Newborn Screenings

Curious what tests newborns need while they are in the hospital?  There are three mandatory tests that will be performed on every newborn before they are discharged home from the hospital.  Also, depending on the size of your baby at birth additional testing may be indicated. 

Every baby in the state of Washington will have a Newborn Screening test submitted while in the hospital.   Each state in our country has something similar but some states will test for different things.  The process is simple. Someone from the lab will come and poke your baby’s heel to collect a small amount of blood for this test. Want to know more?  Here is a link to the WA State Department of Health site for parents:  

Every baby will get a test for bilirubin.  This is a measure of jaundice.  The initial test is done by placing a meter on their forehead and can get a reading from their skin.  This is quick and painless for the infant.  If the level is on the high side your Pediatric provider may request that an additional blood test be sent.   Jaundice is something that occurs in all infants.  While many babies will only need testing few will require treatment with phototherapy. There is no specific number or value that is acceptable.  The number that requires an infant to be treated is calculated on both their gestational age at birth and the hours of age at the time of the lab sampling.

Every baby will have a CHD or Congenital Heart Disease screen test prior to discharge from Overlake hospital.  This is a quick and painless test for the infant.  The test is performed with a pulse oximeter and is able to evaluate the amount of oxygen in the infants blood.  Low levels are a signal that the infant may need further evaluation for a potential heart defect.

 Babies born to women who were diabetic during pregnancy or babies who are smaller or larger than expected for their gestational age at birth are at risk for hypoglycemia, also known as low blood sugar.  Short term hypoglycemia is unlikely to cause the infant long term damage but prolonged and profound hypoglycemia can put infants at risk for brain injury.  Because the possibility of brain injury exists hypoglycemia is taken very seriously.  Most infants can be treated with a small amount of supplemental formula and are then able to keep their blood glucose level in a safe range.  If that treatment is unsuccessful then the infant may require admission to the NICU (newborn intensive care unit) for intravenous fluids.

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Save the Date! NICU Reunion

The NICU staff is actively preparing for Overlake Medical Center’s second annual NICU Reunion.  This celebration will be held on September 7, 2014 from 1 – 4:30 p.m. in the PACCAR Education Center.  There will be activities for all ages and light refreshments.  We hope to see a lot of our graduates and their families. Invitations to this event will be mailed out in early August – so be sure to check your mailbox.  If you haven’t received one please call the unit so we can make sure we get one to you.  Looking forward to seeing you in September!

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Food Safety for Moms-to-Be

Did you know that a woman who is pregnant is in a high-risk group for foodborne illness? That’s because her immune system is altered during this time, so it’s harder for her body to fight off certain harmful foodborne microorganisms that can affect her and/or her developing baby. FDA’s targeted program — Food Safety for Moms-to-Be — is newly updated for 2014 and includes a wealth of materials for educating this special audience. The program features such topics and tips as:

  • Follow the Four Simple Steps to Food Safety. During pregnancy, it’s especially important to be diligent with all of these actions: Clean — wash hands and surfaces often; Separate — don’t cross-contaminate; Cook — cook to proper temperatures; and Chill — refrigerate foods promptly.  
  • Be mindful of methylmercury. Methylmercury is a metal that can be found in fish, including swordfish, tilefish, king mackerel and shark. If eaten by a pregnant women, the methylmercury in these fish can be harmful to her unborn baby. So, while fish is an important part of an overall healthful diet, pregnant women should avoid eating those certain types of fish.
  • Prevent listeriosis. This infection is caused by Listeria monocytogenes — a harmful bacterium that can be found in foods made from unpasteurized (raw) milk; refrigerated, ready-to-eat foods; and contaminated fresh fruits and vegetables. Prompt refrigeration at 40° F or below is critical for preventing listeriosis, as is discarding any food left at room temperature for more than two hours (and following the Four Steps named above).  
  • Avoid Toxoplasma gondii. This parasite is found in raw or undercooked meat, unwashed produce, contaminated water, soil, and dirty cat–litter boxes. If ingested, it can cause toxoplasmosis and harm a woman or her baby. Pregnant women can help prevent this dangerous infection by following the Four Steps and by avoiding drinking untreated water and not touching cat litter while pregnant.  

Online Resource:

Download the Food Safety for Moms-to-Be program and share the handout materials with women in your community. All materials are available in both English and Spanish.

Reference/Resource: U.S. Food and Drug Administration

 

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Coming Soon to Overlake’s Women’s Clinic: Overlake Mother’s Milk Depot

Human milk is the best nutrition for all babies, including preterm babies. Studies showing strong clinical benefits and recommendations by many health organizations have prompted a growing number of hospitals to provide pasteurized donor human milk for premature infants when mother’s own milk is not available. As highlighted in a previous blog, Overlake is among those hospitals. 

What is a milk depot?

A milk depot is a controlled collection point where healthy, lactating women can donate their surplus breast milk for premature babies. The milk collection, shipping, processing and distribution are overseen, with strict guidelines, by the Human Milk Banking Association of North America, an organization consisting of many banks and collection depots. Our depot will have a partnership with the Mother’s Milk Bank of Colorado who will provide necessary screening and blood testing at no cost to donating moms.

How does the process work?

Moms who have been screened and accepted as prospective donors can come to Overlake Women’s Clinic to drop off their frozen breast milk and have blood work done at our outpatient lab. The milk is temporarily stored in a deep freezer and soon shipped to Mother’s Milk Bank of Colorado for processing along with blood samples. Busy, nursing moms are spared the task of packaging and shipping their donated milk.

What happens after the drop off?

Mother’s Milk Bank of Colorado performs testing on mailed blood samples to assure donors meet criteria (much like testing for blood donation). Milk that is safe for use is then pasteurized, cultured after pasteurization to assure no contamination from processing, and frozen in 2 and 4 oz bottles for shipment to hospital neonatal intensive care units.

Why?

Donating breast milk is a true labor of love that can provide life-saving nutrition and immune support to fragile, premature babies. In the US, there is a critical shortage of donor human milk and we hope, by opening Overlake’s depot, to remove some of the barriers from the process and make it more convenient for moms to donate their precious gift. Last year, Overlake’s NICU used over 1000 oz of donor human milk to help critically ill premature babies. Milk banks depend on “drop off” milk depots to meet the growing demand for donor human milk and only milk from a HMBANA milk bank can safely be given to preterm infants in the hospital.

For more information on how you can become a milk donor, call 425-635-6150.

 

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Success! March for Babies 2014

A HUGE thank you to everyone who participated in this year’s March for Babies on May 3 at the Seattle Center.  So far, Overlake has raised $15,981 – ranking third in the list of Top 10 company teams.

You can still donate by going to one of our department pages:

 

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Are you a new mother? Join us!

Our After Baby Comes Groups offer new moms a caring environment to grow more confident and comfortable in their new role while building relationships with other moms.

Available Groups: 10:30 a.m. and 1 p.m. on Thursdays. This group is for mothers with babies 0-3 months of age. On Wednesdays at 11 a.m., we offer a group for mothers with babies 3-6 months of age.

Sign up today: www.overlakehospital.org/classes — click the Parenting category.

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Hand Expression: Tips For Increasing Milk Supply

Research is showing that hand expression helps increase milk supply in mothers who are dependent on the pump to bring in their breast milk. A low milk supply is the most common reason for mothers to stop breastfeeding. We have learned that what we do (or do not do) in the first 3 days after delivery can have a major impact on future milk production potential. Research has found that milk production in pump-dependent mothers of preterm babies depended on the frequency they used hand expression in the first 3 days after delivery.

Mothers who used hand expression more than 5 times a day in the first 3 days, yet pumped with the same frequency as other study mothers, expressed an average of 955 mls, about a quart a day by 8 weeks. This is more than a term 4 month old would need. Mothers also found consistent increases in production when they did not rely solely on pump suction alone to remove milk, but used “hands-on pumping”. This technique combines breast massage, compression and hand expression with electric pumping and does not require more time than simple pumping. By the end of the study, these women were producing 45 percent more milk than women who used hand expression fewer than twice a day during the first three postpartum days.

For mothers of term and late preterm babies, there is an important role for an alternative way to remove colostrum when the infant has not yet learned to latch on and nurse effectively.  Occasionally, mothers can have difficulty getting their baby to latch in the first day. Hand expression is one way to continue to remove breastmilk and give it to baby even if mother and baby are still working on latching well.

Make sure you ask a nurse to show you how to hand express and incorporate this into your pumping routine. If you would like to watch a video of hand expression, Stanford University School of Medicine has an excellent video teaching hand expression located at this link:

http://newborns.stanford.edu/Breastfeeding/HandExpression.html

(All research study information and statistics taken from “Lactation Matters: Official Blog of the International Lactation Consultant Association”)

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Join us! March for Babies

March for Babies Walk sponsored by the March of Dimes will take place on Saturday, May 3, 2014.  The Childbirth Center has four teams: MBU, L&D, NICU and Women’s Clinic.  We would love to have staff, family, friends and former patients join us on this 3 mile walk.  This fundraiser provides money for treatment and research for the very tiniest of infants.

If you would like to join a team just go to the marchforbabies.org website and register.  Should you join a Overlake Childbirth Center team by April 4, you will receive one of our hot pink t-shirts “We walk for future generations!”  Our goal is  100 walkers between the four teams, so please consider walking with us.

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Who are all these people?

You have waited months for the birth of your new baby.  Finally, the laboring process has begun and you are being coached by your labor and delivery  team, your obstetrician or midwife.  They are all there to assist you and welcome your new baby into the world and as such you may become quite bonded with them.

As the birth nears additional team members may appear who haven’t been through the labor process with you.  You may be suddenly thinking, “Where did all these people come from?”  “Who are they?”  The labor and delivery team is continually monitoring your baby and as such may feel it necessary to have additional team members present.  These new members’ primary responsibility is for the care of for your newborn infant once he/she is born.  Depending on the circumstances one or multiple people may make up this neonatal team.

The neonatal team can consist of several members; a neonatal nurse practitioner, a registered nurse and/or a respiratory therapist.  Their sole responsibility is to support and monitor your baby in those first few minutes after birth.  As your newborn successfully transitions from birth the neonatal team will return care of your baby to you and the labor and delivery staff.

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A change in the standard fetal karyotype: News from Maternal Fetal Medicine

The most recent widespread advance in the genetic evaluation of the fetus is the introduction of micro arrays for whole genome evaluation.  Think of microarray analysis as a high definition image of the chromosome, compared to a traditional karyotype, which is more like a blurry web cam image.

Traditional prenatal diagnosis uses amniotic fluid or placental villi to grow fetal cells, then stain and count fetal chromosomes. This allows the diagnosis of numerical disparities or gross abnormalities of chromosomes, the most common of which is trisomy 21 (Down syndrome).

Microarray analysis starts the same way, with some form of fetal tissue, such as cells from an amniocentesis or CVS. Rather than just staining and counting, however, the microarray technique takes the fetal DNA and cuts it into small pieces, which are then matched to small standard sequences arranged on a microchip (the array). Pieces that don’t match are abnormal, and thus abnormal sequences or deletions and duplications of the DNA can be identified, in addition to confirming the correct number of chromosomes. These deletions and duplications would not be detected by traditional karyotyping and are not related to maternal age. In addition, because microarray analysis does not require growing and dividing cells it is more reliable than karyotype in cases of stillbirth.

Micro-deletions and duplications account for up to 15% of human genetic disease.  Both the American College of Obstetricians and the Society for Maternal Fetal Medicine now recommend that microarray analysis replace traditional karyotyping for cases of fetal abnormality seen on ultrasound, and suggest that it has merit even in the normal appearing baby having an amniocentesis for other reasons. Studies have shown that babies with abnormalities on ultrasound with a normal karyotype have clinically significant microarray abnormalities in about 6% of cases. In addition, about 1-2% of babies with a normal ultrasound and normal karyotype can have an abnormal microarray analysis (“The use of chromosomal microarray analysis in prenatal diagnosis”. Committee Opinion No. 581. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:1374–7).

For this reason, Eastside Maternal Fetal Medicine has now transitioned to using FISH and microarray analysis in replacement of FISH and karyotype for all fetal chromosome analysis. In most cases the patient’s insurance will cover this in the same fashion as a traditional karyotype.

Like all new technology, there are occasions when information found can be confusing or of uncertain significance. We have dedicated genetic counselors that are happy to help providers and families navigate these issues.

For patients and their families who are interested in hearing more about prenatal screening and prenatal testing options, Eastside Maternal Fetal Medicine is planning to offer monthly free classes.  Contact our genetic counselor Claire Clark at claire.clark@integratedgenetics.com for further details. Patients can call our front desk to register for these classes at 425 688 8111.

The ACOG committee opinion is available here: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Genetics/The_Use_of_Chromosomal_Microarray_Analysis_in_Prenatal_Diagnosis

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