NEWBORN

SCREENING
Republic Act no. 9288 otherwise known
as Newborn Screening Act of 2004.
NEWBORN SCREENING (NBS)

A simple procedure to find out if a baby

has a congenital metabolic disorder
that may lead to mental retardation or
even death if left untreated.
It is ideally done on the 48th hour or at
least 24 hours from birth. .
NEWBORN SCREENING (NBS)

It is important because most babies

with metabolic disorders look “normal”
at birth
May be detected even before clinical
signs and symptoms are present
Treatment can then be given early to
prevent serious consequences of
untreated metabolic conditions
Newborn screening program in the
Philippines currently includes screening
of six disorders:
 Congenital Hypothyroidism (CH),
 Congenital Adrenal Hyperplasia (CAH),
 Phenylketonuria (PKU),
 Glucose-6- Phosphate Dehydrogenase (G6PD) Deficiency,
 Galactosemia (GAL) and
 Maple Syrup Urine Disease (MSUD).
The expanded screening will include
22 more disorders such as
hemoglobinopathies and additional
metabolic disorders, namely, organic
acid, fatty acid oxidation, and amino
acid disorders. The latter are included
in the standard care across the globe.
7
DISORDERS INCLUDED IN
NEWBORN SCREENING
(NBS)
1. CONGENITAL HYPOTHYROIDISM (CH)
- results from lack of/absence of
thyroid hormone, which is essential to the
growth of brain and body.\
- If not detected or hormone replacement
is not initiated within 4 weeks, the baby’s
physical growth will be stunded and may
suffer mental retardation
DISORDERS INCLUDED IN
NEWBORN SCREENING
(NBS)
2. CONGENITAL ADRENAL HYPERPLASIA (CAH)
- An endocrine disorder that causes severe salt
loss, dehydration and abnormally high levels
of male sex hormone in both boys and girls.
- If not detected or treated early, babies may
die within 7-14 days
DISORDERS INCLUDED IN
NEWBORN SCREENING
(NBS)
3. GALACTOSEMIA
- 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,
DISORDERS INCLUDED IN
NEWBORN SCREENING
(NBS)
4. PHENYLKETONURIA (PKU)
- A metabolic disorder in which the
body cannot properly use one of the
building blocks of protein called
phenylalanine.
- Excessive accumulation of
phenylalanine in the body causes brain
DISORDERS INCLUDED IN
NEWBORN SCREENING
(NBS)
5. GLUCOSE-6-PHOSPHATE
DEHYDROGENASE (G6PD deficiency )
-A condition where the body lacks
G6PD enzyme.
- Babies with this deficiency may have
hemolytic anemia resulting from exposure
to certain drugs, foods, and chemicals.
 DISORDERS INCLUDED IN
NEWBORN SCREENING
5. MAPLE SYRUP (NBS)
URINE DISEASE (MSUD).
-A condition where there is an absence of a
group of enzymes called “branched-chain ketoacid
dehydrogenase” (BCKAD).
The job of this enzyme group is to break down three
different amino acids called leucine, isoleucine and
valine. When they cannot be broken down, these
amino acids build up in the blood and cause
problems.
 It is named for the sweet maple syrup smell
of the urine in untreated babies
Classic MSUD
Symptoms start as soon as a baby is fed protein, usually shortly
after birth. Some of the first symptoms are:
 poor appetite
 weak suck
 weight loss
 high pitched cry
 urine that smells like maple syrup or burnt sugar
Babies with MSUD have episodes of illness called metabolic crisis.
Some of the first symptoms of a metabolic crisis are:
 extreme sleepiness
 sluggishness
 irritable mood
 vomiting
If not treated, other symptoms can follow:
 episodes where muscles tone alternates between being rigid and
floppy
 swelling of the brain
 seizures
 high levels of acidic substances in the blood, called
metabolic acidosis
 coma, sometimes leading to death
 Symptoms of a metabolic crisis often happen:
 after going too long without food
 during illness or infection
 during stressful events such as surgery

Without treatment, brain damage can occur. This

can cause intellectual disabilities or spasticity.
Some babies become blind. If not treated, most
HOW IS NBS IS 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
ENBS?
 The blood sample for ENBS may be collected by any of the following:

 Physician
 Nurse
 Medical technologist
 trained midwife.
Where is ENBS available?

ENBS is available in hospitals,

lying-ins, rural health units,
health centers and some
private clinics.
How much is ENBS?

 Expanded newborn screening costs ₱1750 and

is included in the Newborn Care Package (NCP) for PhilHealth
members.

What is Newborn Care

Package?
NCP is a PhilHealth benefit package for
essential health services of the newborn
during the first few days of life. It covers
essential newborn care, expanded newborn
screening, and hearing screening tests.
What are the eligibility conditions for
newborn to avail of the NCP?

 Newborns are eligible for NCP if ALL of the following are met:
• Either of the parents are eligible to avail of the benefits,
• Born in accredited facilities that perform deliveries, such as
hospitals and birthing homes; and
• Services were availed of upon delivery.
 How can results be claimed?
 Results can be claimed from the health facility where ENBS was availed.
Normal ENBS results are available by 7 - 14 working days from the time
samples are received at the NSC.
 Positive ENBS 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.
What is the meaning of the new
born screening result?
A NEGATIVE SCREEN means that the ENBS re
sult is normal.
A POSITIVE SCREEN means that the newborn
must be brought back to his/her health
practitioner for further testing.
What must be done when a baby has a po
sitive ENBS result?

 Babies with positive results must be referred at once to a specialist

for confirmatory testing and further management.
What happens to the dried blood samples
after screening?

 After the dried blood spot has been tested, it will be stored in a
secure locked area. The stored sample is retained to allow for normal
quality assurance and may be used for ethics committee approved
researches for the benefit of the public.
 INTEGRATED
MANAGEMENT OF
CHILDHOOD
ILLNESSES
 Facts:
 Every year almost 11 million children under the age of five in third world
countries die from preventable and treatable illnesses such as dehydration,
acute respiratoy infections, measles, and malaria. Malnutrition complicates
half of theses cases.
 Manyof these children have never even
been seen at a health facility for several
reasons:
 Services do not exist
 Families lack access to these services
 Families and other caregivers do not recognize
the warning signs of life threatening diseases
 WITH THIS , IMCI WAS BORN
 INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESSES
 Simply the umbrella program through which
all community health interventions can be
delivered to children under 5 years of age .
 First developed in 1992 by the United Nations
Children Emergency Fund (UNICEF) and the
WORLD HEALTH ORGANIZATION (WHO) with the
aim of prevention or early detection and treatment
of the leading cause of childhood deaths.
 Also emphasizes prevention of illness, through
education on the importance of immunization,
micronutrient supplementation, and improved
nutrition.
 IMCI seeks to reduce childhood mortality and
morbidity by improving family and community
practices for the home management of illness and
improving case management of skills of health
workers in the bigger health system.
WHY AN INTEGRATED APPROACH?
 Ten million children die each year and majority of these deaths are caused
by 5 preventable and treatable conditions namely: pneumonia, diarrhea,
malaria, measles and malnutrition. Three (3) out of four (4) episodes of
childhood illness are caused by these five conditions
Most children have more than one illness at one time. This overlap means that
a single diagnosis may not be possible or appropriate.
WHAT ARE THE STEPS IN THE IMCI CASE MANAGEMENT PROCESS?

 ASSESS THE CHILDS ILLNESS

 CLASSIFY THE ILLNESS BASED ON SIGNS
 IDENTIFY TREATMENT
 TREAT THE CHILD
 COUNSEL THE CARETAKER
 FOLLOW-UP
WHAT ARE THE FOCUS OF IMCI?

 Improving case management skills of health

workers
 Improving over-all health systems
 Improving family and community health
practices
WHAT ARE THE BENEFITS OF THE IMCI STRATEGY?

 Addresses major child health problems because it

systematically address the most important causes of children
illness and death.
 Responds to demands.
 Promotes prevention as well as cure because IMCI emphasizes
important preventive interventions such as immunization and
breastfeeding.
 Is cost-effective- most cost-effective interventions in low and
middle income countries (World Bank).
 Promotes cost-saving.
 Improves equity – IMCI improves inequity in global health care.
What is the disease focus of IMCI in
the Philippines?
 PNEUMONIA
 DENGUE
 DIARRHEA
 MALARIA
 MEASLES
 MALNUTRITION
 PRINCIPLES OF THE IMCI CASE
MANAGEMENT GUIDELINES
 All sick children aged up to 5 years are examined for general
danger signs and all sick young infants are examined for very
severe disease. These signs indicate immediate referral or
admission to hospital
 The children and infants are then assessed for main symptoms.
For older children, the main symptoms include: cough or difficulty
breathing, diarrhea, fever and ear infection. For young
children, local bacterial infection, diarrhea and jaundice. All sick
children are routinely assessed for nutritional and
immunization and deworming status and other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to
a child’s classification within one or more symptom
groups rather than a diagnosis.
 IMCI management procedures use limited number of
essential drugs and encourage active participation of
caretakers in the treatment of children
 Counseling of caretakers on home care, correct
feeding and giving of fluids, and when to return to
clinic is an essential component of IMCI

WHAT IS THE EXTENT OF IMCI
IMPLEMENTATION?
 IMCI is implemented in 70% of all health
facilities nationwide. IMCI is also integrated in
the Nursing, Midwifery and Medical Pre- Service
Education. The attached lists/addresses of DOH
Centers for Development (CHDs) in 17 regions
can provide technical assistance in IMCI
training. The list also includes the Nursing and
Midwifery Schools designated as Training
Institution for IMCI Pre-Service.
EARLY ESSENTIAL
INTRAPARTAL
AND
NEWBORN CARE
(EEINC)
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE
 The EINC practices are
evidenced-based standards
for safe and quality care of
birthing mothers and their
newborns, within the 48
hours of Intrapartum
period (labor and delivery)
and a week of life for the
newborn.
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE
 Essential lntrapartum and
Newborn care (EINC) is a
package of evidence-based
practices recommended by the
Department of Health (DOH),
Philippine Health Insurance
Corporation (PhilHealth), and the
World Health Organization (WHO)
as the standard of care in all
births by skilled attendants in all
government and private settings.
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE
 InDecember 2009, the
Secretary of the Department
of Health Francisco Duque
signed Administrative Order
2009-0025, which mandates
implementation of the EINC
Protocol in both public and
private hospitals. Likewise,
the Unang Yakap campaign
was launched.
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE
EINC distinguishes the
necessary practices in
the delivery and care
for the newborn and
the mother, from the
unnecessary.
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE
 Itis a basic component of
DOH’s Maternal, Newborn
and Child Health and
Nutrition (MNCHN) strategy.
The EINC practices for
newborn care constitute a
series of time- bound,
chronologically-ordered,
standard procedures that a
baby receives at birth.
THE EINC PRACTICES DURING
INTRAPARTUM PERIOD

 Continuous maternal support, by a

companion of her choice, during
labor and delivery
 Mobility during labor – the mother is
still mobile, within reason, during
this stage
 Position of choice during labor and
delivery
 Non-drug pain relief, before offering
labor anesthesia
THE EINC PRACTICES DURING
INTRAPARTUM PERIOD

 Spontaneous pushing in a semi-

upright position
 Episiotomywill not be done,
unless necessary
 Activemanagement of third
stage of labor (AMTSL)
 Monitoringthe progress of labor
with the use of partograph
Recommended EINC practices for newborn
care are time-bound interventions at the
time of birth
 Immediate and thorough drying of the newborn
 Early skin-to-skin contact between mother and the newborn
 Properly-timed cord clamping and cutting
 Unang Yakap (First Embrace) of the mother and her newborn for early
breastfeeding initiation
Notes

• Health workers should not touch the newborn unless there is a medical indication.
• Do not give sugar water, formula or other prelacteals.
• Do not give bottles or pacifiers.
• Do not throw away colostrum.
 Unnecessary interventions
 eliminated
These are enemas and shavings, fluid and food intake
restriction, and routine insertion of intravenous fluids.
Fundal pressure to facilitate second stage of labor is no
longer practiced, because it resulted to maternal and
newborn injuries and death.
 Newborn: routine suctioning, early bathing, routine
separation from the mother, foot printing, application of
various substances to the cord, and giving pre-lacteals
or artificial infant milk formula or other breast-milk
substitutes.
 Basic Emergency Obstetric
and Newborn Care (BEMONC)
The Paradigm Shift

 RISK Approach -Identifies high risk pregnancies for referral during the
prenatal period
 EmONC Approach- Considers all pregnant women at risk of
complications at Childbirth.
Emergency Obstetric and Newborn
Care(EmONC)
 … the elements of obstetric & newborn care needed for the
management of normal and complicated pregnancy, delivery,
postpartum periods and the newborn.
 Early detection and treatment of problem pregnancies to prevent
progression to an emergency.
 Management of emergency complications*
BASIC EMERGENCY OBSTETRIC and NEWBORN
CARE (BEmONC)

It refers to lifesaving services for emergency maternal and newborn

conditions/complications being provided by a health facility or professional

BEmONC-CAPABLE FACILITY or provider can perform the

following 7 obstetric functions:
1. Parenteral administration of oxytocin in the third stage of
labor.
2. Parenteral administration of loading dose of anticonvulsants
3. Parenteral administration of initial dose of antibiotics
4. Administration of maternal steroids for preterm labor
5. Performance of assisted deliveries ( imminent breech
deliveries )
6. Removal of retained products of conception
BASIC EMERGENCY OBSTETRIC
and NEWBORN CARE (BEmONC)

BEmONC-CAPABLE FACILITY can

also provide emergency newborn
interventions
1. Newborn resuscitation
2. Treatment of neonatal sepsis/
infection
3. Oxygen support
BASIC EMERGENCY OBSTETRIC
and NEWBORN CARE (BEmONC)
 Isalso capable of blood transfusion services on
the top of its standard functions, depending on
the presence of qualified personnel and required
equipment and supplies.
 BeMONC facility shall consist of the core district hospital.
 For geographically isolated/disadvantaged areas/ densely populated
areas, the designated BeMONC facilities are the following: Rural
Health Unit, Barangay Health Station, Lying-in Clinics and Birthing
Homes.
 Accessibility within 1 hour from residence or referring facility within
the ILHZ (Inter-local Health Zones)
 Shall operate within 24 hours with 6 signal obstetric function.

 Shall have access to communication and transportation facilities to

mobilize referrals.

 Staff composition: (1) Medical Doctor (ON CALL), (1) Registered

Nurse/(1) Registered Midwife.

 WHO recommends ratio of 1 BEMONC facility per 125,000 population

 CeMONC- Comprehensive
Emergency Obstetrics and
Newborn Care facility
 CeMONC- Comprehensive
Emergency Obstetrics and Newborn
 Care facility
Can perform:
1. the 7 signal obstetric functions as in BEmONC
2. Provide Cesarean delivery services
3. Other highly specialized obstetric intervention
4. Capable of providing neonatal emergency interventions for
bemonc plus management of low birth weight or preterm
newborn and other specialized newborn services
 WHO recommends ratio of 1 CEmONC facility per 500,000
population
 PUBLIC HEALTH
LAWS
Magna Cart for Health Workers – R. A. 7305 where all Implementing
Rules and Regulations regarding Health Workers is embedded.

Sanitation Code – P.D. 856 empower the DOH with the following power
and function: Undertake the promotion and preservation of the health of the
people and raise the health of the People and raise the health standards of
individuals and communities in the Philippines.

Clean Air Act – R.A. 8749 is a comprehensive air quality management

policy and program which aims to achieve and maintain healthy air for all
Filipinos.

Generic Act of 1988 – R.A. 6675 to promote drug safety by minimizing

duplication in medications and or use of drugs with potentially adverse drug
interactions
National Health Insurance Act (Universal Health Care Act,
2019) – R.A. 11223 The patient IRR on the implementation of
Health Care in the Philippines

National Blood Services Act – R.A. 7719 promotes voluntary

blood donation to provide sufficient supply of safe blood and
regulate blood banks. This act aims to inculcate public awareness
that blood donation is a humanitarian act.

Laws on Notifiable Diseases – R.A. 11332 Mandatory Reporting

of Notifiable Diseases

Senior Citizens Act of 2010- R.A. 9994 defines the privileges of

all senior citizens 60 and above 20% discount and VAT exempted
Revised Dangerous Drugs Law – R.A. 9165 of 2012 repealing R.A. 6425
of 1972 law enforcement of all provisions on any dangerous drugs, controlled
precursors and essential chemicals as provided in this act.
Act on cheaper medicine - R.A. 9502 of 2008, the Cheaper Medicines
Act, is intended to achieve universally accessible and cheaper and quality
medicines by pursuing an effective competition policy in the pharmaceutical
sector. The President subsequently issued an executive order requiring
maximum retail prices for a number of drugs.

Violence Against Women and Children 2004 -Republic Act 9262 It is

hereby declared that the State values the dignity of women and children and
guarantees full respect for human rights. The State also recognizes the need
to protect the family and its members particularly women and children, from
violence and threats to their personal safety and security.

Disaster Risk Reduction Management - RA 10121 provides a

comprehensive, all-hazard, multi-sectoral, inter-agency, and community-
based approach to disaster risk management through the formulation of the
National Disaster Risk Management Framework
Breast-feeding Act of 1992 - R.A. 7600 This Act shall be known as
"The Rooming-In and Breast-feeding Act of 1992". The State adopts
rooming-in as a national policy to encourage, protect and support the
practice of breast-feeding. It shall create an environment where basic
physical, emotional, and psychological needs of mothers and infants
are fulfilled through the practice of rooming-in and breast-feeding.

The Responsible Parenthood and Reproductive Health Act of

2012 – R.A. 10354 , informally known as the Reproductive Health
Law or RH Law, is a law in the Philippines, which guarantees universal
access to methods on contraception, fertility control, sexual
education, and maternal care.

Mandatory Infants and Children Health Immunization Act of

2011 - Republic Act No. 10152 Signed by President Benigno Aquino
III in July 26, 2010. The law includes basic immunization for children
under 5 including other types of immunization that will be determined
by the Secretary of Health.
Children’s Safety on Motorcycles Act of 2015 –
R.A. 10666 or the Children’s Safety on Motorcycles
Act of 2015 prohibits any person from driving a
motorcycle on public roads with a child on board.
CONCEPT: “Think Health, Health Link”

1. HEALTHY BARRIO► Residents actively participate in

attaining good health; they are • PARTNERS in health care •
Highlight Project: BOTIKA SA PASO CAMPAIGN Goal : to
maintain herbal plants in pots for family use

2. HEALTHY CITY ► The physical environment in the

workplace, streets, and public places promotes health,
safety, order, and cleanliness through structural manpower
support • Health-related Strategies: Construction of well-
maintained, income-generating public toilets; designation of
a “Pook-Sakayan, Pook-Babaan”
3. HEALTHY MARKET ► adequate water supply
► proper drainage ► well-maintained toilet
facilities ► proper garbage and waste disposal
is observed by vendors ► cleanliness
maintained ► affordable quality foods ► has a
well-organized and honest market system

4. HEALTHY HOSPITAL ► A “CENTER OF

WELLNESS” ► Promotes preventive care ►
provides clean and adequate resources,
affordable and accessible services ► Patient-
centered ► Governed by competent health
team members and personnel
5. HEALTHY SCHOOL ► Health instructions provided through classroom/extra-
curricular activities ► Maintains adequate, basic health services to both pupils,
teachers, and other personnel Sample School Initiative : Little Doctor Program -
outstanding students are chosen yearly on the bases of their healthy conditions
and lifestyles

6. HEALTHY STREET ► Well-maintained roads and public waiting areas ► Well-

marked traffic signs and pedestrian crossing lane and visible street names ►
Clean and obstruction-free sidewalks ► With minimal traffic problems ► With
adequate strict law enforcement Project: Pook-Tawiran (Kapag ikaw ay nahuli,
walang sisihan) Goal : To promote and reorient people especially erring
pedestrians on the use of pedestrian crossings. 7. HEALTHY PRISON ► Physical
Environment: clean, safe detention place with adequate facilities ► Psychosocial
Environment: services address the mental, spiritual, physical, social and economic
needs of inmates; has an atmosphere that actively promotes JUSTICE, PEACE,
REHABILITATION and a HEALTHY LIFESTYLE
 END!!
THANK YOU!!
 End
thank you