Although your baby may look well after birth, there are screenings at 24 hours that can help identify that his/her health is on the right track or if any potential issues need to be addressed. Early detection and immediate treatment can prevent many disorders that may interfere with a newborn’s healthy development. In the United States, some tests are mandated by the state, therefore becoming the standard of care for better outcomes.
24-hour screenings include
· Weight
· Critical Congenital Heart Defect (CCHD)
· Bilirubin
· Blood Spot Screening
· Hearing
Weight
Baby will be undressed and placed safely on an infant scale, where the weight in grams and pounds will be captured. The 24-hour weight will be put into the electronic chart, where the weight loss will be calculated into a percentage. If the percentage is at 10 percent or greater, feedings will be monitored closely to ensure effectiveness and at this time, shorter durations between feeds (for both breastfed and formula fed infants) and supplementation (for breastfed only infants) may be encouraged to promote weight gain.
Critical Congenital Heart Defect (CCHD)
During this test, a small pulse oximeter is placed on the baby’s right hand and another pulse oximeter is placed on the right or left foot. These sensors are connected to a machine(s) at the same time to measure how much oxygen is in the baby’s blood. If the reading is ninety-four percent or lower or a difference greater than three points between the right hand and foot, this would be a fail and could suggest the possibility of a congenital heart defect.
When a failure happens, this test will be repeated to a maximum of up to three times, depending on the hospitals' policy. An ultrasound of the heart may be done along with a pediatric cardiologist (a physician who specializes in congenital heart defects) consult to determine if there is a condition that needs immediate attention during this hospital stay or follow up can be done in the cardiologists’ office after discharge.
Bilirubin
All newborns are screened for jaundice,a yellow color of the skin caused by elevated levels of bilirubin in the blood, by a transcutaneous bilirubin meter (TCB), total serum bilirubin (TSB), a collection of blood sent to the laboratory or both, depending on the hospitals' protocol.
To collect a blood specimen for this lab, a heel warmer will be placed on the baby’s right or left foot for three to five minutes to reduce discomfort during the procedure by increasing blood flow. Once the foot is warmed, the baby’s heel will be poked with a lancing device on the outer portion of either side of the heel and the collection of blood will be gathered in a small tube and sent to the laboratory for testing.
If the results of the TSB (total serum bilirubin) are high, a repeat TSB will be done per hospital protocol (usually rechecked in 12 hours or 36 hours of life). If levels continue to be high, Phototherapy (a type of light therapy used to treat jaundice in newborns) will likely start. This therapy will help by making it easier for the liver to break down and remove the bilirubin from baby’s blood by excretion in the urine and stool. Repeat bilirubin lab work will continue to determine duration of phototherapy in the hospital. Once discharge home is anticipated, you will contact baby’s pediatrician to follow up in one to two days.
Blood Spot Screening
Blood spot screening, also called newborn screening, looks for serious metabolic, genetic and developmental disorders (rare disorders) that might not be detected right away in a newborn baby. In the United States, most states have mandated this testing, however different states require different tests. But early detection is best, as certain metabolic disorders are treatable. This test requires a heel stick to obtain blood to be transferred to the blood spot card (which contains five circles to be filled with blood). Because this test is part of the 24-hour screening, the baby most likely will only need to be stuck once if good blood flow continues after obtaining blood for the bilirubin (as mentioned above).
The blood spot card will be checked to confirm all information required is filled out and then sent to the hospital laboratory, then sent to the department of human services. Once testing is completed, results will be sent to your baby’s pediatricians office where results can be discussed. If there are any abnormal results or if more blood is needed, the department of human services will contact you directly for further instructions.
Hearing
Hearing is generally done at the hospital before the baby is discharged to determine if there is hearing loss. Most times a hearing screen technician that is contracted through the hospital will administer the test, however in smaller, rural cities it might be your baby’s nurse. Soft headphones are placed over baby’s ears and gentle clicking sounds are played. This test will not harm your baby and can take anywhere from five to fifteen minutes.
Results will be given right away when test is completed. If your baby has a clear response in both ears, it is unlikely they have hearing loss and considered passed. If the testing does not show a clear response in one or both ears, it is then considered, “referred” and the hearing test will need to be repeated, whether in the hospital or outpatient. Your appointment will be scheduled prior to baby being discharged home.
Summary
Newborn 24-hour screenings are crucial for assessing a baby’s health and identifying potential issues. These screenings include:
Weight Assessment: Babies are weighed, and weight loss is calculated as a percentage. If weight loss exceeds 10%, feeding is closely monitored to promote weight gain.
Critical Congenital Heart Defect (CCHD) Test: A pulse oximeter measures oxygen levels in the blood. Low readings or significant differences between hand and foot readings could indicate a congenital heart defect, requiring further evaluation.
Bilirubin Screening: Newborns are checked for jaundice using a transcutaneous bilirubin meter (TCB) or total serum bilirubin (TSB) test. High bilirubin levels may require phototherapy.
Blood Spot Screening: This test looks for rare metabolic, genetic, and developmental disorders. Early detection is essential for better outcomes.
Sources:
Newborn Screening Tests
Newborn Screening for Critical Congenital Heart Defect (CCHD)
Jaundice in the Newborn
Infant with Loss of 10% Birth Weight
Newborn Screening Testing
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