The case of girls exchanged at birth at the San Millán hospital in Logroño in 2002 has reopened an old debate on the system for identifying newborns in Spanish hospitals. It has also reawakened the ancestral fears of parents about the correct identification of their children at birth. The vast majority of health professionals defend that at present there is no margin of error in the identification process, and that therefore the case that has been known could not now occur. But not everyone agrees with this resounding statement and there are specialists who defend that the error is unlikely but not impossible. Antonio Garrido-Lestache,Renowned pediatrician with sixty years of experience and who has devoted much of his life to defending the need for a child's identity document before the scientific community, he is one of the doctors who continues to demand greater guarantees for the unequivocal identification of people from the very moment of his birth, a right recognized internationally in the Convention on the Rights of the Child of November 20, 1989 and also specifically in Spanish legislation.a right recognized internationally in the Convention on the Rights of the Child of November 20, 1989 and also specifically in Spanish legislation.a right recognized internationally in the Convention on the Rights of the Child of November 20, 1989 and also specifically in Spanish legislation.
According to an article published in 2017 by the Spanish Association of Pediatrics (AEP), the system to identify a newborn should meet several essential requirements: that it be carried out at the time of delivery before any possible separation between mother and child, and verify this identification throughout the hospital stay and at the time of discharge. But it also adds other concepts such as reliability, which remains over time and allows a quick resolution of possible identity doubts.
Guadalupe Fontán, nurse at the Research Institute of the General Nursing Council and former head of the O'Donnell Maternity Hospital in Madrid, emphasizes the improbability of the error: “The identification of patients is a priority in a hospital and in the case of births has been improving and adding guarantee filters. A few years ago it was done with the mother's fingerprint and the child's sole, but this had limitations because it is very difficult to collect fingerprints correctly: it is difficult for a newborn to plant the foot correctly and also the skin is very wrinkled , also on the fingers of the hand. All this caused failures to be observed in this system almost two decades ago and it is not carried out in many hospitals ”. A statement endorsed by the Spanish Association of Pediatrics in its report,although he clarifies that it is due to the "low quality of the taking of said impressions by health personnel not qualified in taking fingerprints, which prevents them from having identifying value by themselves in more than 70% of the cases".
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Isabel Salgado, nurse supervising midwife of the Department of Obstetrics of the Vall D'Hebron hospital in Barcelona, describes the protocol that is routinely followed to identify a newborn. “We use a specific kit that is used throughout Spain. The mother has her identification as an individual patient and also this kit destined to the identification of the mother-newborn binomial ”. The neonatal encoder, which is its technical name, consists of different pieces with the same number and with a unique barcode for each mother-newborn. This code is printed on a bracelet that is placed on the woman in labor, on another that is placed on the baby's ankle as soon as it is born and also on the clamp that closes the umbilical cord at birth,a clamp that cannot be opened or changed until the cord falls off. If it is a multiple birth, a different encoder is used for each newborn and therefore the mother must wear several bracelets, one for each of her children's codes.
"In addition," Salgado continues, "that same sticker with the unique identification code is included on the child's health card and on the mother's entry sheet." In the Vall D´Hebron hospital it is also mandatory that just after the birth, the father or companion goes to the admissions service so that the newborn's hospitalization is digitized and a second bracelet can be added to the baby with his or her name and surname.
The AEP affirms that despite the improvement that this system has brought about, it is not infallible either: “Remotely there is still the possibility of losing a loose bracelet or the cord clamp if the newborn needs, for example, the canalization of the umbilical vessels. ”.
The same entity points out in its 2017 writing other more innovative methods to identify babies: electronic biometric systems for reading and printing fingerprints of both the mother and the newborn and DNA analysis.
Regarding the first, doubts continue about the quality of its identifying value.
On the second, questions are opened about his custody and custody.
DNA analysis
The Government of La Rioja, sparked by the scandal of the two girls born in the San Millán hospital, clarifies that, currently, in its two public management hospitals, together with the neonatal encoder, “a sample of blood from the umbilical cord is carried out. DNA analysis exclusively for cases in which there is doubt of identity ”. This method is already applied in hospitals in other autonomous communities such as the Basque Country, Andalusia or Murcia. And it is also in process in some hospitals in Catalonia, such as the Vall D'Hebrón in Barcelona. Isabel Salgado and Guadalupe Fontán agree that this is the only procedure that "guarantees without a doubt" that a newborn is the child of a specific mother and they believe that this method will be implemented shortly in all hospitals.But there are also gaps in the guarantee of genetic fingerprinting because, as Fontán points out, its real application not only has to do with its cost, but also “with the time that this information must be kept and with the custody of it”. Important details to be resolved. “The legislation”, explains Fontán, “obliges the unequivocal identification of the newborn, but it does not go so far as to detail how it should be done, that is why each community and, sometimes, each hospital, decides its own protocols”.but it does not go so far as to detail how it should be done, that is why each community and, sometimes, each hospital, decides its own protocols ”.but it does not go so far as to detail how it should be done, that is why each community and, sometimes, each hospital, decides its own protocols ”.
Emili Villegas, midwife at the Vithas Granada hospital describes how DNA identification of the baby is currently carried out in the hospitals of the Community of Andalusia: “There is a document from the Andalusian Government that is sent to hospitals. It has the appearance of a sheet that folds over itself on the sides of which there are adhesive strips that at the end of the process are used to seal it and that is sealed as if it were an envelope. Inside there are four perfectly identified circles, in two they put mother and in the other two newborn and they are destined to pour in them a few drops of the mother's blood and others collected from the baby's umbilical cord at the moment of birth. The documentation includes three codes,one of them is attached to a card that the parents take as a certificate that the correct identification of their baby has been made and the other two stickers, with the same code, go to the bracelet that is put on the newborn in the hospital and to the mother's medical history. This document is kept in the hospital and is kept for 1 to 5 years depending on the center. At that time, if the parents have any kind of doubt, they would have to contact the health center and go with the receipt that was given to them when their baby was born and that document would be rescued from the mother's medical history on paper to check the maternal blood and that of the child and check that it coincides with that collected at the time of birth ”.They go to the bracelet that is put on the newborn in the hospital and to the mother's medical history. This document is kept in the hospital and is kept for 1 to 5 years depending on the center. At that time, if the parents have any kind of doubt, they would have to contact the health center and go with the receipt that was given to them when their baby was born and that document would be rescued from the mother's medical history on paper to check the maternal blood and that of the child and check that it coincides with that collected at the time of birth ”.They go to the bracelet that is put on the newborn in the hospital and to the mother's medical history. This document is kept in the hospital and is kept for 1 to 5 years depending on the center. At that time, if the parents have any kind of doubt, they would have to contact the health center and go with the receipt that was given to them when their baby was born and that document would be rescued from the mother's medical history on paper to check the maternal blood and that of the child and check that it coincides with that collected at the time of birth ”.At that time, if the parents have any kind of doubt, they would have to contact the health center and go with the receipt that was given to them when their baby was born and that document would be rescued from the mother's medical history on paper to check the maternal blood and that of the child and check that it coincides with that collected at the time of birth ”.At that time, if the parents have any kind of doubt, they would have to contact the health center and go with the receipt that was given to them when their baby was born and that document would be rescued from the mother's medical history on paper to check the maternal blood and that of the child and check that it coincides with that collected at the time of birth ”.
In this scenario, the AEP opts for the combination of neonatal encoders together with a sample of maternal blood and blood from the placental end of the umbilical cord as the most recommended method of identifying the newborn.
A method, the latter, which they recommend should be extended to all the autonomous communities but must also be carried out with certain guarantees: “always with the maternal consent and always with the sole purpose of guaranteeing and being able to verify the mother-child identification, but not for be used to carry out paternity tests or for any other type of genetic study or research ”.
A newborn in his mother's arms in a hospital Orbon Alija / Getty Images
It should be emphasized that this entire process occurs in the midst of the stressful situation that any birth generates for the mother and father of the child to be born. María, who recently gave birth to her daughter Carmen, remembers how the girl was identified in front of her with a bracelet that they placed on her ankle, but she only noticed that the umbilical cord clamp had a sticker with the same barcode after your return home. "I think the girl's bracelet had the same data as the one that was placed on my wrist when I entered the hospital, but honestly at that time I did not pay much attention to those things." He also has to remember to remember that at some point he had to put his footprint on paper and that they did something similar with his daughter. “I don't know if it was the footprint,” he says, “ugh,I am not clear when they did that ”. She only remains totally calm when she affirms that her daughter was not separated from her at any time until they left the hospital together.
Pilar Maicas had her second daughter, Lucía, a year ago at the Lozano Blesa Hospital in Zaragoza. “It was a quick delivery and at all times I or the father were with the girl. But six years earlier I had my first child, Sergio, and the delivery was more difficult. They had to use a suction cup and for more than a quarter of an hour after he was born neither I nor my husband saw our son's face. At the time I didn't think of anything, but later I did come to wonder that anything could happen at that time. Nobody really explains to you how they identify your child until they give you the birth certificate and a sheet with data such as their weight or the time of birth ”.
In these simple descriptions of recent births, some more than the 338,435 that occurred in Spain in 2020, it is already detected that the arrival of a child in the world is not the most conducive situation for a mother to be aware of the identification details of your child and that mother or child may require specific attention that requires them to be separated.
The question remains in the air: Is the identification system currently being followed completely reliable?
A historical claim
For Antonio Garrido-Lestache, who is currently 90 years old and continues to raise his voice to guarantee the identity of newborns, the systems still seem insufficient. A complaint from him prompted the UN to include the right of the child to identification in one of its 1989 conventions, a resolution signed by all countries with the exception of the United States and Somalia. And his insistence on implementing a DNI with the fingerprints of newborns prompted the Community of Madrid to include in the Law of Guarantees of the Rights of Children and Adolescents of March 28, 1995 that "all children and girls have the right to be correctly identified at the time of their birth, according to the most advanced and accurate methods,by means of a child identification document that will be delivered immediately after the birth ”.
The pediatrician Antonio Garrido-Lestache.álvaro garcía / © Álvaro García.
For Garrido-Lestache, in the absence of the implementation of a general DNA identification, real and lasting over time, the most reliable, simple and economical thing to do is to link the mother's fingerprint with that of her son right in the moment of birth. “It is false that it is not reliable, what happens is that you have to do it well. The fingerprint of a person is completely formed after 120 days of intrauterine life and I have shown with analyzes carried out by the Finger Identification group of the Spanish police, providing 1,500 fingerprints of newborns, that it is an absolutely reliable method already who concluded that all of them "were perfectly identifiable." According to the experienced pediatrician, the trick is to turn the baby down so that it almost naturally reaches out.“I got the first fingerprint of a baby in 1990 using this method and with a special ink. It seems easy but it is not, it has to be done by personnel specialized in fingerprinting, but if it is done correctly it is absolutely reliable because fingerprints persist until the disintegration of the tissues. The key is that this function must be performed by specialized identifying personnel. What's more, biometric technology now allows simple and reliable devices to take and recognize newborn fingerprints, which exceeds what was previously done with ink. I still find it incomprehensible to inaugurate hospitals with the latest technology and not deal with this identification, which is a minimal act but of absolute relevance for the future of the newborn ”.
Garrido-Lestache continues to advocate for what he considers to be the simplest, cheapest and safest system: using a fingerprint and a newborn ID card that could also include blood samples from the mother and the newborn and, a posteriori, all the vaccines they receive. the minors and that in the end many do not remember in maturity. Other professionals believe that with the information generated by the case of the exchange of babies that occurred in Logroño almost 20 years ago, future fathers and mothers are going to start demanding the DNA sample service - which is currently not generalized - and that these The requests, together with those of the health workers who advocate this system, will in the short term cause this necessary unequivocal identification of the newborn to be regulated in legislation with a single protocol that is mandatory for all.