby? breathing. Those babiesthat have a total score below 4 are normally pale, limp and unresponsive. Theywill require immediate life-saving efforts. The baby?s lungs will have to beexternally inflated and the throat will have to be suctioned to clear the airpassage. Such babies will have to be closely monitored in the intensive care untiltheir bodies take over and they can wing it on their own.
 
The five minute score
 
The Apgar test is repeatedafter fiveminutes. While the one-minute score is anindication to doctors as to the nature of the immediate care required post-delivery, the five minute score was thought to be a good predictor of the baby?ssurvival and development in early infancy.
 
 
Newborn - Reflexes
What reflexes should be present in a newborn?
Reflexes are involuntary movements or actions. Some movements are spontaneous,occurring as part of the baby's usual activity. Others are responses to certain actions.Reflexes help identify normal brain and nerve activity. Some reflexes occur only inspecific periods of development. The following are some of the normal reflexes seen innewborn babies:
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root reflex
This reflex begins when the corner of the baby's mouth is stroked or touched.The baby will turn his/her head and open his/her mouth to follow and "root" inthe direction of the stroking. This helps the baby find the breast or bottle tobegin feeding.
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suck reflex
Rooting helps the baby become ready to suck. When the roof of the baby'smouth is touched, the baby will begin to suck. This reflex does not begin untilabout the 32nd week of pregnancy and is not fully developed until about 36weeks. Premature babies may have a weak or immature sucking abilitybecause of this. Babies also have a hand-to-mouth reflex that goes withrooting and sucking and may suck on fingers or hands.
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