Parenting: Babies
What to Can Expect During Your Hospital Stay
“The initial evaluation and management of the newly-born infant assures a healthy and smooth transition from in utero to extra-uterine life,” says Dr. Alan Meltzer, general pediatrics division director at Morristown Memorial Hospital in Morristown, NJ.
After Birth
Within one minute of birth, your baby will be given an APGAR score from 0 to 10 based on an evaluation of heart rate, respiration, muscle tone, reflexes and color. A score of 0, 1 or 2 will be assigned for each category. For example, a limp baby will receive a 0 for muscle tone, while a baby who actively moves his arms and legs will receive a 2. This evaluation is repeated at five minutes after birth, and most babies score between 7 and 9.
“The APGAR score helps with communicating the condition of the newborn in the first minutes of life,” says Dr. Meltzer. Once your baby’s APGAR score is recorded, he will be given back to you to hold and bond with for several minutes before being weighed and measured.
Most babies are born with very low levels of vitamin K, which is essential for normal blood clotting. It is therefore standard practice to give newborns a vitamin K injection in the upper thigh, usually within the first hour of life. This injection prevents a serious bleeding condition known as hemorrhagic disease of the newborn (HDN).
Some hospitals also give newborns a hepatitis B vaccine in the hospital, but most will hold off until the first visit to the pediatrician. “As long as Mom does not have the disease, we are in no hurry to give the vaccine,” says Dr. Tanya Remer Altmann, a pediatrician in Westlake Village, Calif., and a clinical instructor at UCLA. The American Academy of Pediatrics (AAP) recommends that newborns whose mothers either are infected with the hepatitis B virus or who have not been tested get their first shot in the three-dose series within 12 hours of birth. All other babies can get their first shot by 2 months of age.
Pediatrician Visit
After your baby’s first feeding and before you bring him home from the hospital, he will be screened for hypothyroidism and phenylketonuria (PKU), along with any other diseases required by your state. This is done by pricking your baby’s heel for a few drops of blood and sending the sample to your state’s health department for analysis.
“The baby should feed before the newborn screening is done," says Dr. Altmann. "The blood test screens for things in the blood that are produced after a feeding, so a test before the first feeding might not be accurate.”
While newborn screenings vary by state – Wisconsin screens for 26 diseases, while Utah screens for just four – parents do have the option of supplemental newborn screenings. “We were offered the opportunity to have a wider range of testing done as part of a state registry," says Laurie Cartwright of Lake Forest, Calif. "Since the amount of blood required was basically the same, we figured it was to our benefit to have the broader spectrum of testing.” Independent laboratories, such as NeoGen Screening and NewScreen, will screen for 55 disorders for less than $100. Baylor Medical Center and Mayo Medical Laboratories screen for 35 diseases for $50 or less.
To take advantage of these supplemental screenings, you’ll need to contact one of the labs for a free testing kit before you give birth. When you arrive at the hospital, just give the kit to your doctor and let him know that you want an extra blood sample drawn at the time of your baby’s routine newborn screening.
Newborn hearing tests also have become common practice. The screening of newborns involves the use of non-invasive measures that include otoacoustic emissions (OAEs), in which sounds are played in your baby’s ears and an echo response is measured, and/or auditory brain response (ABR), which tests an infant’s ability to hear soft sounds through miniature earphones. Both are painless and can be done while your baby is resting quietly.
The First Few Days
Now comes the fun part: It’s time to go home to the nursery that’s waiting for your baby. A regular schedule of well-baby visits with your pediatrician will then keep your baby healthy. So just sit back, watch your baby grow and enjoy this special time that you have together.
After nine long months of waiting for your baby to make his first appearance, he’s finally here. But before you take him home to the nursery you’ve lovingly prepared, how do your doctors make sure he’s ready to come home? Between APGAR scores, antibiotic eye ointment and vitamin K injections, your doctors and nurses will take good care to make sure your baby’s transition to the outside world is a healthy one.
When your baby first leaves the comfort and safety of the womb, he is vulnerable to countless germs and diseases. So once his umbilical cord is clamped and cut and he is dried and wrapped up, your baby will receive various medications and screenings to protect him from infection and help ensure his well-being.
To prevent serious eye infection caused by exposure in the birth canal to gonorrhea or chlamydia, both of which can be asymptomatic in the mother, the antibiotic ointment, erythromycin, will be applied to your newborn’s eyes soon after delivery. However, because the eye treatment can cause puffiness and temporarily blurred vision, you may want to ask your doctor to delay treatment at least until you’ve had time to feed and bond with your new baby. “I specifically wrote in my birth plan that I wanted the eye ointment and any shots delayed as long as possible after birth," says Terri Lindeman, mother of two from Hercules, Calif. "I was glad I did, as I felt like I had ample time to hold and look at my babies.”
Within 24 hours, your baby will receive a full exam from a pediatrician who will evaluate your baby’s color, make sure his movements are symmetrical and feel the soft spots on his head. Most importantly, however, he will listen to your baby’s heart for murmurs and make sure he’s not breathing too fast, both of which may show up first as a problem, according to Dr. Altmann.
According to the American Academy of Audiology, as many as three in 1,000 babies are born in the United States each year with hearing loss, making it vital that you have your baby’s hearing tested before leaving the hospital. Otherwise, mild to severe hearing problems may not be identified until your child is about 2 years of age. When hearing loss is detected late, language development can be delayed.
Once the initial newborn checkup has been completed, your baby will be monitored carefully during the first days of his life. His heart rate, respiratory rate, heart and breathing sounds, temperature, skin color and feeding and bowel movement patterns will be checked regularly to ensure that he is continuing to do well. While your baby may lose up to 10 percent of his body weight in the first couple of days, he should regain this weight within the first two weeks.
