Rainy Days….Dengue Days
Summer heat is over. Rainy days are here. Its time to bring out our umbrellas and raincoats. Rain is good. Our plants and rice fields need it. It cools down our environmental temperature. A bowl of soup
or coffee seem to taste better during this kind of weather.
As parents , we need to watch out for a few things too during rainy days. Many tend to get sick during these days. Cough, colds, diarrhea are just a few. One other disease associated with rainy days is Dengue. This disease can affect all ages---even babies. The infection can be obtained from a bite of a dengue virus carrying mosquito. It presents as fever usually very high (lasting for 3-5 days) and is very good in mimicking flu-like symptoms (headache, body pains, loss of appetite etc.). What happens after fever is gone differentiates it from flu. Those who suffer from flu usually improve when fever disappears. Those with dengue may feel even worst when fever is gone. The hemorrhagic form of dengue can have bleeding as a presentation (from the nose, gums, under the skin or inside the body). It can also take the form of dengue shock syndrome when bleeding becomes massive and blood pressure drops. These forms are life threatening.
What can we do? Here are a few guidelines that could be helpful:
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Have you children wear protective clothing (long pants or long sleeves) whenever possible.
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Apply non-DEET containing insect repellent
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Make sure there are no breeding places for mosquitoes in your house or in your child’s school. Mosquito breeds in places where there’s a pool of water no matter how small. Look at old tires, pots, tin cans, canals, or any area where water tends to be stagnant.
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Consult your pediatrician immediately when your child has fever and other symptoms that may suggest dengue.
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VISIT A PEDIATRICIAN WHILE YOU'RE PREGNANT
Maybe you will say, am I reading this right? Yes you are. If you are pregnant and expecting your baby soon, visit a pediatrician for a Pediatric Prenatal Visit. As much as you prepare for the big event of giving birth, preparing for your baby's coming is one important aspect of that preparation. Why see a pediatrician even before baby comes?
The American Academy of Pediatrics recommends a Pediatric Prenatal Visit for the following purposes:
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to establish a relationship with your pediatrician
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for the pediatrician to gather basic information vital to caring for baby during birth and onwards
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to help parents obtain basic parenting skills
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for the pediatrician to assess a potentially high risk situation and help parents prepare
This visit may take several forms. It maybe a short visit. This is when your pediatrician has already
some knowledge of your health and family background. The visit could be a discussion of concerns for this particular pregnancy and baby. The visit can be several and may take long particularly when you are expecting your first baby. The main objective is to prepare the parents well for the baby's coming.
Here's a few tips to make this visit worthwhile for you:
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Be prepared with all your concerns and questions. You may want to list them down to make sure you do not forget any. Be honest and open. Let your pediatrician know your expectations, worries and views.
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Have information and documents you want to show your pediatrician with you. This can include tests done on you and your baby (eg. your blood type, hepatitis B screening test, ultrasound results if there are any), prescriptions/medications given to you and other documents pertaining to past illnesses. Include also information on the current status of your pregnancy and previous pregnancies when applicable.
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Think of particular illnesses that runs in your families (eg. Blood problems, hearing problems, diabetes etc.) and inform your pediatrician.
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Bring your birth plan. Provide your pediatrician details of your birth plan (where you will deliver, who your obstetrician will be, plan to breastfeed, plan to circumcise if you are having a boy etc.)
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Discuss the preparations you have so far made so your pediatrician can help you if there others you can prepare.
Your pediatrician is your partner in having a safe delivery and in raising a healthy child. This partnership starts long before your baby is born. Have a Pediatric Prenatal Visit now.
For more information about Pediatric Prenatal Visit, you can call Health Dynamics for an appointment with one of our pediatricians.
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PREGNANT POINTS : PREGNANCY BASICS PLUS MORE
BABY TESTS OF FETAL WELL BEING
By Dr. Zarinah Gonzaga
It’s true. Babies are supposed to take tests even before they were born. Like school grades, their scores in these tests often times determine how well they do in later life. These are called “fetal surveillance tests” and are actually non-invasive simple tests that determine how well the babies are doing inside the uterus. These tests are being done to monitor the growth and health of the baby and detect if there are any problems with the pregnancy. Usually, fetal testing is used in pregnancies with a high risk of fetal death while still inside the womb. Some of the conditions in which testing is appropriate include the following maternal conditions: poorly controlled hyperthyroidism, cyanotic heart disease, chronic renal disease, diabetes mellitus, hypertensive disorders, and antiphospholipid antibody syndrome. It also includes the following pregnancy-related conditions: decreased fetal movement, abnormally low or abnormally high amounts of amniotic fluid, intrauterine growth restriction, post term pregnancy and twin pregnancy with significant growth discrepancy between the twins. Antepartum fetal testing is usually initiated beginning at 32 weeks to 34 weeks of gestation in these women at increased risk of stillbirth. In women with multiple or particularly worrisome high risk conditions, testing may even begin as early as 26 to 28 weeks of gestation.
The first and simplest of these is the Fetal Movement Counts. This is a test that a pregnant woman can do on her own at home. Because it requires that a woman take note of the number of times her baby moves or kicks, it is also called fetal kick count. A good time to do this is after a meal when the baby is usually active. The woman then writes down how long it takes for the baby to have 10 movements. Any change in the normal pattern or number of movements is noted and forms the basis for consult with the obstetrician.
The next test is the Non Stress Test or NST. With the woman on her back, two belts are strapped across her abdomen, one at the highest point of her tummy and the other just where the sound of the fetal heart rate is loudest. These belts have special transducers that are attached to a fetal monitor, a simple machine that records the baby’s heart beat and movements and the contractions of the uterus. The NST traces the changes in the baby’s heart beat in response to his movements. Normally, the baby’s heart beat lies somewhere between 120 to 160 beats per minute. A healthy normal baby’s heart rate is expected to increase when he moves. The underlying principle is similar to an adult whose heart rate is goes up with exercise. These heart beat accelerations are recorded in the paper as sudden peaks in the tracing coincident with the baby’s movements. This is called a reactive NST. Babies with at least 2 such heart beat accelerations over the 20-minute test period pass the test. Aside from the accelerations of the heart beat, the ‘wiggliness’ of the fetal heart rate is important as well. The more wiggly the tracing, the healthier the baby is. With reactive NST, the mothers and their obstetricians are assured of the baby’s well being over the ensuing 7 days. Babies with abnormal or nonreactive NST undergo more tests to determine their well being.
The second test is similar to the NST and is called the Contraction Stress Test or CST. The same fetal monitor used in this test. In contrast to the NST, this test traces the changes in fetal heart beat with every contraction of the uterus. To do this, the woman must be having contractions. Some women, especially those who are having the test late in their pregnancy, have uterine contractions at the time of the test. Mothers who are not having contractions at the time of the CST will be asked to stimulate their nipples for a few minutes before the test. The act of nipple stimulation will release hormones that will in turn stimulate the uterus to contract. When the contractions are adequate enough, the woman can proceed with the CST. The point of the CST is to determine if the baby is healthy enough to tolerate the demands of labor. Imagine the uterus as a big muscle with the baby inside. Every time the uterus contracts during labor, the blood vessels within the muscle are compressed. As these blood vessels are compressed, the blood supply and therefore the oxygen going to the baby, diminishes. A healthy baby can tolerate several seconds of diminished blood supply with each contraction of the uterus. On the other hand, babies who cannot tolerate this experience a temporary decrease in heart beat because of the low oxygen supplying it. This heart beat deceleration is recorded in the CST. The CST of a healthy baby does not show decelerations in the baby’s heart beat during each contraction. This is called a negative CST. The CST of a baby in distress may show these decelerations and is called a positive CST. The CST is not safe for all pregnant women. Women with conditions that are associated with an increased risk of preterm labor and delivery, uterine rupture or uterine bleeding are not good candidates for CST. These conditions include the following: preterm labor or certain patients at high risk of preterm labor, preterm rupture of membranes, history of extensive uterine surgery or classical caesarean delivery, and known placenta previa.
Babies with abnormal or positive CST usually undergo another test, the modified biophysical profile. This test incorporates the result of the NST and four more additional factors that are determined during an abdominal ultrasound. During the ultrasound, the following parameters are noted: the amount of amniotic fluid, the baby’s breathing, movement, and body tone. The amount of amniotic fluid is significant because it reflects the urine production by the baby. Babies who receive a sufficient blood supply from the placenta generally produce adequate amounts of urine. Therefore, how much amniotic fluid is present is indicative of the long term function of the placenta in delivering the essential nutrients to the baby. An amniotic fluid index of more than 5cm is considered adequate. The real pressure during the BPP is on the baby. The baby is expected to show the following during the 30-minute test period: at least one or more episodes of breathing lasting 30 seconds or more, movements of the body or limbs for 3 or more times, and extension of a fetal arm or legs with return to flexion or opening of closing of a hand at least once during the procedure. Each of these five components is given a score of 2 when it is present or 0 when it is absent or insufficient. A reactive NST is given a score of 2. The highest score the baby can get is 10. A score of 8 is normal, a score of 6 is equivocal and a score of 4 or less is abnormal. The modified biophysical profile is considered normal if the NST is reactive and the amniotic fluid index is greater than 5 cm
A normal test is a reassuring sign that the baby is doing well at that time. It is important to remember that no test is 100% accurate. Following an abnormal NST, a CST and a BPP are usually performed. Subsequent management will be discussed with the patient depending on the result of these tests, the age of the pregnancy, the amount of amniotic fluid, and the condition of the mother. If all the surveillance tests are normally but the clinical condition that has prompted testing persists, repeat testing either weekly or twice a week is usually done until delivery.
In summary, there are many tests available to mothers that will assess the well being of the baby during pregnancy. The goal in the care of the pregnant woman is, and always will be, a healthy baby with a healthy mother.
About Dr. Zarinah Gonzaga
Dr. Gonzaga took her OB-gynecology residency at The Medical City. She has special interest on writing and research. She writes practical and useful topics on pregnancy and child birth.
JOIN OUR PREGNANT POINTS CIRCLE if you are expecting a baby and we will connect you to others who are pregnant too. Share and compare notes and experiences.
Email us at
parentinghub@gmail.com. Tell us how many months you are in your pregnancy and your expected date of delivery.
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