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.

Once you and your baby are ready, there are some standard tests that are done for nearly all babies, including those born at home. The following procedures are commonly done in the first few days of your baby's life.

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. It is not actually a test at all, but an observation.

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 to 10 is considered normal, while 4 to 7 might require some resuscitation measures, and a baby with an APGAR score of 3 and below requires immediate resuscitation.

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

Weight and Length Measurement

Weight and length are routinely checked, although when these tests are done does vary from place to place. Some hospitals will check a baby's weight immediately after birth.

Since babies have a short period of quiet alertness before entering a deeper sleep state, some parents wish to use that time to connect with their baby. So they request in their birth plans that procedures such as weighing the baby be delayed until after the 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

In the past silver nitrate was used routinely to prevent infection. These drops burned a baby's eyes. Now it is more common to use an antibiotic (erythromycin) instead. It does not burn babies' eyes. Many state laws require application of eye drops because of the serious consequences of eye infections (including loss of sight).

The U.S. Preventive Services Task Force recommends prophylactic eye drops for all newborn babies. Drops should be administered within two hours of birth.

Administration of Vitamin K

This is usually an injection given after birth. Vitamin K deficiency is common in newborns. If vitamin K is not replaced, babies are at risk of vitamin K deficiency bleeding (VKDB), which can be serious or even fatal.

Oral vitamin K supplements aren't appropriate for babies born prematurely, or babies who have certain medical conditions. They require multiple doses over several weeks or months, instead of a single injection, and are not as effective as injected vitamin K.

Newborn Screening

Newborn screening is the term for the set of tests that screen your baby for various diseases, including phenylketonuria, commonly called PKU. In every state, newborn screening is required because of the importance of early detection of potentially serious medical conditions.

There is some variance on what each state's screening covers. But typically, babies are screened for 50 to 60 diseases and conditions, including galactosemia, thalassemia, cystic fibrosis, and sickle cell disease.

This test involves blood drawn from the baby's heel with a needle stick. It is only accurate when your baby has been receiving a diet containing phenylalanine, in either human milk or infant formula, for a period of 24 hours. For this reason, a baby should not be tested until at least one day after birth.

Many hospitals do the test before you are discharged and ask you to return in one week to have the test repeated. In about 10 states, it is required to be repeated. Your pediatrician will guide you, or you can check state-by-state listings at babysfirsttest.org.

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. Talk to your pediatrician about what is best for your baby.

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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