Prenatal Hospital Bag Checklist

G6PD Deficiency

G6PD ( Glucose-6-phosphate dehydrogenase ) deficiency (蚕豆症) is an X-linked recessive hereditary disease.  A person with G6PD deficiency is characterized by abnormally low levels of G6PD-ase enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism.

G6PD deficiency present in > 400 million people worldwide.  It may have been around since antiquity, as favism was widely known in the Mediterranean 2,500 years ago.

Genetics

Signs & Symptoms

·Most individual with G6PD deficiency are asymptomatic.

·Symptomatic patients are almost exclusively male ; female patients are rare.

·Prolonged neonatal jaundice, possibly leading to kernicterus.

·Hemolytic crises in response to illness, certain drugs / food / chemicals.

·Diabetic ketoacidosis.

·Acute kidney injury ( AKI )

·Favism

Triggers

·Antimalarial drugs, eg. primaquine, pamaquine, chloroquine…

·Sulfonamides, eg sulfanilamide, sulfamethoxazole, mafenide…

·Analgesics, eg. aspirin, phenazopyridine, acetanilide…

·Non-sulfa antibiotics, eg. nalidixic acid, nitrofurantoin, isoniazid, dapsone, furazolidone…

·Henna 散沫花 ( Lawsonia inermis )

·Faba bean 蚕豆 ( Vicia faba )

·金银花 ( Lonicera japonica )

·Camphor 樟脑 ( extracted from Cinnamomum camphora, Rosmarinus officinalis, etc )

·Naphthalene, eg. Mothballs 臭丸

·Gentian violet / crystal violet / methyl violet / proctanine (紫药水/藍藥水)

·Tonic water ( contains quinine )

Diagnosis

·Complete blood count & rticulocyte count

·Liver enzymes test

·Lactate dehydrogenase test

·Haptoglobin test

·Coombs’ test

·Beutler fluorescent spot test

·Motulsky dye-decolorration test

Treatment

·Avoidance of certain drugs & foods that cause hemolysis.

·Vaccination against hepatitis A & B to prevent infection-induced attacks.

·Blood transfusions in case of acute hemolysis.

·Dialysis in case of acute renal failure.

·Splenectomy to remove spleen, the site of red cell destruction.

·Folic acid

Side effect

Immune against malaria caused by Plasmodium falciparum.

Breastfeeding Position

Type of Attachments

1. Laying Down

Mother lying down with baby in parallel position.

2a. Cradle Hold

Holding baby across the lap, supporting with the same arm

2b. Cross Cradle Hold / 
Transitional Hold

Holding baby across the lap, supporting with opposite arm.  
Useful for premature babies or babies with a weak suck because it gives extra head support and help babies stay latched.

3a. Clutch Hold / Rugby Hold

Holding baby underarm.  

Useful for mothers who had a Caesarean and mothers with large breast, flat or inverted nipples.

3b. Twins hold

Holding two babies underarm with a cushion.

4. Koala Hold

Baby straddled across the knees in an upright position.

5a. Laid Back

Semi-reclined with baby laying across stomach or shoulder.

5b. Laid Back after a  Caesarean

Semi-reclined with baby lying vertically away from the Caesarean wound.

Checking the Attachment

When baby is correctly attached to the breast :

• breastfeeding feels comfortable, not painful

• baby takes the whole nipple and a large amount of the areola into him/her mouth, more on the chin side than the nose side

• baby’s chin is pressed into the breast

• baby’s lips are turned out over your breast (not sucked in)

• nipples stay in good condition, and don’t show any signs of damage

• baby is draining the breast properly, so that it feels floppy after a feed.

Breaking the Attachment

To take baby off the breast, avoid pulling baby away from the breast. Instead, break the attachment by inserting little finger into the corner of baby’s mouth, between his gums, and gently remove him/her from the breast.

Baby might need to burp after feeding.

Source :

1. Good Positions for Breastfeeding   http://www.babycentre.co.uk/a8784/good-positions-for-breastfeeding

2. Breastfeeding Attachment Techniques   http://raisingchildren.net.au/articles/breastfeeding_techniques_article.html

3. Breastfeeding  http://www.womenshealth.gov/breastfeeding/learning-to-breastfeed/#e