Well-Child Care Screening Laboratory Tests PDF

Summary

This document provides an overview of well-child care and screening laboratory tests, focusing on procedures for newborns, children, and adolescents. It details various tests such as anemia, lead, tuberculosis, and HIV screening. The Azerbaijani Medical University offers this educational resource.

Full Transcript

AZERBAIJAN MEDICAL UNIVERSITY FAMILY MEDICINE DEPARTMENT Well-child care Screening laboratory tests Ph.D. Dr. Aygun Guliyeva Screening Laboratory Tests  Every state requires newborns to undergo serologic screening for inbor...

AZERBAIJAN MEDICAL UNIVERSITY FAMILY MEDICINE DEPARTMENT Well-child care Screening laboratory tests Ph.D. Dr. Aygun Guliyeva Screening Laboratory Tests  Every state requires newborns to undergo serologic screening for inborn errors of metabolism, preferably at age 2-3 days. Funded by the Department of Health and Human Services, Baby's First Test (www.babysfirsttest.org) is an unbiased website that provides information for providers about the mandated screening requirements in each state. Examples of commonly screened conditions are hypothyroidism, phenylketonuria, maple syrup urine disease, congenital adrenal hyperplasia, and cystic fibrosis. Most institutions routinely screen newborns for hearing loss (US Preventive Services Task Force [USPSTF] recommendation for universal screening level B).The USPSTF assigned a level I (insufficient evidence) to universal screening of newborns for risk of chronic bilirubin encephalopathy with a transcutaneous bilirubin. Screening Laboratory Tests  The AAP (The American Academy of Pediatrics) recommends screening for anemia with finger stick hemoglobin or hematocrit at age 12 months. Although the USPSTF (US Preventive Services Task Force) assigned a level I to screening for iron deficiency, it did recommend iron dietary supplementation for children age 6-12 months. Because of the high prevalence of iron deficiency anemia in toddlers (about 9%), repeat screenings may be necessary in high-risk situations. Measurement of hemoglobin or hematocrit alone detects only those patients with iron levels low enough to become anemic, so dietary intake of iron should be assessed. Pregnant adolescents should be screened for anemia. A positive screening test at any age is an indication for a therapeutic trial of iron. Thalassemia minor is the major differential consideration. A sickle cell screen is indicated in all African American children. Commonly screened components of newborn screening panels Diseases Screened Incidence of Disease in Live Births Congenital hypothyroidism 1:4000 Duchenne muscular dystrophy 1:4500 Congenital adrenal hyperplasia 1:10,000-1:18,000 Phenylketonuria 1:14,000 Galactosemia 1:30,000 Cystic fibrosis 1 :44,000-1 :80,000 (depending on population) Biotinidase deficiency 1:60,000 Screening Laboratory Tests  The AAP (The American Academy of Pediatrics) recommends universal lead screening at ages 12 and 24 months. Recently high levels of lead in the water supply have supported this recommendation. If the child is considered to be at high risk, annual lead screening begins at age 6 months. Risk factors include exposure to chipping or peeling paint in buildings built before 1950, frequent contact with an adult with significant lead exposure, having a sibling under treatment for a high lead level, and location of the home near an industrial setting likely to release lead fumes or in a city with lead pipes as part of the water supply system. Although many agencies require a one-time universal lead screening at 1 year of age because high-risk factors are often absent in children with lead poisoning, the USPSTF recommends against screening children at average risk and assigns a level I to screening for high-risk children, but these recommendations are under review in 2018. Screening Laboratory Tests  Tuberculosis (TB) screening using a purified protein derivative (PPD) is offered on recognition of high-risk factors at any age. Routine testing of children without risk factors is not indicated. Children require testing if they have had contact with persons with confirmed or suspected infectious TB, have emigrated from endemic countries (Asia or the Middle East), or have any clinical or radiographic findings suggestive of TB. Children without specific risk factors for TB but who live in high-prevalence communities may be tested at ages 6 months, 1 year, 4-6 years, and 11-12 years. Screening Laboratory Tests  Human immunodeficiency virus (HIV) infected children require annual purified protein derivative (PPD) tests. Children at risk for HIV due to exposure to high- risk adults (e.g. HIV positive, homeless, institutionalized) are retested every 2-3 years.  The AAP recommends an HIV test for all 20-year-olds. Screening Laboratory Tests  The AAP (The American Academy of Pediatrics) recommends universal dyslipidemia screening at ages 10 and 20 years. A cholesterol level may be obtained after age 2 years if the child has a notable family history. The National Cholesterol Education Program recommends screening in a child with a parent who has a total cholesterol of ~240 mg/d.L or a parent or grandparent with the onset of cardiovascular disease before age 55 years. Clinical evaluation and management of the child are to be initiated if the low-density lipoprotein cholesterol level is ~130 mg/d.L. The USPSTF assigns a level I to cholesterol screening during childhood.

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