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Neonatal

Early detection and Early Intervention to Limit the disability, and to Improve the National Health Index .

Abstract:

Neonatal screening tests check for rare but serious conditions in babies just after birth. There are certain screening tests to be performed on newborns, even if they appear healthy. These screening generally include a variety of Blood tests, Hearing test and Critical congenital heart diseases (CCHDs). Most of these disorders checked in the Newborn screening test have no visible signs at birth. Early detection of these disorders gives physician a critical edge in treating them before they can cause the baby serious and long-lasting harm.

Screening tests give only preliminary information that tells doctors whether to do more precise diagnostic testing, which is needed to determine whether there’s truly a problem.

Purpose:

The purpose of the medisys Neonatal Screening Management and Information System (NSMIS) is to simplify and automate the process of Online Neonatal Screening Test for early detection of any disorders related to Blood, Hearing or Critical Congenital Heart Diseases (CCHDs) which might lead to physical disability or even can cause death. And thus, the System allows the physician in decision making before the symptoms developed. 

Introduction:

Neonatal screening tests look for developmental, genetic, and metabolic disorders in the newborn baby. This allows steps to be taken before symptoms develop. Most of these illnesses are very rare, but can be treated if detected early. The types of Neonatal screening tests that are done vary from region to region. The most thorough standardized panel Neonatal Screening checks for about 40 disorders. However, Phenylketonuria (PKU) was the first disorder for which Neonatal Screening Test was developed. In addition to blood tests, screening for Hearing disorder and Critical Congenital Heart Disease (CCHD) is recommended for all Newborns.

Medisys has pioneered itself as a Hospital Information System (HIS, LIS, RIS, Acuity Care System, EMR, BBMS, Delivery Room Management System, and Neonatal Screening Management Information System-(NSMIS)) solution provider company with over Three decades of experiences.

Medisys Neonatal Screening Management and Information System (NSMIS) is a State-of- Art web-based application specially designed to perform Neonatal Screening test. The system features a contemporary look, intuitive functionality and easier navigation which provide more efficiency, safety and quality and a much better user experience. The system is designed to provide numerous statistical reports to help the administrative authority to expedite the process of decision making.

Mother Registration:

    • System has the facility to register Mother with and without a Medical Record File number.
    • System has the facility to consider special case mother registration – incase the mother doesn’t possess her national ID just by clicking the check box Special Case which will disable the Mother National ID Required Field.

Baby Information:

    • System has the facility to record Out Borne Baby with Zone and Region and records whether the baby came in as ER, Referral or OPD Patient.
    • System has the capability to register the Found/Abandoned baby for screening just by Clicking on the Found button which will disable the required upper block regarding mother’s demographic information.
    • If the Baby is already admitted to NICU Ward, System Records date of Admission and doesn’t allow the users to go through the screening tests for that baby.

Overview of Features:

Newborn Registration Process for Screening:

Registration:

    • User friendly and Simple All in One screen for Registration of Neonatal Screening
    • Online Registration facility
    • Embedded link with the Baby can be established if the Mother is already been registered and having a Patient No. in that Hospital
    • Facility to register mother and newborn at the same time
    • Baby is registered using Mother’s National ID
    • Embedded National ID Validation Check facility available
    • Facility to register the Nationality of father of the Newborn.
    • Facility to register special case
    • Delivery Date and Time recorded
    • Facility to Register Multiple Newborn for Screening from the Same delivery at the same screen
    • Facility to records mother’s medical alert and family history alert related to screening
    • Facility to register Found/Un-identified Newborn for screening
    • Age should not be less than 24 hours for screening. For better result

Screening Process:

Only qualified NICU Nurse having Access to perform the screening is cable to perform the following two preliminary screening. There are Three Role based predefined Category of Nurses who can perform the screening test.

Role Group – I               Can Perform Hearing Test

Role Group – II              Can Perform Cardiac/Echo Test

Role Group – III             Can Perform Both

1. Hearing Screening:Screening date and Time recorded by the system

        • Right Ear (RE) -> Result Value: Pass or Refer
        • Left Ear (LE) -> Result Value: Pass or Refer

2. CCHD Screening: CCHD Screening can be performed by any of the following Two ways:

a. Cardiac Screening: Screening date and time recorded by the system

            • Perfusion Index (PI)

– Right Hand (RH) -> Normal Range:0 to 20

 – Left Leg (LL)  -> Normal Range:  0 to 20

            • SPO2

– Right Hand (RH)->Normal Range: 20 to 100

– Left Leg (LL) -> Normal Range: 20 to 100

b. Echo-cardiogram: Screening date and time recorded by the system

            • Echo-cardiogram: Procedure performedResult  Pass or Refer

Hearing Screening Test: Normal

First Hearing Screening Test: Normal

System has the facility to record Right Ear and Left Ear Hearing Screening Test. There could be possibly Two Set of Results i.e., Pass or Refer. In the First Screening Test if any of the Two Ears – Screening Results appears as ‘Refer’ then system automatically opens the facility to conduct the Second Screening Test which can be seen from the screen shot below.

Second Hearing Screening Test: Right Ear – Refer

If the Second Hearing Screening Test result appears as ‘Refer’ then system automatically opens the facility to conduct the Third Screening test to confirm the screening result which can be seen from the screen shot below.

Third Hearing Screening Test: Right Ear – Refer

If the Third Hearing Screening Test result appears as ‘Refer’ then system will confirm and record the result. System automatically enables two options. Result Rejected by the Family or If Accepted then System facilitates an Appointment with the Audiologist.

CCHD Screening Test: Normal

Critical congenital heart disease (CCHD) Screening Test can be performed in two ways:

    1. Cardiac Screening
    2. Perfusion Index (PI)
    3. Blood Oxygen Saturation Level (SPO2)
    4. Echocardiogram

First Cardiac Screening (PI) Test:

If the First Cardiac Screening (PI) Test results for (RH or LL) appear out of the normal range – system will automatically open the facility to conduct the Second Cardiac Screening test with system displayed message ‘Ensure Connection and Repeat’ to confirm the screening result which can be seen from the screen shot below.

Second Cardiac Screening (PI) Test:

If the Second Cardiac Screening (PI) Test results for (RH or LL) appear out of the normal range – system will automatically open the facility to conduct the Third Cardiac Screening test with system displayed message ‘Ensure Connection and Repeat’ to confirm the screening result which can be seen from the screen shot below.

Third Cardiac Screening (PI) Test:

If the Third Cardiac Screening (PI) Test results for (RH or LL) appear out of the normal range – system will confirm and record the result. System automatically enables two options. Result Rejected by the Family or If Accepted then System facilitates an Appointment with the Cardiologist.

First Cardiac Screening (SPO2) Test:

If the First Cardiac Screening (SPO2) Test results for (RH or LL) appear out of the normal range – system will automatically open the facility to conduct the Second Cardiac Screening test with system displayed message ‘Repeat within One Hour’ to confirm the screening result which can be seen from the screen shot below.

Second Cardiac Screening (SPO2) Test:

If the Second Cardiac Screening (SPO2) Test results for (RH or LL) appear out of the normal range – system will automatically open the facility to conduct the Third Cardiac Screening test with system displayed message ‘Repeat within One Hour’ to confirm the screening result which can be seen from the screen shot below.

Third Cardiac Screening (SPO2) Test:

If the Third Cardiac Screening (SPO2) Test results for (RH or LL) appear out of the normal range – system will confirm and record the result. System automatically enables two options. Result Rejected by the Family or If Accepted then System facilitates an Appointment with the Cardiologist.

CCHD Screening (Echocardiogram):

System has the facility to conduction CCHD Screening using Echocardiogram also. Echocardiogram screening has two options – Pass or Refer. In both Cases Nurse need to enter diagnosis from the List – and if the diagnosis selected as others from the list – System automatically enables comments field to write the user comments.