Procedures for Newborns Soon After Birth

mother holding newborn baby

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Your newborn baby has just arrived. This first, precious, golden hour is upon you. What happens now? Many practitioners will allow you to have the baby placed directly on your abdomen or chest. Warm towels or blankets will be placed over both of you to help keep your baby warm. This time for bonding in many hospitals and birth centers limited to the first hour, though this can vary from place to place and by your request. Once you and your baby are ready, there are some standard tests that are done for nearly all babies, including those born at home.

Newborn testing is an important thing to think about before labor. During pregnancy we focus so much on the actual birth preparation sometimes we don't devote enough time to other topics, including newborn testing. The following procedures are commonly done in the first few days of your baby's life.

Measuring Weight and Length

Weight and length are also done routinely everywhere, although when these tests are done does vary from place to place. Some hospitals will immediately remove your baby from you and begin an initial assessment.

Many professionals believe that this is a bad idea because the baby has a very short window of the quiet alert state in which to really connect with the parents before entering a deeper sleep state. Many parents are requesting in their birth plans that these procedures are delayed until after that first hour of life.

If you are giving birth in a birth center or home, these procedures are more flexible. Talk to your doctor or midwife about the normal protocol and see how it fits with your ideas.

Administration of Eye Drops

Eye drops have changed recently in many states. In the past Silver Nitrate was used routinely and this burned a baby's eyes while trying to prevent infection. Now, more commonly you will find erythromycin used. Make sure you ask.

Again, this is something that you may wish to be delayed until after that first hour of life. While the newer medication doesn't burn your baby's eyes it will make it more difficult to see, and newborns can see. There are state laws that govern the application of eye drops. Most states have laws that say it is up to the practitioner to provide the eye drops, with no specific time indicated. Find out what your state law says.

Injection of Vitamin K

This is usually an injection given after the birth. Your baby isn't born with intact clotting factors. This started being common and become law when forceps deliveries were very common, to help prevent bleeding in the brain because of the extra trauma to the baby's head.

Today we are still giving babies vitamin K routinely, despite the fact that forceps deliveries have changed and occurred less frequently because it still provides benefit to babies. Some countries have newer policies of when to provide vitamin K as opposed to doing it routinely.

Some families request that vitamin K be given orally instead of injected. While we aren't sure how well this works, many pediatricians agree to this alternative. Discuss the issue with your pediatrician prior to birth. 

Newborn Screening and PKU Testing

Newborn screening is the term we use to define the set of tests done to screen your baby for various diseases, including phenylketonuria, commonly called PKU. While many moms may say they are having the PKU screening, they are really being tested for multiple disorders at one time. What exactly is being tested for varies by state.

Phenylketonuria (PKU) is a genetic disorder. It is routinely tested for during the first few days of life. In many states, the test is required and is frequently done in conjunction with several other tests, such as galactosemia, thalassemia, etc.

This test involves sticking the foot of the child for blood. It is only accurate when your baby has been receiving a diet containing phenylalanine, in both human milk and artificial formulas, for a period of 24 hours. For this reason, a breastfed baby should not be tested until at least one day after birth. If your hospital or doctor is trying to encourage breastfeeding mom to take this test before then, the results will not be valid.

Many places do the test before you leave the hospital and ask you to return in one week to have the test repeated. This is usually for their convenience to make sure you've at least had one test for their records, even though it is not valid. Talk to your pediatrician about having this done only once, though, in about 10 states, it is required to be repeated. Your pediatrician will guide you or you can check the state by state listings.

Hepatitis Vaccine Administration

This vaccine is now mandatory in most states. You have two choices for when to start the hepatitis vaccine, at birth or at the two-month check-up. If you choose to have this vaccine, I encourage you to assess your own risk of hepatitis before deciding when to have this vaccine done.

Talk to your practitioner about the use and safety of this and any vaccine.

APGAR Testing

The APGAR is your baby's first "test." In most places, it is done without ever being noticed by the parents because it's simply an evaluation of the way your baby looks and sounds.

A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitation measures, and a baby with an APGAR Score of 3 and below requires immediate resuscitation.

Despite what parents will tell you this doesn't correspond to your child's SAT scores later in life. In fact, in some circles, this test is criticized for not being very useful. For example, a baby obviously in distress will not be left alone until the one-minute APGAR says that they need help. All in all, this is a harmless test that many parents look forward to hearing their baby's score.

How APGAR Is Scored

Sign 0 Points 1 Point 2 Points
A Activity (Muscle Tone) Absent Arms and Legs Flexed Active Movement
P Pulse Absent Below 100 BPM Above 100 BPM
G Grimace (Reflex Irritability) No response Grimace Sneeze, cough, pulls away
A Appearance (Skin Color) Blue-gray, pale all over Normal, except for extremities Normal over entire body
R Respiration Absent Slow, Irregular Good, Crying

Other Procedures and Tests

There are many things that may be done either on a routine or not so routine basis, including a hearing test, blood sugar testing, ultrasound, etc.

Make sure that you have all of the information necessary to make a well-informed decision about your baby's care—just as you did during pregnancy.

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Additional Reading
  • Costich JF, Durst AL. The Impact of the Affordable Care Act on Funding for Newborn Screening Services. Public Health Rep. 2016;131(1):160-6.
  • DekkerR. Evidence for the Vitamin K Shot.Evidence Based Birth.2014.
  • National Newborn Screening Status Report. National Newborn Screening and Global Resource Center. 2014.
  • Newborn Screening Tests for Your Baby. March of Dimes. March 2015.