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Your Baby

New Guidelines for Newborn Genetic Screenings

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Certain medical conditions can be present at birth but not easily identifiable. Metabolic or inherited disorders can impede a child’s normal physical and or mental development in lots of different ways. Without even knowing that they are carriers, parents can pass on the genes that produce these types of disorders. That’s where genetic screening of newborns comes in. With a simple blood test doctors can tell if the newborn has a condition that may eventually cause the child problems. Some of these disorders, if treated early, can be managed.

The federal government has not set any national standards, but many states have mandatory newborn screening programs. Parents can opt out of genetic testing if they want. Parents should discuss genetic screening with their pediatrician or child’s doctor so they can weigh the pros and cons.

Many states screen for more than 30 disorders and the screenings are often covered in the delivery and hospital charges. If a parent wants expanded testing on their newborn, they may have to pay an extra cost but it may be worth it to their baby.

To help guide states and parents determine what criteria should be used for genetic screening, the American Academy of Pediatrics and the American College of Medical Genetics and Genomics just offered new guidelines.

The new guidelines say that all newborns should be tested for the genetic diseases that are included in their state's newborn screening panel, but anything beyond that is up to parents and the decision must be made in the child's best interest.

The recommendations distinguish between genetic testing for childhood onset conditions versus those for adult onset conditions.

"There is an important role for counseling before and after genetic screening," added policy author Dr. Lainie Friedman Ross, a pediatrician and ethicist at the University of Chicago. "The focus should be on education of families, counseling them and helping them make decisions that focus on the child's best interest."

Testing for disease in the presence of symptoms is another area addressed by the new recommendations. "Clearly, if a child has symptoms, we need a diagnosis to help the family make clinical decisions that are in the child's best interest. This is important even when the disease has no current therapies," Friedman Ross added.

She also said that the results should be explained to the child when they reach the appropriate age.

New technology offers direct-to-consumer genetic screening tests, but the authors caution parents about using these products because of a lack of oversight and results are open to interpretation.

Some experts agree that being forewarned is being forearmed, but are not fans of the direst-to-consumer genetic tests.

"We highly discourage these even on adults, and particularly on children, because there is nobody there to provide counseling and interpretation," says Dr. Joyce Fox, a medical genetics doctor at North Shore University Hospital in Manhasset, N.Y. “These can also be very costly, and are likely not covered by insurance." Fox says.

Parents should educate themselves about genetic screening before the baby is born.  Most babies are born healthy and glide right through the genetic screening. But there are cases when the genetic testing panel reveals serious conditions such as PKU or Sickle Cell Anemia. 

If a baby’s screening results are negative, it means the tests did not show any signs of the conditions in the screening. On the other hand, if there are any positive results, it means there are signs of one or more of the conditions included in the screening,

A positive result does not always mean that the baby has the condition. It does mean though, that further testing is needed to make a final determination.

Early treatment for some of the conditions screened for can prevent serious future complications; so don’t delay if more tests are needed.

Pediatricians and geneticists say they approve of the new guidelines. The guidelines were published online in the journal Pediatrics.

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Sources: Denise Mann, http://consumer.healthday.com/Article.asp?AID=673692

http://kidshealth.org/parent/system/medical/newborn_screening_tests.html#cat150

Your Baby

Delayed Cord Clamping May Improve Infant’s Health

2:00

According to a new study, delaying umbilical cord cutting by 2 minutes after birth may result in better development in a newborn’s first days of life.

When to cut the umbilical cord has been debated and changed over a long period of time. Before studies began in the mid-1950s, cord clamping within 1 minute of birth was defined as "early clamping," and "late clamping" was defined as more than 5 minutes after birth. And the American Congress of Obstetricians and Gynecologists (ACOG) have stated, "the ideal timing for umbilical cord clamping has yet to be established."

To provide further evidence in the debate of early versus late cord clamping, researchers led by Professor Julio José Ochoa Herrera of the University of Granada, assessed newborn outcomes for infants born to 64 healthy pregnant women to determine the impact of clamping timing on oxidative stress and the inflammatory signal produced during delivery.

All of these women had a normal pregnancy and spontaneous vaginal delivery. However, half of the women's newborns had their umbilical cord cut 10 seconds after delivery and half had it cut after 2 minutes.

Results showed that with late cord clamping there was an increase in antioxidant volume and moderation of inflammatory effects in newborns.

Other studies have shown that delaying clamping allows more time for blood to move from the placenta through the cord, improving iron and hemoglobin levels in newborns.

If delaying cord clamping is beneficial for newborns, then why do many doctors perform a quick cut? Apparently there are several reasons.

According to ACOG, a previous series of studies into blood volume changes after birth concluded that in healthy term infants, more than 90% of blood volume was attained within the first few breaths he or she took after birth.

As a result of these findings, as well as a lack of other recommendations regarding optimal timing, the amount of time between birth and umbilical cord clamping was widely shortened; in most cases, cord clamping occurs within 15-20 seconds after birth.

The World Health Organization (WHO) believes waiting longer is better. WHO supports late cord clamping (1-3 minutes) because it "allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to 6 months after birth."

ACOG states on their website that “Concerns exist regarding universally adopting delayed umbilical cord clamping. Delay in umbilical cord clamping may jeopardize timely resuscitation efforts, if needed, especially in preterm infants. However, because the placenta continues to perform gas exchange after delivery, sick and preterm infants are likely to benefit most from additional blood volume derived from a delay in umbilical cord clamping.”

WHO states clearly that that early cord clamping - less than 1 minute after birth - is not advised unless the newborn is asphyxiated and needs to be moved for resuscitation.

Simply holding a wet, crying and wiggling baby for 2 minutes may also prove difficult for physicians whose hands are gloved. The better option may be to place the baby on the mother’s stomach, wait the 2 minutes and then cut the cord.

More and more studies are finding that in certain circumstances, waiting a couple of minutes longer to cut the umbilical cord may be best for baby.

According to this study, there’s really no reason why newborns from a normal pregnancy and vaginal delivery should not be allowed at least 2 minutes before the cord is clamped after birth.

Mothers and fathers-to-be should discuss cord cutting timing with their doctor before the baby is born. If your preference is to allow more time before cutting the cord when your baby arrives, let your physician know ahead of time.  He or she can then advise you on when early clamping may be necessary and when it can wait a couple of extra minutes.

Scientists from the University of Granada and the San Cecilio Clinical Hospital in Spain conducted the research. The results were published in the journal Pediatrics. Source: Marie Ellis, http://www.medicalnewstoday.com/articles/287041.php

http://www.acog.org

Your Baby

Formula-Fed Babies: How Much and How Often?

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There are many reasons a mother may choose to use formula instead of breast milk when feeding her newborn. There are also times when mothers decide to switch from nursing to formula, as their baby gets a little older.  Whether you’re breastfeeding or giving formula, it’s generally recommended that babies be fed when they seem hungry.

What kind of schedule and how much formula do formula-fed babies need? It all depends on the baby. While each infant’s appetite and needs may be a little different – there are general rules of thumb that can be helpful for moms to know.

According to Healthychildren.org, after the first few days, your formula-fed newborn will take from 2 to 3 ounces (60–90 ml) of formula per feeding and will eat every three to four hours on average during his or her first few weeks.

Occasionally, you may have a sleeper who seems to like visiting dreamland longer than most babies. If during the first month your baby sleeps longer than four or five hours, wake him or her up and offer a bottle.

By the end of his or her first month, they’ll usually be up to at least 4 ounces (120 ml) per feeding, with a fairly predictable schedule of feedings about every four hours.

By six months, your baby will typically consume 6 to 8 ounces (180–240 ml) at each of four or five feedings in twenty-four hours.

Since babies can’t communicate with words, parents have to learn how to read the signs and signals baby uses to express wants.

How do you know your baby is hungry? Here are signs baby may be ready to eat:

•       Moving their heads from side to side

•       Opening their mouths

•       Sticking out their tongues

•       Placing their hands, fingers, and fists to their mouths

•       Puckering their lips as if to suck

•       Nuzzling against their mothers' breasts

•       Showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

•       Crying

The crying signal can be confusing for parents. It doesn’t always mean the same thing. Crying is also a last resort when baby is hungry. Your baby should be fed before he or she gets so hungry that they get upset and cry. That’s why guidelines are helpful when starting out.

Most babies are satisfied with 3 to 4 ounces (90–120 ml) per feeding during the first month and increase that amount by 1 ounce (30 ml) per month until they reach a maximum of about 7 to 8 ounces (210–240 ml). If your baby consistently seems to want more or less than this, discuss it with your pediatrician. Your baby should drink no more than 32 ounces (960 ml) of formula in 24 hours. Some babies have higher needs for sucking and may just want to suck on a pacifier after feeding.

Eventually, baby will develop a time schedule of his or her own. As you become more familiar with your baby’s signals and sleep patterns, you’ll be able to design a feeding schedule tailored to your infant’s needs.

Between two and four months of age (or when the baby weighs more than 12 pounds [5.4 kg]), most formula-fed babies no longer need a middle-of-the night feeding, because they’re consuming more during the day and their sleeping patterns have become more regular (although this varies considerably from baby to baby). Their stomach capacity has increased, too, which means they may go longer between daytime feedings—occasionally up to four or five hours at a time. If your baby still seems to feed very frequently or consume larger amounts, try distracting him with play or with a pacifier. Sometimes patterns of obesity begin during infancy, so it is important not to overfeed your baby.

The most important thing to remember is that there is no “one schedule and formula amount fits all” when it comes to babies and their needs.

No one can tell you exactly how often or how much your baby boy or girl needs to be fed, but good communication with your pediatrician and learning how to read your baby’s body language will go a long way in keeping baby’s feedings on track.

Story sources: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Amount-and-Schedule-of-Formula-Feedings.aspx

http://kidshealth.org/en/parents/formulafeed-often.html

 

Daily Dose

Common Newborn Questions Answered!

Dr. Sue answers common questions about newborn babies.Well, it seems like it takes more than one column to discuss the first days home with a newborn baby.  After discussing the nuances of breast feeding, there are also many questions regarding all of the noises that babies make.

Everyone thinks that infants are pretty quiet, that is until you sleep with a newborn in the bassinet right next to your bed.  Newborns are noisy!!  They not only cry (that is a whole other topic) but they squeak, grunt, stretch, yawn, have weird breathing noises, hiccup and pass tons of gas. (Dad’s are so cute when they say, “there is something wrong with my baby girl as she FARTS and it stinks, this can’t be normal?”) The first thing that many parents will notice is that their infant has “weird” breathing patterns. The baby seems to take some rapid breaths and then pauses and it looks like “they have stopped breathing” for a few seconds, and then resumes their more normal breathing.   This is called periodic breathing and is quite normal for the first few weeks of a baby’s life.  I swear only first time parents notice this, as you have the time to watch your precious baby and count their breaths. Every subsequent baby in the family is equally loved, but is typically not under the microscope like a first born and we only notice that they are ‘’’breathing”.  As an infant matures so does the breathing pattern and the respiratory rate becomes more rhythmic. If your baby has any color changes, i.e  turns dusky, or blue with their breathing that is a cause for immediate concern and a call to the doctor or 911. Another common concern is often how many times a day a baby will hiccup. If you remember, the baby often hiccupped in utero, and this too continues after they are born. Babies seem to hiccup for an inordinate amount of time, which bothers parents, but usually seems not to faze the baby at all. It is fine to try and give your newborn water if they are hiccupping and it is really bothering either you or them, but is not necessary.  Just like an infant’s startle (Moro) reflex, babies seem to get the hiccups when they are younger and they slow down as the baby’s nervous system matures.  A baby may hiccup for minutes to an hour and then just stop and fall asleep, oblivious to the concern that this event has caused their parents. Babies also make a lot of stretching and grunting and groaning noises, and are perfectly comfortable.  But these noises will awaken a sleeping parent.  If your baby is not crying during all of these noises, I would not pick he/she up, but would wait to see if they then go back to sleep. Some of these noises occur even while a baby is sound asleep. In this case the adage, “never wake a sleeping baby” is good advice.  These noises do not necessarily mean a baby needs to eat, especially if you think they may have just eaten an hour ago. Again, your baby should not appear in any distress or have color changes, they are just noisy! Lastly, GAS!  All babies have gas, and no one knows that until they have cared for a newborn.  It does not matter if a baby is breast or bottle fed, they produce gas, and it is loud and may be stinky. I think that infants produce more gas in the first 3-4 months of life than they will again until they are old (grandparents age, ask them). It seems like so many things occur both early and later in life, and gas is just one example. As a newborn’s GI tract matures, they seem to produce less gas, and are also often more comfortable after a feeding. When a baby is “gassy” they often like to have movement, so they like to be rocked, or put on their tummy and patted (only if awake, never to sleep), and they may enjoy the swing, or the motion of riding in a car, or putting the infant seat on top or a vibrating washing machine or dryer.  There are many “home remedies” but maturation of the GI tract just takes time. In most cases, changing an infant’s formula or a mother’s diet will not change the gas, but many people will try it. Remember, this too shall pass! 
(no pun intended) That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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