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National Newborn Screening Awareness Month

Newborn Screening: A Few Drops of Blood Can Save a Baby’s Life

First Written For News-Herald Media

September is National Newborn Screening Awareness Month, and 2013 is the 50th anniversary of newborn screening nationally. The first newborn screening test was for PKU. Wisconsin began testing for PKU in 1965.

MADISON — Welcoming a new baby to your family can be one of the most exciting and information-overloaded times in your life. But there is one piece of information you need to be sure to ask your baby’s health care provider about: What are my baby’s newborn screening results?

Newborn screening is a test performed on a few drops of blood from a baby’s heel.

Between 24 and 48 hours after a baby is born, hospital staff (or a midwife for home births) will prick the baby’s heel and a few drops of blood are put on a special newborn screening collection card. The card is sent via courier to the Wisconsin State Laboratory of Hygiene’s Newborn Screening Laboratory at the University of Wisconsin-Madison, where scientists test the dried blood spots for 44 rare, serious disorders that, if not treated quickly, can lead to severe health problems and sometimes even death.

If a baby tests positive for one of the disorders, the state lab immediately contacts the baby’s doctor. More tests will be done to confirm the screening result.

Depending on the situation, the baby’s doctor may start treating the baby for the disorder while this additional testing is being performed. Some of the disorders screened for include cystic fibrosis, phenylketonuria (PKU), hypothyroidism, sickle cell disease, severe combined immunodeficiency (SCID) and galactosemia.

Treatment of the disorders varies from special diets to medication to surgery.

“We screen nearly 70,000 infants a year for these rare, serious disorders and about 125 to 130 will have one of the 44 disorders,” says Mei Baker, a UW-Madison pediatrics associate professor and co-director of Wisconsin’s Newborn Screening Laboratory. “For those babies, a few drops of blood from their heel saved their life and gave them a chance for normal growth and development.”

If a baby’s newborn screening results are normal — and that’s the case for 99.9 percent of babies — the test results will be sent to the baby’s health care provider within a week after testing is completed.

Even though the vast majority of babies have normal newborn screening results, it’s still important to screen all of them.

“Nearly all of the 44 disorders are unrecognizable at birth, at least by routine physical examination,” says Patrice Held, co- director of the Newborn Screening Laboratory. “We have an opportunity to identify and treat babies with these disorders before they develop serious health problems.”

Another component of newborn screening in Wisconsin is hearing screening. The baby’s hearing is tested at the hospital or by a midwife after a home birth.

In Wisconsin, newborn screening testing is mandatory, but parents can opt out for religious reasons. The comprehensive program is administered by the Wisconsin Department of Health Services and the Wisconsin State Laboratory of Hygiene. The program also includes physician consultants, genetic counselors and nutrition professionals from around the state.

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Routine Newborn Appointments May Undermine Breast Feeding

Upon discharge from birth facilities new parents are asked to bring their newborn into a pediatrician’s office several times in the first week postpartum. Bringing the newborn to a medical facility requires the postpartum mother to attend to social standards that are not helpful to the establishment of good breastfeeding technique.

  • Getting dressed in “out of the house” clothing, putting on makeup and fixing hair, managing infant car-seat, driving to and from the medical office–these things do not assist the process of healing from childbirth, nor help mom’s bodies produce milk or give babies opportunities to learn good latch, sucking and swallow coordination
  • Mothers often feel inhibited about breastfeeding in public places, especially when baby is very very new; while in a clinic we may be less likely to attempt breastfeeding when our babies exhibit hunger cues
  • Parents are more likely to use pacifiers in the car or at the clinic to keep babies quiet, potentially contributing to nipple confusion
  • Babies bundled up in travelling clothes do not have ready access to good breastfeeding positions and skin contact

Typical time investment for a pediatric appointment: One hour for mother to get ready for appointment, 30 minutes to one hour to get baby bathed, dressed and adjusted into car seat/strapped in, 15-30 minutes drive time to clinic, 15-30 minutes in waiting room; 15-30 minutes with physician; 10 minutes scheduling next appointment, 15-30 minutes drive time to home, 15-30 minutes undoing car seat, removing outerwear, changing diaper and settling in at home.

This adds up to a three to four HOUR time investment for each pediatric office visit (assuming you live within 15-30 minutes of the clinic).  That translates to the potential interruption of about two feeding cycles per visit. If a mother/infant pair misses two feeding cycles every day or every other day during the first week postpartum, they will have missed six to ten critical feeding opportunities in the first week!

Core Knowledge to Help Breastfeeding Happen for Mothers and Infants:

  • Skin-to-skin contact 24-hours a day (or as much as possible-think “honeymoon”)
  • Nurse baby on demand
  • Recognize and respond to early hunger cues: rooting, smacking lips & tongue, pushing hand into mouth; don’t wait for crying!
  • Postpartum rest for mother assists physical healing and mother’s energy is put into milk production
  • No artificial nipples of any kind: No pacifiers, No bottles
  • Optimal positioning of baby’s body to mother’s body is tummy to tummy, baby’s face and body directly toward mother’s torso and breast
  • Optimal positioning of baby’s mouth is wide open, tongue down
  • It is not unusual to offer the breast to a newborn every hour during the first few days…the more opportunities to latch that the baby has, the more quickly he/she learns how to effectively and efficiently nurse.

While medical check ups are a necessary part of postpartum and newborn care, I propose that our health system institute widespread use of HOME CARE for all postnatal mothers and newborns. If your pediatrician is unable to provide home care consider hiring a postpartum midwife to provide home maternal & pediatric check ups in place of the pediatric office visits during the first two weeks postpartum.

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Bold for the cause…

“My goal is to be bold for the cause of home birth and natural childbirth. We live in unusual times with the national cesarean rate above 30%; certain doctors’ and hospital rates have soared beyond 50%. More than ninety percent of American births include drugs, I.V.’s, pulling babies out with instruments of great force and other invasive procedures. Vaginal births after cesarean are on the way out in the land of the free, home of the brave. Against these odds, we are at risk of forgetting how to give birth normally.

My prayer  is that the recording and sharing of birth stories and natural childbirth information will serve to restore confidence in God and His design for us to bring forth our children in grace and strength.”