Neonates and Infant

HEALTH SCREENING
A. Apgar Scoring
Apgar score was developed in 1952 by an anesthesiologist named Virginia Apgar.
Referred to as an acronym for: A- Appearance, P- Pulse, G- Grimace, A- Activity,
R Respiration. The very first test given to newborn
Criteria
Indicator
0
1
Appearance

Color

Pale or Blue Acrocyanosis

Totally pink
(body pink extremities blue)

Pulse

Heart rate

Absent

Grimace
Reflex irritability
Activity
Muscle tone
Respirations Respiratory effort

Less than 100

No response Grimace
Limp
Some flexion
Absent
Slow and regular

More than 100

Vigorous cry
Active movement
Good cry

B. Newborn Screening Tests

Nearly all babies will have a simple blood test to check for disorders that are not apparent immediately after
delivery.
Some of these disorders are genetic, metabolic, blood, or hormone-related.
A heel-prick is used to sample the baby's blood. The blood drops are collected in a small vial or on a special
paper. The blood is then sent for testing.

1. Phenylketonuria (PKU) -absence of enzyme needed to metabolize essential amino

acid phenylalanine; Guthrie blood test.
Sx:
2. Hypothyroidism -absence or deficiency of thyroid hormones; heel-stick blood sample.
Sx:
3. Sickle cell Anemia - A genetic disorder that the hemoglobin changes its shape into a banana shape. It is chronic &
lifelong problem. They commonly afflict African American race. As a rule: all babies born are required to be tested for
this illness
prior to discharge.
Sx:
C. MMDST- Metro Manila Developmental Screening Test Form
Generalized Assessment tool; measures the:
1. Personal-Social Sector
2. Fine Motor- Adaptive Sector
3. Language Sector
4. Gross Motor Sector
- From newborn to six months
HEALTH PROMOTION Guidelines for infants
1. Health Examination
Screening of newborns for hearing loss; follow-up at 3 months and early intervention by 6 months if appropriate.
At 2 weeks at 2, 4, 6, and 12 months
2. Protective Measure
Fluoride supplements if there is inadequate water fluoridation (less than 0.7 part per million).
Screening for tuberculosis, Screening for PKU & other metabolic conditions
Prompt attention for illnesses, Appropriate skin hygiene and clothing
Immunizations EPI

EPI Expanded Program Immunization

Main Objective of EPI Program
Reduce the morbidity and mortality rates of the seven EPI diseases
To reduce the incidence of neonatal tetanus by providing pregnant women with tetanus toxiod immunization.

Routine Immunization Schedule for Infants in the Philippines

Vaccine

Min. Age at
Ist dose

1. BCG

Birth or
anytime after
birth
6 weeks

2. DPT

No. of
doses

Min. interval Reason

bet. doses

Protects with TB, meningitis & other TB

infection

4 weeks

Reduces the chance of severe pertusis

3. OPV

6 weeks

4 weeks

Protect against polio

4. Hepa B

6 weeks

4 weeks

Reduces the chance of being infected by

Hepa B, Liver cirrhosis, & liver CA.

5.Measles

9 months

Protect against measles.

3. Infant Safety

Importance of supervision. Car seat, crib, playpen, bath, and home environment safety measures.

Feeding measures (e.g., avoid propping bottles). Providing toys with no small parts or sharp edges

Eliminate toxins in the environment (e.g., chemicals, radon, lead, mercury).

Use smoke and carbon monoxide (CO) detectors in home. * Chocking and chemical intoxication
4. Nutrition
Breast and bottle feeding techniques. Formula preparation
Feeding Schedule. Need for iron supplements at 4-6 months. Introduction of solid foods at 4-6 months
4 common breastfeeding position ( Football, lying down, cradling, across the lap)
* Breastfeeding and introduction of solid foods
5. Elimination
Stool: Meconium is the 1st stool of the newborn, normally up to 24 after birth.
Black, tarry, odorless and sticky. Transitional Stools- 2nd to 3rd day up
to 10th day. Greenish yellow, contain mucus and loose.
Urine: About 15 to 60 ml per day after birth. infant may urinate as often as 20
times a day. Neonates urine colorless, odorless & specific gravity of .008.
6. Rest and Sleep
Usual Sleep and rest patterns
Infants sleep as long as 22 h/day, or others as little as 10 -12 h/day.
at 4 months, most infant sleep thru the night & establish a daytime nap
At 1 year, they take 1-2 naps/day & sleeps about 14h of every 24h
7. Promoting Sensory Stimulation
Vision
Teach parents to make eye to eye contact with the infant to stimulate vision and to promote socialization
Infant enjoy mobiles and crib mirror
Photos of family members may be posted near the baby cribs.
Hearing
Infants toys should have soft, musical or cooing sounds.
An audiotape of family voices might be soothing reminder of their presence when they are not around.
Touch
Clothes should feel comfortable and diaper should always be dry.
Teach parents to handle the infant with assurance and with gentleness. Kangaroo hold promotes close physical
contact.
Taste
Infants turn away or spit out a taste they do not enjoy.
Urge parents to make a mealtime for fostering trust as well as supplying nutrients.
Solid foods may be introduced at 4-6 mos in the following sequence
1. Cereals, 2. fruits, 3. Vegetables, 4. meats,. Then eggs.
Smell
Infant smell accurately within 1-2 hours after birth
Infants draws back frown irritating smell and enjoys pleasant odors like that of the breast milk. Teach parents to
be alert to substances that cause sneezing when sprayed into the air.