Happy 2013!

Snoopy Happy New Year

Happy New Year everyone! Looking forward to share more information and updates to all parents and guardians for the betterment of the health of our children! Cheers! 🙂

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January 6, 2013 at 9:07 am Leave a comment

What Is Newborn Screening?

The DOH celebrates the National Newborn Screening on the first week of October (October 4-8).  Newborn Screening (NBS) is a public health program for the early identification of disorders that can lead to mental retardation and death.  It was first introduced in the Philippines in 1996 and was subsequently mandated by Republic Act No 9288 or the Newborn screening Law in 2004.  This law states that every newborn must be offered newborn screening.

The Newborn Screening Reference Center (NSRC) was created by the National Institutes of Health of the University of the Philippines as commissioned by the NBS Law of 2004.  It is responsible for organizing and implementing newborn screening in the country.  The brochure above, is one of the NSRC’s means of disseminating information about NBS.  This is usually distributed in hospitals, health centers, and clinics of OB-Gyn and Pediatricans.  Here are some of the frequently asked questions and their answers provided by the NSRC, that every parent or guardian must know about.

BASIC INFORMATION ABOUT NEWBORN SCREENING

What is newborn screening?

Newborn Screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation or even death if left untreated.

Why is it important to have newborn screening?

Most babies with metabolic disorders look “normal” at birth. By doing NBS, metabolic disorders may be detected even before clinical signs and symptoms are present. And as a result of this, treatment can be given early to prevent consequences of untreated conditions.

When is newborn screening done?

Newborn screening is ideally done on the 48th – 72nd hour of life. However, it may also be done after 24 hours from birth.

How is newborn screening done?

A few drops of blood are taken from the baby’s heel, blotted on a special absorbent filter card and then sent to Newborn Screening Center (NSC).

Who will collect the sample for newborn screening?

The blood sample for NBS may be collected by any of the following: physician, nurse, medical technologist or trained midwife.

How much is the fee for newborn screening?

P550. The DOH Advisory Committee on Newborn Screening has approved a maximum allowable fee of P50 for the collection of the sample. Newborn Screening is now included in the Philhealth Newborn Care Package.

Where is newborn screening available?

Newborn screening is available in Hospitals, Lying-ins, Rural Health Unit, Health Centers and some private clincs. If babies are delivered at home, babies may be brought to the nearest institution offering newborn screening.

When are newborn screening results available?

Results can be claimed from the health facility where NBS was availed. Normal NBS Results are available by 7 – 14  working days from the time  samples are received at the NSC.

Positive NBS results are relayed to the parents immediately by the health facility. Please ensure that the address and phone number you will provide to the health facility are correct.

A NEGATIVE SCREEN MEANS THAT THE NBS RESULT IS NORMAL.

A positive screen means that the newborn must be brought back to his/her health practitioner for further testing.

What should be done when a baby is tested a positive NBS result?

Babies with positive results must be referred at once to a specialist for confirmatory testing and further management. Should there be no specialist in the area, the NBS secretariat office will assist its attending physician.

What are the disorders tested for newborn screening?

The disorders tested for newborn screening are:

(1) Congenital Hypothyroidism (CH)

(2) Congenital Adrenal Hyperplasia (CAH)

(3) Galactosemia (GAL)

(4) Phenylketonuria (PKU)

(5) Glucose-6-Phosphate-Dehydrogenase Deficiency (G6PD Def.)

(6) Maple Syrup Urine Disorder (MSUD)*

Why screen your baby?

 

NBS Panel of Disorders         

Congenital Hypothyroidism (CH)

CH results from lack or absence of thyroid hormone which is essential for the physical and mental development of a child. If the disorder is not detected and hormone replacement is not initiated within two (2) weeks, the baby with CH may suffer from growth and mental retardation.

Congenital Adrenal Hyperplasia (CAH)

CAH is an endocrine disorder that causes severe salt loss, dehydration and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies with CAH may die within 7-14 days.

Galactosemia (GAL)

GAL is a condition in which babies are 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.

Phenylketonuria (PKU)

PKU is a rare condition in which the baby cannot properly use one of the building blocks of protein called phenylalanine.  Excessive accumulation of phenylalanine in the blood causes brain damage.

Glucose-6Phosphate Dehydrogenase Deficiency (G6PD def)

G6PD deficiency is a condition where the body lacks the enzyme called G6PD.  Babies with this deficiency may have hemolytic anemia resulting from exposure to oxidative substances found in drugs, foods and chemicals.

Maple Syrup Urine Disease (MSUD)*

MSUD is a genetic metabolic disorder resulting from the defective activity of the enzyme branched chain alpha-keto-acid dehydrogenase complex. Accumulation of the branched chain amino acids are toxic to the brain.

*Currently being phased into the program

 

This photo is an example of how NBS has helped in the prevention of mental retardation as a consequence of an inborn disorder.  The boy in the stroller was 14 years old and the girl beside him was 8 years old when this was taken.  Both of them were diagnosed with Congenital Hypothyroidism at birth.  The girl however, had NBS at 2 days old, was diagnosed and subsequently treated with maintenance medication.  The boy, on the other hand, was only brought to the hospital at 12 years old.  He could not walk, talk nor sit alone, and his mental age was placed at 1 month old.

October 31, 2012 at 4:00 pm Leave a comment

Global Handwashing Day

Today, October 15, is the Global Handwashing Day! Follow the proper techniques of handwashing.  It is still the best prevention for most if not all, infectious or communicable diseases!

October 14, 2012 at 10:28 pm Leave a comment

Bullying and School Violence

We have watched several international and local movies where there is a bully (the “kontra-bida”) and the victim (the “bida).  This doesn’t just happen in the movies, it happens in reality all over the world.  But, unlike in the movies, sometimes the victim remains a victim.  In the past 2 weeks, we have heard in local television, news about bullying in schools resulting to display of violence.  The reported bullying occurred in a private school and in a public school.  Hence, bullying can happen in any school campus, be it private or public, coed or exclusive, and in elementary, high school and college.

Bullying has been rampant in the United States and pediatricians have been putting efforts in addressing this problem because of its long term consequences in children.   The problem of bullying among children and teens in schools is now being recognized in the Philippines because of the rising reported cases.  As parents, how do you recognize if your child is being bullied or if your child is a bully?  How should you react to both situations? Here is an article from HealthyChildren.org, a  parenting website of the American Association of Pediatrics on bullying (AAP).

Bullying: It’s Not OK

Bullying is when one child picks on another child again and again. Usually children who are being bullied are either weaker or smaller, are shy, and generally feel helpless.

Facts About Bullying 

  • Both girls and boys can be bullies.
  • Bullies target children who cry, get mad, or easily give in to them.
  • There are 3 types of bullying.
    • Physical—hitting, kicking, pushing, choking, punching
    • Verbal—threatening, taunting, teasing, hate speech
    • Social—excluding victims from activities or starting rumors about them

Bullying Happens:

  • At school—in the halls, at lunch, or in the bathroom, when teachers are not there to see what is going on.
  • When adults are not watching—going to and from school, on the playground, or in the neighborhood.
  • Through e-mail or instant messaging—rumors are spread or nasty notes are sent.

Bullying is Different from Fighting or Teasing:

  • A bully has power over another child.
  • Bullies try to control other children by scaring them.
  • Being picked on over and over can make your child a victim.
  • Bullying usually happens when other children are watching.

Talk With Your Child About Bullying

Even if you don’t think your child is bullied, a bully, or a bystander, you will be helping to protect your child just by asking these questions:

  • “How are things going at school?”
  • “What do you think of the other kids in your class?”
  • “Does anyone get picked on or bullied?”

When your child is bullied, talk with your child about how to stay safe.  Bullies always pick on smaller or weaker children. If there is a fight, and the bully “wins,” this will only make matters worse for your child.

Help your child learn how to respond

Let’s talk about what you can do and say if this happens again.

Teach your child how to:

  • Look the bully in the eye.
  • Stand tall and stay calm in a difficult situation.
  • Walk away.

Teach your child how to say in a firm voice:

  • “I don’t like what you are doing.”
  • “Please do NOT talk to me like that.”
  •  “Why would you say that?”

Just telling your child to do and say these things is not enough. For many children, these skills do not come naturally. It is like learning a new language—lots of practice is needed. Practice so that, in the heat of the moment, these skills will come to your child naturally.

Teach your child when and how to ask for help. Your child should not be afraid to ask an adult for help when bullying happens. Since some children are embarrassed about being bullied, parents need to let their children know that being bullied is not their fault.

Encourage your child to make friends with other children. There are many adult-supervised groups, in and out of school, that your child can join. Invite your child’s friends over to your home. Children who are loners are more likely to get picked on.

Support activities that interest your child. By participating in activities such as team sports, music groups, or social clubs, your child will develop new abilities and social skills. When children feel good about how they relate to others, they are less likely to be picked on.

Alert school officials to the problems and work with them on solutions.

  • Since bullying often occurs outside the classroom, talk with the principal, guidance counselor, or playground monitors, as well as your child’s teachers. When school officials know about bullying, they can help stop it.
  • Write down and report all bullying to your child’s school. By knowing when and where the bullying occurs, you and your child can better plan what to do if it happens again.
  • Some children who are bullied will fear going to school, have difficulty paying attention at school, or develop symptoms like headaches or stomach pains.

When Your Child is the Bully

If you know that your child is bullying others, take it very seriously. Now is the time when you can change your child’s behavior.

In the long run, bullies continue to have problems. These problems often get worse. If the bullying behavior is allowed to continue, then when these children become adults, they are much less successful in their work and family lives and may even get in trouble with the law.

Set firm and consistent limits on your child’s aggressive behavior. Be sure your child knows that bullying is never OK.

Be a positive role model. Children need to develop new and constructive strategies for getting what they want.

Show children that they can get what they want without teasing, threatening, or hurting someone. All children can learn to treat others with respect.

Use effective, nonphysical discipline, such as loss of privileges. When your child needs discipline, explain why the behavior was wrong and how your child can change it.

Help your child understand how bullying hurts other children. Give real examples of the good and bad results of your child’s actions.

Develop practical solutions with others. Together with the school principal, teachers, counselors, and parents of the children your child has bullied, find positive ways to stop the bullying.

In the Philippines, the Philippine Pediatric Society (PPS) Inc. also denounces child bullying in school communities.  Pediatricians are encouraged to actively engage in the detection and prevention of child bullying in schools.  It also recommends that teachers and educators serve as co-equal frontliners in the identification of both perpetrator and victim of child bullying by practicing vigilance and a high index of suspicion especially in picking up the “subtle” manifestations of this dysfunctional condition. Families are also advised to encourage open lines of communication with their children to facilitate an environment where an honest and open disclosure of this “hidden” problem can be made.

October 3, 2012 at 2:00 pm 1 comment

Essential Newborn Care in the Philippines

In September of 2000, the Philippines, together with 190 other United Nation member states, joined in signing the UN Millenium declaration to commit into achieving the 8 Millennium Development Goals (MDG) by the year 2015.  The MDG was made to reduce poverty and hunger, tackle ill-health, gender inequality, lack of education, lack of access to clean water and environmental degradation.  The MDG 4, in particular, aims to reduce under-five childhood mortality by two-thirds by the 2015.  Almost 90% of all children deaths have been attributed to 6 conditions namely, neonatal causes, pneumonia, diarrhea, malaria, measles, and HIV/AIDS. http://www.who.int/topics/millennium_development_goals/en/

To be able to achieve the MDG 4, the DOH implemented the Essential Newborn Care Protocol (ENC)  in our country to rapidly reduce the number of newborn deaths.  This was issued on December 7, 2009 under Administrative  Order 2009-0025.  The ENC Protocol is a simple, concise and straightforward guideline that is backed by solid research evidence for health workers and medical practitioners to improve neonatal as well as maternal care. Its implementation has the potential to avert approximately 70% of newborn deaths due to preventable causes. These time-bound interventions are:


Immediate drying

Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms and legs.

Uninterrupted skin-to-skin contact

Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrum feeding, stimulation of the mucosa—associated lymphoid tissue system, and colonization with maternal skin flora that can protect the newborn from sepsis and other infectious disease and hypoglycemia.

Proper cord clamping and cutting

Waiting for up three minutes or until the pulsations stop is found to reduce to chances of anemia in full term and pre-term babies. Evidence also shows that delaying cord clamping has no significant impact on the mother.

Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in

The earlier the baby breastfeeds, the lesser the risk of death. Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia), administering glucose water or formula and foot printing (which increases risk of contamination from ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from infection).

On the other hand, necessary actions such as eye care, vitamin K administration must be timed. Eye care must be done after the infant has located the mother’s breast.

UNANG YAKAP is the campaign to spread the use of he ENC protocol.  It is a call to action by the DOH on the national and local sectors, public and pivate health and related sectors, individuals and organizations, mass media, and academe to strengthen alliances to implement the ENC protocol.  The Philippines is currently “on track” to reach its MDG 4 target of reducing under-five mortality.

October 3, 2012 at 12:51 am Leave a comment

Leptospirosis: Are Children Spared?

Children of all age groups are also affected by Leptospirosis.  This disease has been present in the country and was first reported in 1932. The rise in the number of leptospirosis cases and deaths has been alarming since the past 3 years, the aftermath of typhoon “Ondoy” in Luzon, and in 2011 after typhoon “Sendong” in Mindanao, and is currently affecting even more after the recent flooding in Metro Manila and Luzon brought by the southwest monsoon (habagat).

By now, we should know how to protect ourselves.  But how do we protect are kids and our teens? The Pediatric Infectious Disease Society of the Philippines (PIDSP) provided guidelines for both physicians and parents on the prevention of leptospirosis in the pediatric age group.  The succeeding paragraphs show the content of the Post Disaster Interim Advice on the Prevention of Leptospirosis in Children.

Leptospirosis is an infectious disease caused by pathogenic bacteria called leptospires. The main carriers of leptospires are animals such as rats, mice, dogs, cats and livestock. Human leptospiral infections can occur when mucus membranes and skin are contaminated by the urine of infected animals, or upon ingestion of contaminated food and water, all of which may occur when an individual is exposed to flood waters. Thus the occurrence of freshwater flooding after typhoons or increased rainfall can lead to an increased risk of leptospirosis.

Manifestations

Initial symptoms of leptospirosis may range from mild to severe, or may even be fatal.  Manifestations of the disease include:

  1. a mild influenza-like illness  (fever, cough, colds, body aches, headache)*
  2. Weil’s syndrome, characterized by jaundice (yellowing of the skin, eyes), renal failure(kidney shut down), hemorrhage (bleeding), and arrhythmias (heart beat irregularities);
  3. meningitis/meningoencephalitis (infection of the brain and meninges) ; or
  4. pulmonary hemorrhage with respiratory failure (bleeding in the lungs)

Case fatality rates range from 12-14% in the Philippines. In studies in India, case fatality rates were lower in the pediatric age group compared to adults.

Prevention

  1. Parents should instruct children not to wade or swim in flood waters.
  2. If exposure to flood waters is unavoidable, protective gear such as boots, goggles, overalls, and rubber gloves should be used.
  3. All food and drinking water should be protected against contamination. Fresh vegetables and fruit should be washed in previously boiled or clean water and then cooked or peeled.
  4. Boil drinking water for at least 10-15 minutes. Physical filtration through ceramic orcharcoal filters is not adequate for leptospirosis.
  5. Food should be protected against rodent attack or contamination.
  6. If children are exposed to flood waters, antibiotic prophylaxis may decrease occurrence of clinical disease and mortality. Prophylactic antibiotics should be given under the supervision of a physician, who can give advice regarding effects, precautions and contraindications for these medications.

Post-exposure Prophylaxis

The following antibiotics are recommended for children exposed to flood waters:

DRUG OF CHOICE

ALTERNATIVE DRUGS

If children are exposed for more than 7 days, the dose should be repeated after 1 week.  Prophylaxis is not 100% effective. Prevention of exposure is most prudent. Monitor all those exposed for the occurrence of symptoms of leptospirosis. The early signs of infection occur between 4 and 10 days after exposure, and usually begin with a fever and an influenza-like illness. Headaches, sensitivity to light, muscle and joint pains, vomiting and fatigue are also common. Seek medical attention once these symptoms are noted.

*words in italics were added  and not included in the guideline

September 12, 2012 at 1:40 pm Leave a comment

Health Advisories on Flood Related Diseases

The Department of Health just posted health advisories on the 3 diseases prevalent in our country at present, namely, dengue, leptospirosis, and athletes foot.  These illnesses are caused by widespread flooding brought by heavy monsoon rains and typhoons.  Dengue and Leptospirosis are the more severe ones and have a markedly rising number of cases and deaths.  Athletes foot, although milder, may cause complications like secondary bacterial infection or sepsis if not treated and if continuously immersed in dirty water. These advisories will help Filipinos become aware of the symptoms of each of the diseases and knowledge on how to prevent it.

DENGUE

LEPTOSPIROSIS

ATHLETES FOOT or ALIPUNGA

September 5, 2012 at 2:30 pm Leave a comment

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