Parents' Guide: 7 important things you need to know about newborn screening

Keep reading for must-know information on newborn screening.

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Parents, here's what you need to know about newborn screening here in the Philippines.

What can you read in this article?

  • What is the importance of newborn screening in the Philippines?
  • What's the expanded newborn screening all about?
  • Is it for free?

After nine months of waiting, finally, your baby is born. Congratulations!

We know you're excited to bring the baby home. But before you can leave the hospital, there are certain things that need to be done to ensure that your child will be safe and healthy, such as newborn screening.

Also, as a new parent, you may wonder: What are these tests? What are the doctors looking for? Are such tests needed?

Importantly, your concerns are as valid as the tests are necessary.  Nevertheless rest assured that these tests cause little pain, if any at all, to your precious little one. Such tests are routine and are essential in ensuring your baby is well and healthy.

Newborn screening in the Philippines

Most babies look normal and the same when they are born. But they might have a congenital disorder that if not attended to right away, may put their health at risk.

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The newborn screening is a simple test that is done on babies after they are born to check if they have a congenital disorder. By doing newborn screening, metabolic disorders can be detected even before clinical signs and symptoms manifest. As a result, treatment can be given early to prevent serious consequences like mental retardation or death.

It was in the year 1996 when newborn screening was implemented in the Philippines, but in 2014, Republic Act 9288 or the Newborn Screening Act of 2014 was mandated into law, which states that all babies born in the Philippines should undergo newborn screening.

Since  May 2019, the Department of Health mandated that all babies should undergo the Expanded Newborn Screening (ENBS), which increased the screening panel of disorders from six (6) to more than twenty-eight.

Newborn screening tests will be done both in your hospital room and in the nursery.

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Newborn screening prevents the infant from experiencing birth defects and complications such as:

  • Severe mental retardation
  • Coma from metabolic crisis
  • Developmental and physical delays
  • Neurologic impairment
  • Seizures
  • Enlargement of the heart & liver
  • Muscle weakness
  • Breathing problems
  • Neurologic damage
  • Painful complications
  • Anemia
  • Stroke
  • Multi-organ failure
  • Death

Newborn screening in the Philippines - things you need to know

Here are some things parents usually ask when it comes to newborn screening in the Philippines.

When is the newborn screening done?

Ideally, the newborn screening should be done within 24 to 48 hours after birth. It is for this reason that the baby cannot be discharged from the hospital without having done the necessary tests.

Where is this procedure available?

According to DOH, enhanced newborn screening is available in certified hospitals, lying-ins, rural health units, health centers, and some private clinics in the Philippines.

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What's included in the Expanded Newborn Screening?

With ENBS, your baby will be screened for the following conditions:

Endocrine Disorders

    •  Congenital Hypothyroidism
    • Congenital Adrenal
    • Hyperplasia

Amino Acid Disorders

    • Homocystinuria
    • Hypermethioninemia/Methionine Adenosine Transferase Deficiency
    • Maple Syrup Urine Disease
    • Phenylketonuria
    • Tyrosinemia Type I
    • Tyrosinemia Type II, III

Fatty Acid Disorders

    • Carnitine Palmi toyltransferase I Deficiency
    • Glutaric Acidemia Type II
    • Carnitine Palmi toyltransferase II Deficiency
    • Glutaric Acidemia Type II
    • Carnitine Uptake Deficiency
    • Glutaric Acidemia Type II
    • Long Chain Hydroxyacyl-CoA Dehydrogenase Deficiency
    •  Medium Chain-Acyl-CoA Dehydrogenase Deficiency
    • Very Long Chain-Acyl-CoA Dehydrogenase Deficiency
    • Tri-functional Protein Deficiency

Organic Acid Disorders

    • 3-Methylcrotnyl CoA Carboxylase Deficiency
    • Beta Ketothiolase Deficiency
    • Glutaric Acidemia Type I
    • Isovaleric Acidemia
    • Methylmalonic Acidemia
    • Multiple Carboxylase Deficiency
    • Propionic Acidemia

Urea Cycle Defect

    • Citrullinemia
    • Argininosuccinic Aciduria

Hemoglobinopathies

    • Hemoglobin C
    • Beta Thalassemia
    • Hemoglobin D
    • Alpha Thalassemia
    • Hemoglobin E
    • Sickle Cell Disease

Others

    • Galactosemia
    • Glucose-6-Phosphate Dehydrogenase Deficiency
    • Cystic Fibrosis
    • Biotinidase Deficiency

How is the procedure 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). A doctor, nurse or certified medical technician will conduct the procedure.

While it may seem uncomfortable for you to see your baby being poked, remember that it is necessary and a few seconds of pain may actually save his life in the long run. It can help if you or your partner will be with the baby during the procedure.

How much is the test?

Expanded newborn screening costs ₱1750, but it is part of the Newborn Care Package (NCP) for PhilHealth members.

Aside from ENBS, the Newborn Care Package includes Vitamin K eye ointment, vaccines for Hepatitis B and BCG, Newborn Hearing Screening Test, and fees for attending health professionals.

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So before giving birth, make sure that your PhilHealth membership is all set and updated.

When can I get the results?

The test results can be claimed from the health facility where it was conducted. Usually, you will hear from them within 7 to 14 days after the test, if the results are normal.

If the ENBS results are positive, the parents may hear immediately from the health facility, so make sure that the address and phone number you provided them are correct.

What do these results mean?

A negative screen means that the ENBS result is normal and the baby is cleared from the diseases mentioned above. Meanwhile, a positive result means that the newborn should be brought back to the health facility or his pediatrician for further observation and testing.

READ MORE: 

Parent's Guide: 6 essential things you'll need in baby's nursery

Parents' Guide: 17 things na hindi dapat gawin sa newborn baby

Preparing for your newborn? Here are the new Always Safe protocols in MakatiMed

Other tests for newborns

Aside from the expanded newborn screening, your newborn would be subjected to the following tests to ensure his overall health before he is discharged from the hospital.

1. Neonatal Reflexes

Reflex is a conscious and thought response to a stimulus which presents in an involuntary action or movement.  An example of reflexes is when you close your eyes when the wind is dusty or remove your hand from a hot surface of a pot.
Newborn babies have unique reflexes that a physician can indicate their health and development. Even in the first minutes after delivery, doctors and nurses can identify the baby’s reflexes.

Types of neonatal reflexes

Baby’s neonatal reflexes last until their adult age. The gag reflex is one of these reflexes, which results in gagging when the throat is triggered or stimulated. 
However, some of these neonatal reflexes are unique in each baby. They usually grow out in any of these reflexes after a few months of delivery, so a doctor can detect problems or issues that may affect your baby’s health.
These reflexes are: 
  • Asymmetrical tonic neck reflex
  • Babinski reflex
  • Grasp reflex
  • Moro or startle reflex
  • Rooting reflex
  • Step reflex
  • Truncal incurvation or Galant reflex
Some of these reflexes are immediately noticeable when born. If a particular adult has experienced brain injury, they may exhibit newborn reflexes again.
Examples of injuries that may exhibit these reflexes are brain damage or stroke.

Neonatal reflex tests: How to assess

The neonatal reflex test assesses if babies react appropriately to every stimulus. These assessments can be done gently at home or can be done with your baby’s doctor for a thorough guide.
Doing these reflex tests is an important part of taking care of your baby. These assessments could determine abnormalities in the central or peripheral nervous system.

  • Asymmetrical tonic neck reflex

Your baby presents an asymmetrical tonic neck reflex when laid down and their head is turned gently on the side. This becomes a “fencer” position.  
This means when the head is turning to the left, the right arm then reflexes while the left arm stretches away from the body with the hand slightly opened. 
If the head turns to the right, the reflex assumes the opposite position.

  • Babinski reflex

This is done by stroking the under-part of your baby’s foot, from the topmost to the heel. The baby’s toes will stretch out wide while the big toe will move upward. In adults, the toes will curl inward.

  • Grasp reflex

This is assessed by opening the hand of your baby and placing one finger on the palm. The baby should grasp your finger and might even grip it firmly.

  • Moro or startle reflex

This is tested by positioning the baby gently in a seating stance while supporting the head. The doctor doing the test may let the baby lean slightly backward, then catch the head before it hits the ground. 
If your baby’s Moro reflex is stimulated, they should be surprised and startled while lifting the palms upward. 
When the baby is caught, they will return to their seating position.

  • Rooting reflex

This reflex is used for breastfeeding clinching. When your baby’s cheek is stroked, your baby will look toward the stroked cheek and will make a sucking movement.

  • Step reflex

To do these, the baby should be held upright while gently letting the baby’s feet touch the surface of a floor or ground. The baby should appear to step or dance.

  • Truncal incurvation or Galant reflex 

The Galant reflex is tested by holding the baby face-down on one hand, while the other hand strokes the baby’s skin tracing his spine. The baby should be in a tickling motion or his spine should curve as a response. 

Reflex tests in the Philippines

In the Philippines, Vision Therapy PH offers a 2-day course lecture workshop on Primitive Reflex. This lecture workshop gives hands-on opportunities to practice and performs primitive reflex testing methods. 
They also administer exercises to be experienced for the integration of primitive reflexes to support neurosensory motor and the combination of sensory and motor modes in reflex test practices.

2. Apgar scoring

In the first minute after your baby is born he will do the first grading test of his life! In the Apgar score test, five factors are used to evaluate the baby’s condition. The five factors are:

1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)

Each factor is given a score on a scale of 0 to 2, with 2 being the best score. The scores for each of the 5 areas are then combined to obtain a total grading out of a possible score of 10. A perfect score of 10 is possible but rare.
Five minutes later, the Apgar test is repeated. Babies usually get a higher score in the second test because their overall condition tends to improve.

3. Quick physical examination

Within an hour of your baby’s birth, the midwife will also perform a quick physical examination. She will check your baby’s weight, length, and head circumference. These figures will go into your baby’s health booklet which will be updated at subsequent check-ups.

The moment your baby is born, their vital signs will be checked through a quick physical examination.

Thorough physical examination

The pediatrician will perform a detailed head-to-toe examination within the first 24 hours of your baby’s life. This will include checking your baby’s heart, reflexes, and breathing. The doctor will also do a physical check for Jaundice's symptoms and how breastfeeding is going.

4. Hearing test

This test can be done easily and doesn’t cause any pain to your baby. Hearing in infants can be tested using two different methods: the auditory brainstem response (ABR) evaluations or the otoacoustic emission (OAE) measures. Moreover, both tests are accurate, noninvasive, automated, and do not require any observable response from the infant.
It is important to detect hearing impairment early on so that treatment can be prescribed if needed. As mentioned earlier, the hearing test is included in the newborn care package which is offered to all babies.
 

A hearing test is part of the routine newborn screening

Vaccinations and injections

All newborns are also required to have these vaccinations before being discharged from the hospital, which is why they are covered in the newborn care package by PhilHealth.
Vitamin K injection
Vitamin K is a routine injection given to help your baby's blot clot and prevent hemorrhaging, especially in instances where forceps or suction have been used to aid delivery.
BCG and Hepatitis B vaccinations
The BCG vaccination protects your child against tuberculosis and the first dose of the hepatitis B vaccine is given shortly after your baby is born.
In addition, this has proven highly effective in preventing serious forms of childhood tuberculosis such as tuberculosis TB meningitis (which occurs when the tuberculosis bacteria invade the membranes and fluid surrounding the brain and spinal cord), and disseminated tuberculosis (a contagious bacterial infection in which TB bacteria has spread from the lungs to other parts of the body through the blood or lymph system).
As the name suggests, the hepatitis B vaccine protects your baby from serious viral liver infections such as hepatitis B. Your baby will get the 2nd dose of the hepatitis B vaccine one month after the first dose and the 3rd dose 5 months after the 2nd dose.
  Additional information by Camille Eusebio and Nathanielle Torre

 

Newbornscreening.PH, DOH, VeryWellFamily, Vision Therapy PH, Healthline

Here at theAsianparent Philippines, it's important for us to give information that is correct, significant, and timely. But this doesn't serve as an alternative for medical advise or medical treatment. TheAsianparent Philippines is not responsible to those that would choose to drink medicines based on information from our website. If you have any doubts, we recommend to consult your doctor for clearer information.

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Written by

Minoli Almeida