Breastfeeding & Newborn Screening

BREASTFEEDING
&
NEWBORN SCREENING
Presented by: Jocelyn B. Panzo
Ma. Kathrina T. Bunao
Marie Kris C. Manalo
Jocelyn.Kathrina.MarieKris

BREASTFEEDING

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.

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.

 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.

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

BREASTFEEDING
 Lower risk of
 Diarrhea
 Constipation
 Infections
 Ear, respiratory, meningitis, urinary tract
 SIDS
 Allergic diseases
 Chronic digestive diseases
 Juvenile onset diabetes
 Acute leukemia
 Adult obesity

BREASTFEEDING
 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

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

BREASTFEEDING
PARENT BENEFITS
 Saves money
 Saves time
 Better relationship

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

LACTATION
 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

LACTATION
 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.

LACTATION
 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

LACTATION
Latch On and sucking
Oxytocin Release
Releases Milk
Infant Empties Breast
Production Increases
Milk Production Occurs
Interference with this cycle decreases the milk supply.

BREASTFEEDING
BARRIERS
 Early breastfeeding failures deprive infants
of the benefits.

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.

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)

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

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.

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.

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.

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.

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.

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.

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.)

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

NEWBORN
SCREENING

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.

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.

NEWBORN SCREENING
Most babies with
metabolic disorders look
normal at birth.
onset of signs and
symptoms.
irreversible.

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).

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.

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.

WHO MAY COLLECT THE SAMPLES FOR
NEWBORN SCREENING?
A trained:
o Physician
o Nurse
o Midwife
o Medical Technologist

THE FIVE (5) METABOLIC DISORDERS BEING
IDENTIFIED BY NEWBORN SCREENING

THE FIVE (5) METABOLIC DISORDERS BEING
IDENTIFIED BY NEWBORN SCREENING
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)
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?
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.

 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.

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

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

Male GenitaliaAmbiguous clitoris

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)
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

 Jaundice
 Poor muscle tone
 Low body temperature
 Long protruding tongue
 Large anterior fontanel
 Umbilical hernia

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.

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.

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.

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.

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.

 Phenylalanine is
neurotoxic
 Excessive
accumulation of
phenylalanine in the
body causes brain
damage.
 “Phenylalanine
hydroxylase” (PAH),
is either missing or
not working properly.

 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

 Severe intellectual
impairment
 Microcephaly
 Eczema
 Seizures
 Hypopigmentation
 Hyperactivity
 Musty or mousy urine odor
 Light hair and skin color
 Autistic behavior

MANAGEMENT:
 Should start as soon as possible but no later than 7
to 10 days.
 Protein diet restriction

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.

 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.

 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.

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

G6PD DEFICIENCY
TRIGGERING FACTORS:
 VITAMIN K
 Naphthalene (moth balls)
 FAVA beans
 Blueberries

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

G6PD DEFICIENCY
PREVENTION/MANAGEMENT:
 Limit exposure to the triggers of its symptoms
 Folic acid
 Phototherapy
 BLOOD TRANSFUSION

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.

SIGNS & SYMPTOMS:
 Feeding difficulties
 Lethargy
 Seizures
 Urine that smells like maple syrup
 Vomiting
 Coma

IF NOT TREATED:
 This disease can be life-
threatening if untreated.
 Neurological damage
 Coma
 Death
 Mental disability

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.

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