 okay so welcome back to another video discussion that we will be having for today so again welcome back to my channel this is drummer adams and i hope that you will be enjoying your time learning today so again welcome back hello everyone so i hope everyone is doing fine so let's start and let's dig into our topic for today so this is actually a continuation of what we had yesterday what we had last time when we discussed the inborn inborn errors of metabolism and also the newborn screening so going back again to your ra 92 88 also known as your newborn screening act of 2004 let's move on to the different article sections that we will all be discussing today okay so for the information of everyone your ra 92 88 isn't this also known as the newborn screening act of 2004 so the main goal of this act is to promulgate a comprehensive policy in a national system for ensuring newborn screening so last time we discussed the importance of newborn screening and how crucial it is in the first um and during the first few days of your newborn so having said that here in the Philippines we actually have the national institute of health or the NIH which is the technical arm in the implementation of the newborn screening and other concerned partners so this is where the newborn screening reference center is actually located it's actually under under the under the supervision in administration of the university of the Philippines so when we are talking about the newborn screening act we will go through the different articles at the same time the different sections with regards to its implementation the nitty gritty and information and details when it comes to your newborn screening act of 2004 so the first one there is of course the general provision so as a parent or a legal guardian can actually refuse testing on the grounds of religious belief of course we do respect that and when we do that when we actually allow them to refuse this testing we actually give them a copy of refusal documentation which actually needed to be made out when the newborn's medical record is being collected so it's very important um even right now there's a lot of people who are considering themselves as anti-vaxxers so there are actually some um some individuals some couples so some really just believe or some belief let's just say that um some beliefs that actually doesn't um doesn't allow or doesn't favor these kinds of testing with regards to blood or with regards to newborn being um being tested dot young so it's very important it's very important when it comes to that because again everyone has a right of choice and everyone can actually go for it or okay they can just simply refuse about it so when it comes to the collection so the collection of specimen using your um using your your test card should be done after 24 hours of life but not later than three days so after 24 hours of life but not later than three days from the complete delivery so it's very important this is for for newborn delivered either cesarean or or normal birth that is actually considered to be um in a sense healthy healthy but still we still have to have them checked okay so a newborn place and nico may be exempted for the three-day rule or three-day requirement but should be tested within seven days of age within seven days of age and maybe you're wondering why is it crucial for us to actually have them tested um within three days or for some some newborn who are in the nico or the neonatal intensive care unit we're actually allowing up to seven days so it's very important because as you as you all know once that the newborn has been delivered much of the function of their body are already independent from the mother already so most of the metabolized they will be digesting it they will be metabolizing it on their own and if you have certain deficiencies and certain enzymes that will be a big problem for them that's the reason why we need to test them within three days or within seven days for newborn on the nico to avoid to avoid the irreversible consequences of those inborn errors of metabolism okay i hope that's clear so maybe some of you are asking how is it done so you do the newborn screening act first by collecting your sample using your filter card so what we usually do is to actually use the um heel prick method so we will be um collecting capillary blood at the from the heel of the baby so a few drops of blood are taken from the baby's heel and they will be blotted on a special absorbent filter paper which then become the specimen holder the blood is to be dried for four hours and would should be sent to the newborn screening center immediately so the thing that is you have to collect the blood properly and one thing that i want to mention is that when you collect blood in on on newborn you always use the planter surface of the heel the lateral side of the planter surface of the heel okay and i want to be very much familiar with the lateral side of the planter surface of the heel why the lat why the planter of course you cannot collect on the dorsal obviously you have to collect on the on the planter surface why not in the middle or why not on the medial on the medians on the yeah on the median side first reason is that in the on your in the middle although that is um although you can say that it's actually fleshy the thing there is that you might hit your calcania calcanius okay you might hit your calcanius and eventually would cause osteomyelitis okay osteomyelitis on the other hand you cannot also um prick on the median side because there is an artery that is near there okay there there is an artery near there so you also want don't want to hit the artery of the baby so again if you were asked what is the um what is the method used it's the cap it's the heel prick method it's the heel prick method and if they ask you to elaborate more regarding the um specimen site so if you already have studied your flibotomy you would actually go and actually go um go through the capillary extra the capillary um collection of your blood and for a newborn we do that on the again the lateral side of the planter surface of the heel so that is somewhere on your pinky down there so you will collect it there okay and again you have to dry that within four hours after collection before sending it to the nation the newborn the reference center for the newborn screening center okay so afterwards testing of sample will be performed by the accredited newborn screening center by the DOH NIH network so if there's a positive result result should be immediately released within 24 hours and if it is a negative result release could be results could be given out within seven working days after the um the national the newborn screening lab received your specimen and again all congenital metabolic disorder require a lifetime management and that's very important that's the reason why we want to we want to identify it early because some of the irreversible um consequences of your inborn errors of metabolism will not just be mental retardation but also death for the baby so again i hope everything is clear and i hope you will be going through it for you to understand it better okay so this is actually some of the again we talk about it your congenital hypothyroidism your congenital adrenal hyperplasia your galactosemia your phenylketinuria your g6pd deficiency or your glucose 6 um your your g6pd your maple seropurine disease as well and different effects and effects if not screened and effect if screened and manage properly so it's very important for us to to really take note of these things because it's crucial for your baby so where the effects if not screened as you can see most of them are actually severe mental retardation you would have death here for congenital hyperplasia for the galactosemia the baby can actually um immediately die or develop cataract again because of the deposition of your galactose on your brain on your liver or even into your eyes your phenylketinuria could also cause severe mental retardation for your g6pd like what i've mentioned a while back um in the last video i will link it also here so your g6pd your your g6pd is a very important enzyme why because um it's also is not just responsible with the um glycolysis but even in your um even in the prevention of your free radicals the oxidation of your red blood cells reason why again some would experience severe anemia aside from that we also have your kernicterus it's also related to your anemia okay it's also related to your anemia because when you have anemia when you have this g6pd it's an abnormal rbc those rbc would be isn't it what is the what is the um what is the lifespan of your rbc that is 120 days but because of g6pd deficiency there will be a premature rupture either intravascularly or extravascularly and those would now cause hemolysis within your um within the body eventually that will increase your bilirubin and kernicterus in a nutshell is the deposition of your delta bilirubin into your brain and that is deadly for the kit for the newborn so msud as you can see it will not even allow us uh the the newborn to thrive because it will die in just a short period of time aside from that we also have the effects and this is what we want to highlight more the effects of screen and manage well and as you can see all will be alive and all will be normal and that is how important your newborn screening is and i cannot overemphasize that because your newborn screening is really important in the prevention of in the prevention of irreversible effects or irreversible damages that would be caused by your inborn errors of metabolism i hope we are clear okay so the establishment of your your newborn screening centers depends on the overall demand in the country actually we have two nsc in louzon two in vizayas and one in mendenao as you can see we have in the northern louzon that is in mariano marcos memorial hospital and medical center i think that's that this one is in ilokos norte we also have one in hangless university foundation medical center the a u f in pampanga we also have oh so we actually have three in louzon already so no not just three so this is the one the the picture i'm showing you is actually a more updated picture so we also have the um nyh in your buyer by up manila and it is in tecno hub up ayala land we also have one in southern louzon in daniel mercado medical center we also have in vizayas in west vizaya state university and in the southern philippines medical center in mendenao so that is very important as you can see there there um if you're gonna look at the the bullets that we have here we also have future newborn screening centers one would also be um in mendenao an additional in the mendenao one also in your um maybe this one is in sebu and this one is in somewhere in albay so that is where um the future newborn screening centers will be established and it is again um very important to have this in our places so aside from that we also have the declaration of policy so the state in section two it states that the state shall protect and promote the right of health of the people including the rights of the children to survival and full healthy development as normal individuals so the state shall institutionalize a national newborn screening system that is first comprehensive integrative and sustainable so as you can see um as our population grows the need or the the demand of your newborn screening test would also increase therefore we also have to enhance and heighten up our um heighten our newborn screening centers as well and this are the these are some of the policies that we have to observe so let's go on to section three in discuss about the objectives of this law first is to ensure that newborn has access to newborn screening for certain heritable this conditions that can result in mental retardation serious health complications or even death death if left undetected and untreated aside from that we also have to establish um and integrate a sustainable newborn screening system within the public health delivery system so as you can see when we first discuss your newborn screening it's actually a public health concern okay it's a public health concern reason why we also have we also need to have a sustainable newborn screening system because as again saying again repeating it again as our population grows so is our um need for a newborn screening center so we also aim to ensure that all health practitioners are aware of the advantages of newborn screening and all of their respective responsibilities in offering newborns the opportunity to undergo newborn screening and of course again maybe this is one good um time to mention this as health practitioner and for you as if you're watching this in a your a student in the medical field med whether it is in your pre-med or in your medicine it's very important for you to be um promoters or promoters of different programs that would actually better the lives of our patients of our um fellow men because as you can see a lot of these things are actually very much preventable okay a lot of these things are very much preventable but again that Filipino mentality that they don't want to go and have themselves tested or they don't want to have their children tested because it's it's expensive this is that and that but if you're gonna think about it that for the information of everyone i'll be showing you later the prices of our newborn screening and it actually ranges from 500 to 1500 from the basic with the six and also the expanded so i am already spinning out the update that we have from six we already are testing or catering tests for around 22 um inborn errors of metabolism and imagine that from 500 to 1500 you can actually save your child's life and you have we as health practitioners need to promote that okay so what do we aim at aside from those things so we also want to ensure that parents recognize their responsibility in promoting their children's right to health and full development within the context of responsible parenthood by protecting their child from preventable causes of disability and death through newborn screening imagine that okay and this is one great thing okay preventable causes of disability and as a parent i know that most of our parents would do anything to to spare us from those disabilities and even spare us from death and we really have to educate our fellow men with regards to these things because if you're gonna look at it isn't it if you're gonna look at it when you hear of g6pd deficiency if you hear about congenital um hypothyroidism congenital adrenar adrenal hyper hypoplasia most Filipinos won't immediately identify those diseases what we know are ubosipon, diabetes, high blood and so many more that's why we have to educate and inform all of them okay so as so as we go along we'll be defining some key terms that is very important for us to comprehend the newborn screening law better and let's go to the first one which is the comprehensive newborn screening system so education of relevant stakeholders is very important this is a collection so when you say comprehensive newborn screening we're not we're not just talking about the newborn screening test but the system itself so we have to educate the relevant stakeholders from the family from the basic unit of the society up to the government we have to educate them and perhaps with what's happening right now so i'm filming i'm filming this video right now what that we are in the enhanced community quarantine and maybe when you look back after years from now and look at this video and listen to this video um maybe some of us would actually agree that a lot of us now in in this pandemic is unprepared because we're uneducated about a lot of things with regards to public health concerns to virology and even physical and health hygiene okay so humuhugot na naman tuloy ako so aside from that we also um talk about the collection and biochemical screening of the blood and this is done by the medical technologies by the way medical laboratory scientist so shout out all of um my kapatid all over the world so check aside from that you also have to check and confirm the test so when we discuss this um the basic the six air inborn errors of metabolism we actually did some screening and confirmatory tests so we have to track that so that we could also monitor those with the disease again we are collecting it for the mortality and morbidity records so again clinical evaluation and biochemical and medical confirmation of the test results is very important drugs and medical and even surgical management and dietary supplementation to address the heritable condition as also under the comprehensive newborn screening and this is very good okay um hindi ito yung kapag nalaman nya iiwan ka nalang nabigla ah may hugot but not that's not the case so what we're talking about here is that even the government would actually support or even do its job in helping families with um this condition take for example nila take for example your r88504 your um our AIDS law okay our AIDS law that even though um after being confirmed with hiv okay so the government also provide aid to our um patients as well so aside from that you also have to evaluate the activities to assess long-term outcomes and patient outcome and of course quality assurance and that's very important and again i cannot overemphasize quality assurance and i know your too familiar or sabi na nating malapit na kayong manawa sa quality assurance but that's very important even in this part so aside from that you also do follow up when we monitor the newborn so that's very um self-explanatory so the health institutions be it a hospital a health infirmary a health center a lying in center a puriculture center or whether public or or private needs to have or needs to follow the mandate of this law so whether your babies or your newborn has been delivered and lying in or a clinic a health center a hospital you have to have them screen so take for example what if your your baby was um delivered at home and you and your midwife doesn't have those tests again you go back to the you go back to the the guidelines for as long as um you take your baby within three days that's the allowable delay okay three three days this is the reason why even if most parents most mothers take for example in provinces in rural area even if they actually deliver their um babies at home eventually they will be advised to visit a doctor immediately okay so what else do we have you also have the health care practitioner so we have the physician the nurses the midwives the nurse nursing is the traditional birth attendants and of course let's not forget the medical laboratory scientists so heritable condition we talk about condition that can result in mental retardation physical deformity or even death so it can either be due to mutation due to um traits or recessive or dominant traits that have been expressed in your infant okay so the NIH stands for stands for National Institute of Health again that is under the UP Manila University of the Philippines Manila so aside from that we also have newborn meaning when we say newborn this is a child from the time of a complete delivery two 30 years old so newborn under one month okay so newborn screening again is the process of collecting a few drops of blood from the newborn onto an appropriate collection card which is your absorbent filter card and performing biochemical testing for determining if the newborn has a irritable condition so either of the six and of course the newborn screening center is the facility equipped with a newborn screening laboratory that complies with the standards whether it be it in the screening and even in the confirmatory and of course we have the newborn screening reference center this is the central facility at the NIH that defines testing and follow-up protocols maintains and external laboratory professionals and national database and this is the one located at the UP Ayala Techno have the University of the Philippines Manila NIH so go visit that okay so again it's very important to have parent education okay so for us to provide the parents and legal guardians very vital information with regards to the newborn screening aside from that we also do locating a newborn we do recall especially when they did not perform and newborn screening or even if they did we will still be monitoring them so of course we also have your treatment and this is now the provision of a prompt appropriate and adequate medicine medicinal and surgical management of dietary prescription to a newborn for a purpose of treating or mitigating the adverse health consequence consequences that that might be experience so for article three this is now more about the newborn screening so again for section eight continuing education and re-education and training health professional as you can see i am not going to read it anymore because i am i'm not here to read it for you but somehow to discuss it and to deepen the the discussion so as you can see if you can remember in quality assurance we have your internal and external quality assurance and part of the external quality assurance is actually proficiency testing and the one that does the proficiency testing is your personnel because in quality control we do want to check three things the stability of your machine the credibility or the quality of your reagent and of course the competence of your personnel and one thing that we can do is to actually send them to continuing education re-education and even training so even after you graduate as medical technologist as nurses as physicians the learning doesn't stop there that's why i am actually a very um a very passionate um um a very passionate um advocate when it comes to doing our um when promoting actually our learning even more so you have to learn how to learn even more so aside from that we also have licensing and accreditation so this talks about more about the licensing because not all hospitals are capable or are being mandated or being commissioned by the DOH and the NIH to perform your um to perform your newborn screening so the DOH and the Philippine Health Insurance Corporation shall require health institution to provide newborn screening services as a condition for licensure and accreditation so most of the time they actually would collect it in most hospitals but they will not be the one to test it they will be sending it to the newborn screening centers that we mentioned a while back okay so again how many how many hours would you wait before you send it five four three two one the answer is four four hours all right okay so for the implementation the lead agency of course for this um law it's the department of health so they are the one that will be establishing advisory committee on the newborn screening aside from that they will also be the one to develop the implementing rules and regulations for the immediate implementation of an nationwide newborn screening program within 108 days from the enactment of this act they also are the one that will be coordinating with the department of the interior and local government or your DILG for the implementation of your national uh of your newborn screening programs all over the Philippines and it's very important again what we want is to prevent preventable diseases iba and i really hope everyone um actually that is what they want as well okay so the advisory committee speaking of that on our newborn screening on the other hand they their job is actually to ensure sustained interagency collaborations as you can see when we talk about a public health concern it doesn't just concern hospital or laboratory it concerns every stakeholder of the society from the barangay from the family from the household from the even the the the barangay official the government officials and eventually all stakeholders of the community as well so integral part of the office of the secretary of the DOH so this is one integral um job and part of the secretary of DOH so they also are the one the three view annual and recommend conditions to be included in the newborn screening panel of this order so again like what i was mentioning a while back from six newborn from six conditions we're actually up to 22 right now i think 22 or 26 somewhere on the number but i'll be giving that to you later on so i thought from that they also are the one that review and recommends the newborn screening fee so right now um the latest that was in there posting is actually 500 to 1500 pesos somehow affordable pack okay i'm actually thinking of an even uh a more pricey um rate but that's that's the end that's their rate only okay so for the advisory committee on newborn we actually have the eight members so we have the chairman of course of this the chairman which is the secretary of DOH an executive director of the NIH the under secretary of the DILG executive director of the welfare of children director of the newborn screening reference centers at three three representative appointed by the secretary of health whether it be it one pediatrician obstetrician endocrinologist family physician a nurse or a midwife i hope they also would include medtex here by the way so they all have three year subject um the terms will be three year subject to the appointment for another three years and of course we also have the NIH secretariat committee to complete the advisory committee on newborn screening okay so for the establishment now and accreditation of newborn screening centers every single national screening newborn screening centers are strategically located so well when we were discussing the the map a while back we have one in ilokos norte one in pampanga one in south duzon who also one here in metro manila we also have one in visayas and one in mindanao so all are strategically um place so that every um everyone all around the Philippines would be catered with this service so said from that we also recall and follow up programs for infants found positive for any and all of the inheritable conditions that they had so they also would be supervising and staffing by trained personnel who have been julie qualified by the NIH and of course submit to periodic announce and unannounced inspection of the reference center so yeah that's true some are surprised some are actually announced and some are just hey men we're here surprised and we're gonna inspect your center so so much about that let's go to the establishment now of a newborn screening reference center at least the NIH that should be the one to establish the newborn screening reference center again which is found in up techno hub so they actually have the national testing database the case registries training technical assistance and even continuing education for laboratory staff isn't it so it's the laboratory the laboratory staff who does that but there i hope they would also be part of the advisory committee as well okay aside from that we also have quality assurance and again it's very important so the NIH is responsible for drafting and ensuring good laboratory practices standards for newborn screening centers so if you're gonna ask me what is the reference um laboratory for your um newborn screening um for your newborn screening it would actually be then the UP NIH okay the university of the Philippines national institute of health because they are the one that performs or that um gives proficiency or external quality assurance program for different institution so they also are the one that establish an external laboratory proficiency testing like while i was saying a while back and certification program and they are the principal repository of technical information relating to newborn screening standards and practices aside from that the technical assistance is also provided by the NIH to newborn screening centers needing such the assistance okay so this is actually the component of the philippine newborn screening we have the screening we have the management the diagnosis and the follow-up and at the center as you can see how important quality assurance because again if you're gonna look back with quality assurance we talk about the confidence interval we talk about the diagnostic efficiency the diagnostic sensitivity specificity and maybe you're hearing false positive false negative and you know it better now and you actually have would be able to explain why do we have false positive and why do we have false negative test results so so much about that let's go to the database so again the database is being maintained by the NIH the reference center for your newborn screening for your newborn screening so nbs reference center shall maintain a national database of patient tested and registry of each of the six condition actually the 22 condition so the newborn screening reference centers should also submit a report annually to the committee the advisory committee to be exact and to the doh on the status of a relevant information derived from the database okay so for the newborn screening fees i guess i am nearing the end of this discussion we also have the testing cost of course the education sample transport follow-up cost and reasonable overhead expenses for our for our patients so the advisory committee is the one that will be assigning it there will be the one as well to implement and make sure that there will be no overpricing of the newborn screening fee okay so so much about that let's have a quick summary we actually have with your ra 90 to 88 or the new um newborn screening act of 2004 we have 19 sections compartmentalized into five different articles the first one is about general provision the definition of terms the newborn screening the implementation and of course the final provision this law was approved april 7 2004 by the former president of the philippines um former president gloria makapagal aroyo okay so i uh let's go to the quick update so this is what i am talking about so the doh approves the expanded newborn so from six from the six congenital hypothyroidism congenital adrenal hyperplasia hyperplasia so phenylketinuria glucose 6 phosphate dehydrogenase and your your galactosemia and your msud has been expanded it will now include 22 more these orders now we include hemoglobinopathies in other metabolic diseases as well so um aside from that um we also have again it's here some hemoglobinopathies additional metabolic orders that that um talks about organic acids fatty acid oxidation and amino acid disorder so as you can see the first option is actually a screening of six disorders the six that uh that was first mentioned in this discussion which actually costs 550 pa la 550 pesos or you can actually have it um for a full compliment of this order at 1500 pesos so at present there's an ongoing discussion with philhealth to increase subsidy for expanded newborn screening so so from six we now have 22 tests and that is a lot to tell you but again that is for um we're saying here um and we're saying here 22 okay 22 more but in total we have 28 disorders now so that is where the 28 is coming from in my mind so from six now we have 28 disorders being screened for our newborn so i hope you did learn something so if you haven't watched the first part of this video please um do check it i will also try to give the link in the description box so we are finished discussing the newborn screening the inborn error of metabolism we also have finished now the ra 9288 and of course we did some updates for our newborn screening act of 2004 from six to 28 tests being performed so so much about that again i'll leave you with this quote by martin luther king jr again intelligence plus character that is the true goal of education so thank you so much if you have any questions please do leave a comment down below or email me on this email or send me an email all right so thank you so much this has been jomar adams so again living you this living you um tonight living you today with my own tabi na natin my own saying strive today so tomorrow you will strive thank you so much and have a great day