on 10/22/2004 4:55 PM, Automatic digest processor at
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Date:    Fri, 22 Oct 2004 15:15:20 -0500
From:    "Suzanne Berman, MD" <[log in to unmask]>
Subject: "colostrum doesn't count" - blah!

Here's a new one for the annals.  As you know, newborn metabolic screening
must occur >= 24 hours after the first feeding.  However, according to one
nurse at my local hospital, breastfed babies must wait "a couple of" days
before the newborn screening can be done because "all the baby got was
colostrum and that doesn't really count as a feeding."

Oh. My. Goodness.

Having to restrain herself from going ballistic,
Suzanne

Suzanne Berman, M.D., FAAP
[log in to unmask]
*******************

Suzanne,

It may be that she has some gaps of information as to why waiting is
important but is not entirely off base in the need to wait for a more
accurate screening. My understanding is that the optimal timing for the
metabolic screen is at 72 hours post partum.

Here is a snip from a Newborn Screening Practitioner's manual:


The trend toward shorter hospital stays after childbirth complicates newborn
screening. In certain
of the metabolic conditions, for example PKU, the accumulation of the
specific amino acid(s) in
the blood does not occur until after birth, when the intake or production
rate exceeds the affected
infant's capacity to metabolize or excrete it. The rate of this rise of the
specific amino acid(s) in
the blood, therefore, varies depending upon the severity of the defect and
the protein intake. This
may lead to a false negative finding when screening an affected infant too
early. Conversely,
because there is a TSH surge in normal infants immediately following birth,
there will be many
false positive results for hypothyroidism in specimens collected prior to 48
hours of age.
Practitioners need to be aware that a specimen taken prior to 24 hours of
age will usually detect
congenital hypothyroidism, galactosemia, biotinidase deficiency, and sickle
hemoglobin, but will

end snip

Warmly,

Lisa Boisvert Mackenzie

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