Monday January 20 2014

Why these simple tests are crucial for your child at birth


By Sarah Tumwebaze

In Uganda, many babies die in the first month of their life. Some die from causes that cannot be prevented while others die from conditions that would have been easily treated had they been detected early enough. That is why when a baby is born, the midwife or doctor who helped you to give birth conducts a physical examination on the baby.
These examinations will continue up to when the child is at least three months old.

Why examinations are done?
Dr Joseph Sseremba a paediatrician with Sseremba Medical Centre in Kampala says examinations are carried out to help detect any condition that the baby may have been born with, but also give an opportunity for the health workers to administer treatment before the ailment causes harm.

When are the tests done?
Dr Sseremba says tests on a new born baby are carried out at different stages. He explains that the first examination is carried out as soon as the baby comes out of the mother’s womb. “During this examination, we check the baby’s breath, skin colour, heart beat rate, reflex response and muscle tone. Each of these is rated out of two, to make a total of 10.”
He adds, “When a baby scores above seven, they are considered to be okay but if they score anything below five, it means they have a problem.”
Dr Sseremba further explains that the next examination is performed before the baby is discharged (between 24 to 48 hours after birth).
He says this examination involves checking the whole body for congenital abnormalities. “The doctors examine the baby from head to toe. This same examination is repeated at six weeks and at 10 weeks.”

Dr Henry Bukenya a general practitioner at Mulago National Referral Hospital says, “When examining the head, we look at its size, if it is swollen, this is an indicator that the child has hydrocephalus (water content in the head).”
Dr Bukenya explains that in this case, an electrolyte test and scan are recommended. “The results from these two will help us to determine the cause of the hydrocephalus and the kind of treatment that will be given to the baby.”
Dr Sseremba adds that they also look out for injuries to the head during birth.

According to Dr Bukenya, after checking the head, the baby’s eyes are examined. He explains that if the baby’s eyes present with yellowish colour, also referred to as jaundice, and if they fail to clear after a few weeks, doctors will recommend a liver test.
He explains, “This yellowish colour is normally produced when the liver breaks down old red blood cells. But when it happens in neonates and fails to clear after a few days, it could be an indicator of a problem with the liver which is why we recommend further tests.”

This is a crucial organ which should also be examined at birth.
Dr Bukenya explains that the normal colour of the tongue is pink. However, in some newborns, it might present in a purple colour and with a white layer on the top.
“If this happens, it means that the child was distressed (got tired) during birth and they will need extra observation. At times it is a sign of excessive proteins in the body. It can also be a sign of dehydration and malnutrition in newborns who are more than one week old,” explains Dr Bukenya.

Baby’s skin
After examining the head, the doctor or nurse attending to the baby must check the skin. Dr Bukenya says skin examination involves looking out for the yellowish and blue colour-plus scaling
Dr Bukenya explains, “If the yellow component does not clear after a few days, we still conduct a liver test and if the skin is scaling, we recommend that the mother feeds well so that the baby gets enough fluids and nutrients in their body. At times, the scaling is as a result of malnutrition and dehydration.”
Dr Sseremba adds that if the baby appears to be blue, it means they have a low supply of oxygen and therefore will need to be put on oxygen.
Dr Sseremba says the baby’s skin should also be pressed to check its tone. If it appears to be swollen, it is a sign of eodema (an abnormal accumulation of fluids in the body). This, he reveals may require that the newborn does a renal (kidney) test to rule out the swelling is a result of a poor functioning kidney.

Weight measurement is another crucial element in determining the health and wellbeing of a baby at birth. Dr Bukenya says any new born baby that is more than 5.5 kilogrammes is recommended to have a diabetes test and a random blood sugar test. “These tests will help to rule out cases of diabetes and obesity,” he explains.

The chest
Dr Sseremba says in this case, they are checking for the baby’s heart beat and the way they are breathing. “A stethoscope is used to listen to these two and if the heart beat is either very fast or slow and the baby is not breathing smoothly, they are taken to the Special Care Unit for closer observation until they stabilise. But if the condition persists, we recommend further tests for the heart.”

After the chest, the abdomen is examined for any kind of swelling which might either be the spline or liver.

Other tests
Dr Sseremba says the genitals are also checked for any abnormities. “We also check the legs, feet, hips and other joints for any kind of either congenital or physical damage which might have occurred at delivery.”

Baby’s cry
According to Dr Sseremba, it is important that a baby cries the moment they are born. “This opens up their lungs and allows them to breathe easily. But if they fail, it means they are distressed and some of them are even resuscitated.”
However Dr Bukenya says after the first incidence, the baby is expected to cry once in a while, and if they cry restlessly and persistently, it could be a result of other injuries to the body and therefore a thorough examination is carried out.

If you give birth from home...
While it is recommended that every mother gives birth in a health facility, there are cases where some do not for various reasons.
In such a case, Dr Asuman Lukwago, from Ministry of Healthy says they should ensure to go to the health facility as soon as possible.
“This is because you cannot get the needed care for a mother and a new born at home. So immediately after giving birth, you should go to hospital for a thorough checkup of the mother and baby.”

Hospital ability to screen newborns
Dr Lukwago says nurses and midwifes are trained to carry out physical examination on newborns, but if after examination the baby needs to go for further tests, different hospitals have varying capacities on how they can manage such a situation.
“At health centres where we have doctors, they can help but if they realise that the condition is more than they can handle, they normally refer such a baby to a paediatrician who are normally at the level of the regional referral hospitals,” explains Dr Lukwago.
He adds that regional referral hospitals have the capacity to conduct all the needed tests. Dr Sseremba also advises that mothers should always be observant of their babies.
“If you notice something abnormal about the baby, immediately inform the doctors and avoid medicating the child without a doctor’s prescription.”

Dcotor’s advise
Besides the tests that are carried out, doctors also offer tips on keeping the baby safe. Always make your baby sleep on the stomach or on the side because when they lie on the back, they can easily choke and vomit.
Keep the baby warm (with a cotton bed sheet when it is hot and a blanket when it is cold) because they also feel hot just like adults.
Over covering will make them uncomfortable and they will start crying. At times they might even get a fever. Do not cover the baby’s head when they are sleeping. They can easily suffocate. If you are going to use a baby mat, put it under a bed sheet and tuck it in well enough so that even when the baby turns, they will not cover their face with the mat.
Do not make babies sleep on pillows. But if you must, put the pillow under the mattress.
With these tips, you will be able to deal with any complications before they become serious and life-threatening.

One mother’s experience

At two weeks, babies will have adjusted to the outside world, and beside the colic that bothers them or makes them cry, they are calm and quiet most of the time. But if they continue to feel uneasy, it could be because of other hidden causes. This was the case for Viola (not real name). At two weeks, her baby was weak and not lively. “She used to cry all the time. At some point we got tired of carrying her because the crying was too much,” she explains.
She adds: “My mother became suspicious so we took her to hospital for a general body examination.” She explains that results from the examination showed that the baby had a heart problem.

“Doctors at the hospital put her on treatment as they waited for her to make one year which was said to be the right age for the surgery. “Our family used this period to raise the Shs31m which was needed for the open heart surgery in the United Kingdom (UK).” At one year and two months, the baby had the operation. She is now two years and six months and is doing well.