Costometic

As an expectant parent or a paediatrician treating a baby, there are a few preventive steps that can be taken to ensure good health for your little one in the future. Vaccinating the baby being one of them and the other being Newborn Metabolic Screening (NMS). The NMS is a novel method by which one can detect problems (Inborn errors of metabolism) even before signs of the condition become apparent, so that in some cases early treatment can be commenced, leading to normal growth and development of the child. The current form of the NMS, screens the baby for more than 40 different metabolic conditions which if undetected or untreated can lead to severe developmental delay or unexpected death of the infant. The most novel aspect of this screen is all these 40 conditions can be tested for using only 4 drops of blood from the baby’s foot!

The newborn metabolic screen is done to detect babies with a complex group of disorders known as Inborn errors of metabolism (IEM). IEM is a group of genetic conditions that prevents the baby from processing food properly. This leads to an accumulation of toxic chemicals in the blood harmful to the baby’s normal development. If the condition remains undetected and untreated at birth, it can cause mental retardation or death in the baby. It is extremely difficult or next to impossible to pick up clinical signs or symptoms of these conditions in the newborn period and by the time they become apparent to the parents or the treating clinician it is usually too late. IEM screens newborns for about 40 disorders and if tested positive in quite a few instances the line of treatment is inexpensive involving dietary modifications or adding trace vitamins and hormones.

Almost all developed countries across the world have implemented universal newborn screening programs which have been tailor made to suit their needs and budget. Some countries screen babies for 40 different conditions whereas some screen them for 5-6 conditions only, based on local prevalence of these conditions and economic restraints. The Newborn Metabolic Screen is an ideal screening test because it is accurate, easily accepted by parents (only 4 drops of blood from the baby’s heel), can be easily performed by a health worker (does not need a doctor) and most important - diagnoses the condition before onset of clinical signs!

Although it is known as metabolic screen, the same test can also diagnose other conditions such as congenital hypothyroidism, G6PD deficiency, Congenital adrenal hyperplasia and other diseases which are not classified as metabolic conditions but have similar consequences, if not diagnosed and treated early in life. These conditions are much more common than the IEM, for example congenital hypothyroidism alone affects 1 in 1500 babies. The importance of diagnosing this condition as early as possible cannot be stressed, since if this condition is detected at birth, it can be completely treated by thyroxine replacement (inexpensive). If this condition goes undiagnosed after birth, the child is almost always going to have problems with their mental development.

The process of diagnosing all these 40 different conditions can be screened using only a few drops of blood, obtained by pricking the baby’s heel. After the infant’s heel is pricked the drop of blood that forms is placed on a special filter paper and allowed to dry. Once it is dried, it is sent to the lab for testing.

Parents who are healthy or have already had healthy children, don’t expect any problems and they are almost always right. Since these disorders are not very common, the chances are excellent that your child may NOT have one of these disorders. However, the few children who are born with these problems are generally from healthy families. Most babies born with these conditions are healthy at birth and signs of ill health may become apparent only after a few days to few months after birth, depending upon the underlying conditions. By screening every baby after birth, we can be sure that each infant who has a disorder can be identified and started on early treatment. The NMS goes a long way in addressing the basic medical philosophy of prevention is the best available treatment.

Though mothers have been breast feeding for centuries, problems may crop up. A paediatrician can sort them out for you.

Your baby is born and you are looking forward to bonding with her. And of course, you want to start your baby on what’s best for her: your own milk. However, breast feeding doesn’t always work out easily. Some mothers may have a problem with breast feeding right from the start, while others may develop one after some time. You may be caught in that difficult choice between your own milk and formula, which ever doctor and parent wants to avoid. One of the most common reasons for the failure to initiate or maintain breast feeding is maternal anxiety and stress. Like most of our body functions, the milk moms produce too depends on having both a healthy body and a happy mind. Being aware of common breast feeding problems and their solutions will ensure that your baby gets a good feed each time.

You’re not making enough milk for the baby

If your body is not producing enough milk, your baby may not get the amount she needs for optimum growth.

An average newborn needs about 300 to 500 ml of milk daily. Though this cannot be measured when breast feeding, you can make out by the fact that your breasts are not completely full between feeds, your baby cries and is restless between feeds, your baby doesn’t pass enough pee and poop, and seems lethargic.

The possible causes of these problems are maternal anxiety, stress, a premature breast feed, lack of awareness about the right feeding techniques, fear and false beliefs that breast feeding will be bad for your figure, and the convenience of bottle feeding formula to your child may be a few of the causes of poor milk production and let-down.

Being aware of breast feeding during pregnancy itself can go a long way in having a normal milk supply. You can learn proper techniques and good latching positions for the baby from your paediatrician or neonatologist. Having someone to help with the breast feeding for the first few days, staying relaxed, eating balanced meals and sleeping enough will all help in having a good supply of your own milk for your baby.

You’re producing too much milk for your baby

Some mother produce so much milk that it tends to leak out in between feeds too.

Too much milk can make many babies struggle to handle the excess milk, and they often tend to choke. Since their swallowing mechanisms are weak, premature and low-birth-weight babies are more prone to choking than normal bewborns.

There is no one cause for this situation: its an individual variation.

What you can do: Use good breast feeding techniques: Hold and compress your breast to control the excessive flow, and keep the baby’s head higher than the rest of the body. Express excess milk between feeds and avoid feeding while lying down. As the baby grows older, the capacity to suckle and swallow large quantities of milk will improve, and the problem will go away within a few weeks.

Your nipples feel sore

Many mothers. especially those with babies who breast feed vigorously, complain of sore or cracked nipples. It can be quite painful and obstruct proper feeding.

As the baby feeds, many parts of the nipple which are stuck to the underlying tissues get stretched and stressed, resulting in blisters, cuts or soreness. In the case of open cuts, the baby tends to swallow a little blood along with the milk. Though not dangerous in itself, this can irritate the baby’s stomach, making her vomit the blood, which may frighten a new mother.

Most often, this is due to the tenderness of the skin in the nipple and breast area, along with the wetness, friction, and vigorous sucking action of the baby.

To avoid such a situation, keep the breasts and nipples as clean and dry as possible between feeds. Applying nontoxic nipple creams, which basically contain lanolin, between feeds helps to heal the soreness. Do wash off the cream before breast feeding or its taste may make your baby reject your milk. Applying breast milk to the sore nipples and letting it dry also helps. You could use a nipple shield, or express milk and feed it to your baby from a boggle or with a spoon. Using as breast pump helps to pull the nipples out gently.

You have ‘inverted nipples’ and find it hard to breast feed

In many women, nipples are not projecting, but flat; in some they turn inwards and are embedded in the breast tissue.

Your baby cannot get a grip on flat or inverted nipples and you struggle to breast feed. As the breast gets more and more filled up with milk, the nipples tend to get more buried in the breast. Some mothers may have one inverted and one normal nipple.

The possible causes: Its congenital: Many women are born and grow up with this condition. Using breat shells or caps during and after pregnancy helps to push back the breast tissue and release the nipples forward. Breast pumps and manual stimulation - by stretching the base of the nipples, or holding the nipples between the forefinger and thumb and pulling it out gently, or pulling the back of the breast tissue as the baby latches on - may help in varying degrees. In many cases, however, the nipples remain stubbornly embedded, and you may have to use a shield or a pump to express the milk. Luckily, many babies learn to take a big chunk of the breast in the mouth, rather than just the nipple.

You’re not sure what to eat while you’re breast feeding

One common question that nearly all mothers ask is - What should my diet be when I’m feeding my baby?

The anxiety that whatever you eat will mix up with your breast milk and find its way to your baby.

Most of the raw material that is needed for milk production has already been stored by the mother during the nine months of pregnancy. However, there are many myths and misconceptions about what the mother should and should not eat.

The simplest advice for the mother is that she should eat a normal balanced diet, without overeating or under eating any food. Very few foods are known to affect the baby adversely: The list includes an excess of coffee, tea, chocolates and colas besides alcohol. You should drink plenty of water and include enough calcium, iron and vitamins in your diet. Try not to eat out too often. The world over, the diets of mothers are very varied: there isn’t any single prescribed diet for the new mother.

You are uncertain about taking medication

Taking medication while breast feeding can make a new mother anxious, for fear that the medicine might be secreted in the breast milk while breast feeding.

Mothers who are sick either don’t take the necessary medicines and suffer, or they stop breast feeding for a while, assuming that it is dangerous for the baby. Mothers know that medicines are chemicals that can get secreted into the breast milk, causing temporary or permanent harm to their babies.

While most common medications that are used to treat colds, coughs, fever, stomach upsets, headaches and simple infections are harmless to the baby, its advisable to consult your paediatrician before taking them. Certain categories of medicines, like those used to treat severe infections like malaria or typhoid, should be strictly avoided.

Your breasts are engorged

It is the initial few days of breast feeding and your breasts feel swollen, tender, lumpy and uncomfortably full. Engorgement is the overfilling of the breast with milk. This is very common when you start or stop breast feeding - and it is painful. You may have temperature too. Sometimes the swelling extends all the way to the armpit. In rare cases, this can lead to mastitis, plugged ducts and abscess.

Engorgement is usually the result of an imbalance between how much milk the mother produces and how much of it the baby consumes. This normally occurs in the early days after birth, when the baby is not feeding well or emptying the breast well. It can also be because the baby is not latching on properly, or inverted nipples are preventing her from doing so. It can also happen if the baby is premature or low-birth-weight, or sick, and doesn’t suckle well. Waiting too long after the baby is born to breast feed, feeding incompletely, bottle-feeding between breast feeding or skipping feeds are common issues.

To avoid breast engorgement, once the baby is born, start breast feeding as soon as possible. The baby should be made to latch on well, and empty both breasts during feeding. If not, you should empty out the breasts in between feedings, either manually or with a pump. This is usually a temporary problem and once the baby is feeding frequently and effectively, it will pass. Warm packs, massaging and mild anti-inflammatory medicines help to prevent engorgement and the discomfort it causes.

Your breasts are inflamed

Mastitis is inflamation of the breast tissue and may quickly develop into an infection. It is common in the first two or three weeks after the baby is born.

Mothers with mastitis have heaviness, redness, swelling, and sever pain, usually in one breast and with an accompanying fever. The milk from the affected breast may become thicker, saltier, and may be stained or mixed with blood or pus, making it difficult for the baby to feed. Mastitis can also lead to the formation of a big pus pocket or abscess in the breast.

The most likely reson for this inflammation is plugged ducts or engorgement. Lack of local hygiene and cracked or sore ipples may be the starting point. Pressure from clothes, breast pads, nipple shields, sleeping in a prone position and infrequent feeding may all contribute to mastitis. In some cases the infection may be caused by bacteria.

To avoid breast inflammation, wear loose clothing and empty the breasts in between feeds, to prevent congestion. Consult a doctor at the first sign of redness or pain: Your doctor my prescribe painkillers, anti-inflammatory medicines, antibiotics or surgical intervention, depending on the severity of the condition. Using a hot compress or dipping the affected breast in a bowl of warm water and Epsom salt, and taking frequent hot showers will help. You can feed the baby, but it is likely to be very painful.

Your milk ducts are blocked

If you find a painful, swollen, hard lump in your breast, sometimes with a red and inflamed patch on the skin near the lump, it may be a plugged milk duct. That means a tube that carries the breast milk may be blocked.

A plugged milk duct may occur when a hole in the nipple or a tube deeper in the breast tissue gets blocked. With time, redness and pain can set in. The discomfort is at its worst before feeding and reduces on feeding. Occasionally, fever may develop; it might eventually end up in mastitis and a breast abscess. A plugged duct may lead to decreased milk output from the affected breast. It may also change the character of the milk due to pus formation and release of certain chemicals due to the inflammation.

Most often, a plugged duct results from engorgement, infrequent feeding, pressure from a nipple shield, tight clothing or sleeping in a prone position. Inflammations and infections of the skin around the nipple can also be a starting point for plugged ducts.

The treatment is similar to that for mastitis: Frequent feedings, hot compresses, soaks, massages, rest and in rare cases, anti-inflammatory medicines and antibiotics. Manual expression of excess milk also keeps the ducts open.

You have thrush

Thrush is a fungal or yeast infection in the breast that is passed on to the baby. This fungal infection of the breast and surrounding areas is caused by a fungus called Candida. It makes your nipples feel sore and itchy. Breast and nipple thrush may be a part of thrush in other areas of the body.

Fungal infections are common in tropical climates and when breast hygiene is poor. Heavy antibiotic usage by the mother during and after the baby is born ( true of C-sec deliveries) can also cause them. The use of breast pads, cups and tight clothing also aggravate them.

To avoid thrush, Take your doctor’s advice: The mother may need anti-fungal medicines and the baby too may need to be treated for oral thrush with child-safe anti-fungal lotions to prevent the spread of infection back and forth. Keep your breasts and nipples clean and dry. Vitamins and probiotic supplements may also help.

Antenatal care is the care that you receive from health professionals during your pregnancy. A healthy diet and lifestyle during pregnancy is important for the development of a healthy baby and may have long-term beneficial effects on the health of the child. It is also important for a pregnant woman to have regular checks with an obstetrician throughout pregnancy, to ensure that any conditions that may pose a risk to you or the baby’s health can be identified and treated. Regular antenatal care is important to ensure that both you and your baby are well.

The major goal of focused antenatal care is to help:

• Identification of pre-existing health conditions.
• Early detection of complications arising during the pregnancy.
• Health promotion and disease prevention.
• Lifestyle management counseling.
• Preparation for birth and possible complications.

A good antenatal care program should be designed in such a way that it detects problems of pregnancy that might need treatment - such as anemia, infection, vaginal bleeding, hypertensive disorders of pregnancy and abnormal fetal growth. It should also incorporate a comprehensive screening program to detect fetal anomalies such as heart and brain defects and also screen for conditions such as Downs Syndrome. Hence it is important to have regular ultrasound scans done by ultrasonologists specially trained in fetal medicine. The program should also incorporate a multidisciplinary team involving an Obstetrician, Ultrasonologist and a Neonatologist so that the results of the screening tests can be discussed and appropriate actions taken when necessary. Oxford Medical Publication’s book A Guide to Effective Care in Pregnancy and Childbirth is a complete guide to take best care of your life, ensure the best for you and your unborn child.

Counseling and health promotion is a very important but often forgotten aspect of antenatal care. Counseling should begin as early as possible and in fact preconception counseling should be offered at all maternity centers where women wanting to conceive are advised about the importance of taking folic acid to prevent congenital anomalies. Preconception counseling should also include providing information leaflets about the Do’s and Dont’s of pregnancy, especially during the immediate period following conception. For example women should be advised not to take Vitamin supplements and medications without consulting their doctor during the first trimester since it can result in malformation of the heart and nervous system.

Following conception it is very important to discuss with the obstetrician about lifestyle habits such as exercise, smoking, alcohol and any medications that may affect your developing fetus.

In addition to the above a good antenatal care program should involve the services of a dietitian and physiotherapist. The importance of a healthy, nutritious diet in pregnancy cannot be stressed more "A nutritious and wholesome diet is the key to a healthy baby ". You should make it a point to spend time with the dietitian to tailor make a diet that is healthy but also acceptable to you.

A value add to any antenatal care package would be a child birth instructor who would be able to explain to you what happens during labor and birth and also teaches you exercises to keep you fit during pregnancy and help you during labor. Out of many books I read when I was first pregnant, I remember a very good book The Baby Care Book: A Complete Guide from Birth to 12-Month Old by famous Jeremy Friedman, helped me take initial precautions and prepare for the little one. The book gave me a clear picture of what to expect at the time of delivery and how to take care of the child after birth.

Finally, it’s always useful if your antenatal classes are held in the hospital where you would be delivering your baby. It gives you a chance to familiarize yourself with the surroundings so that when you arrive for the delivery, you do not feel out of place. It also gives you a chance to visit the labor ward as well as the other medical facilities in the hospital such as the nursery.

Pregnancy is an important time of your life, ensure the best for you and your unborn child by availing good and safe antenatal care during this period. I think good antenatal care is not an option but a basic necessity to ensure a bright future for your child.