Sieve for the Future of Children

“There is always a moment in childhood when the door opens and lets in the future.”, Graham Greene.

Passing something through the “Sieve” means conscientiously examining or selecting it according to the Royal Spanish Academy of Language. Applied to childhood, it means examining the newborn thoroughly to find any disease that, being diagnosed early, can be treated in a timely manner and therefore let the future in with an even start in life.

During 2021, around 1,912,178 births were recorded in Mexico according to the Inegi. So, examining them thoroughly is a task that requires resources to minimize the risk of not detecting a disease in time that can affect the life and journey of newborns.

When a newborn “arrives into the world”, it is necessary to immediately evaluate its adaptation to the change from the maternal womb to the external environment, since one in 10 may require help to make this transition successful. The first test they must pass is called “Apgar” with a scale of 1 to 10 that is measured at one and five minutes. It considers five parameters: heart rate, breathing, muscle tone, reflex response and color of the newborn.
Thus, for example, if it is born vigorous, crying and pink, it will have a score between 8 and 10 points and favors contact with the mother from the first minutes of life. If he is born flaccid, does not cry and is purple -cyanotic- he will have a score of less than six and will require immediate attention for resuscitation.

The umbilical cord is then tied, secretions from the airways are aspirated, and a complete physical examination is performed, including weight, height, vital signs, upper and lower gastrointestinal patency, and finally, a blood sample is taken. cord to determine blood group. With this, the doctor determines if the newborn is able to go with his mother to breastfeed as soon as possible or if he requires more observation, monitoring or some special study.

Also in the physical examination, it is examined if there are no congenital malformations such as congenital dislocation of the hip or genetic conditions such as Down Syndrome. With technologies and trained professionals, serious or critical congenital heart disease, hearing disorders and vision disorders -retinopathy of prematurity- or congenital cataracts can be detected.

In Mexico, the General Health Law has been amended several times over time to guarantee child care and monitoring of its growth, comprehensive development, including the promotion of timely vaccination, prenatal care, as well as the prevention and detection of hereditary and congenital conditions and diseases, and where appropriate care, which includes the application of the expanded screening test, and their visual health (2005 and 2013); the application of the neonatal ophthalmological screening, at the fourth week of birth, for the early detection of malformations that can cause blindness, and its treatment, in all its degrees (2005, 2013, 2016); the review of the retina and hearing screening for premature infants (2013); screening for severe or critical congenital heart disease before hospital discharge (2021).

However, there is a group of metabolic or hereditary diseases that can only be diagnosed with blood tests of the newborn. One of these diseases is called “Congenital Hypothyroidism” which occurs in 333 children per million newborns, with girls being the most affected (66%). Newborns cannot make enough thyroid hormone or are born without a thyroid. If this condition is not diagnosed and treated, children can suffer irreversible neurological disorders and growth problems. But the good thing is that a timely diagnosis and proper treatment can prevent these problems. In most cases, this condition is permanent, and the patient will need lifelong treatment. In our country, since 1998, the technique for the screening and treatment of this congenital disease has been established, taking a giant step forward.

For 2017, the “Sieve” was “expanded” to diagnose six diseases: congenital hypothyroidism, congenital adrenal hyperplasia, phenylketonuria, galactosemia, cystic fibrosis, and glucose phosphate dehydrogenase deficiency. In this 2022, there are very significant advances that would make it possible to diagnose more than 65 metabolic diseases -deficiency of amino acids, fatty acids, organic acids, urea metabolism and endocrine disorders, among others- and, therefore, treat them to improve the quality of life of patients. newly born.

Last Thursday, the Health Commission of the Senate of the Republic approved an initiative presented on September 6, 2022 by its president, Senator Lilia Margarita Valdez Martínez of the Morena Parliamentary Group for the detection of “immune-mediated” conditions and, where appropriate, care , which includes the application of the compulsory test of the “expanded” neonatal screening. Hopefully soon it will go to the plenary session and be approved.

The approval of a draft opinion on various initiatives that we have presented since March 2022 is pending in the Chamber of Deputies, requesting the implementation of the “expanded metabolic screen” and the budget allocations that allow it in the public health system, in addition to providing the medical interventions, medications and advice necessary to treat the rare diseases diagnosed. On instructions from the Ministry of Finance and Public Credit (SHCP), it was withdrawn from the agenda of the session where it would be approved. Let’s hope they bring it up again to the plenary session and it is approved already given the precedent in the Senate.

I wholeheartedly hope that the SHCP thinks better of it, opens the door and, in the best interest of Mexican children, allows all new Mexicans to arrive and look towards a future with less inequality.

*The author is a surgeon, specialized in public health, doctorate in health sciences and public administration, and is a re-elected deputy of the PAN parliamentary group in the LXV Legislature.