Great Expectations: Baby’s First Year

Newborn Tests and Screening

NAME OF TEST	WHAT IT’S FOR	HOW IT’S ADMINISTERED
Apgar score	To evaluate how the baby is faring in minutes 1, 5, and 10 after birth.	Your baby’s breathing efforts, muscle tone, color, reflexes, and heart rate will be given a score, with 1 being the lowest and 10, the highest. Most newborns will be ranked between 7 and 9 by the second scoring. A score of 4 to 7 may mean the baby needs extra help, and 3 or less signals that the baby requires immediate care.
Eye treatment	To protect the baby from eye infections caused by gonorrhea, chlamydia, or other sexually transmitted diseases (STDs) acquired from the birth canal.	Your baby will be given eye drops or his eyes smeared with an ointment that contains medication to control infections. It may cause the baby’s eyes to sting or interfere with vision. (You can request to have the treatment postponed until you’ve had a chance to interact with your baby and feed him.)
Vitamin K shot	Usually vitamin K is produced by the baby’s gut, but normal newborns have very low levels. It’s given to encourage blood clotting and prevent hemorrhagic disease of the newborn (HDN), a serious bleeding condition that could appear in the first few days of life.	It will be given as an intramuscular injection in your baby’s upper thigh. The baby may experience pain and swelling at the injection site, and more rarely, may develop a rash from the injection. Too much K has been associated with an increased risk of jaundice. (Ask that the shot be administered when your baby is skin-to-skin with you to help diminish his sensation of pain.)
Metabolic screening	The screening includes testing the blood for pnenylketonuria (PKU), a condition in newborns in which the body lacks a specific enzyme that can lead to abnormal metabolism, and when untreated, could result in brain damage. All fifty states require screening for other disorders, but the number of tests varies from state to state.	The baby’s heel is lanced and the blood collected for the screen. Lancing the heel is painful to the baby. A newer method is to use the back of the baby’s hand along with a topical anesthetic, which makes the procedure less painful for the baby and blood-collecting more efficient. (Having your baby in skin-to-skin contact with you during the procedure can help to diminish the baby’s sensation of pain.) The March of Dimes recommends that all babies be given tests for an additional 20+ disorders. You can ask your pediatrician to request a more comprehensive screening. (For more information on newborn screening, visit www.marchofdimes.com.)
Blood-sugar testing	Conducted on small babies weighing under 5 pounds, or large ones weighing over 9 pounds; when the mother is diabetic; or when the baby has tremors and shaking that are symptoms of low glucose levels (blood sugar). The concern is that the baby may suffer brain damage from prolonged low blood sugar.	The blood from your baby’s heel will be used for the test. If your baby is found to have low blood sugar, he will be given extra glucose to help raise levels. Again, having skin-to-skin contact between you and your baby can help to diminish your baby’s sensation of pain.
Hepatitis B vaccine	Hepatitis B (HBV) can cause inflammation of the baby’s liver. The baby is at greatest risk if his mother has HBV.	The baby will be given a series of shots over several months. Parents of low-risk babies may choose to start the series at birth or wait until the baby is 1 to 2 months old. (The pain of the shot is much less if the shot is given while your baby is experiencing skin-to-skin contact with you.)
Hearing tests	Significant hearing loss is one of the most common defects present at birth, and early intervention is critical to a baby’s normal language development. Some states now mandate hearing tests for newborns.	Small probes may be placed in your baby’s ear to conduct an otoacoustic emissions test that measures the response of outer hair cells deep inside the baby’s ear to determine your baby’s ability to hear. An auditory brain stem response test measures the way the baby’s brain responds to a “click” by using miniature earphones. Sensors measure the baby’s entire hearing pathway to determine if the sounds are heard normally. Both tests are harmless to the baby.

If your baby is still in the nursery and you want to see him, you can call the nursery yourself to see if your baby can be brought to your room. If there’s a delay for some reason, you may need to walk or be wheeled to the nursery to peek in. Sometimes a baby’s return to his mother can be delayed as the baby waits for a visit from the on-duty pediatrician, and if that’s the case you can request that when the pediatrician arrives, the baby’s checkup be performed in your room.

After birth, you’ll be facing two huge tasks: recovering from labor and learning to care for your new baby. Many women experience shivers and body shakes after delivery; if you do, cover yourself with warm blankets. They should subside within a few hours after delivery. You may be less likely to experience shivers if you keep your baby on your chest with skin-to-skin contact, because your body will heat itself up to help keep the baby warm.

You may also feel dizzy and woozy when you try to get up and walk. Until the dizzy phase passes— probably by the following day— you’ll probably need to ask for help standing up and moving around. Always sit on the edge of the bed and dangle your feet for a few minutes before getting up, to help prevent dizziness when you stand up.

After you’ve been given any required medications and stitches, you may be allowed to rest in your birthing room for a time with your baby. Keep your baby skin-to-skin as much as possible for both you and your baby’s sake.

In a busier hospital, you may be moved immediately from the delivery room into a recovery room so your blood pressure and overall condition can be monitored and other bodily functions checked periodically by the nurse on duty.

An epidural will take one-to-four hours to wear off. You may feel a tingling sensation as this happens, and you may experience side effects like a headache and itching.

You also may be shocked by postpartum nurses, who are the kindest and most helpful people around, but who will erase any traces of modesty you may have left by lifting your gown and checking your stitches, pads, and ice packs at all hours of the day and night.

Your respite may also be disturbed by food service, housekeeping, a visit from the doctor on duty, and your own doctor. If you’re in a teaching hospital, medical residents may request permission to examine you. Various professionals on different shifts will come around to take your blood pressure and temperature, and to administer medications. They may be so bold as to insist you get up on your feet and start walking. It’s for a good cause: to help to prevent blood clots from forming in your legs.

If you haven’t peed already, you’ll be asked to so that your care provider can be assured that your urinary tract and bladder weren’t damaged during birth. If it just isn’t happening for you, here are some tips: Ask for privacy; listen to running tap water; run warm water over your hand; use a spritz bottle to squirt warm water over your vaginal area; and drink water to build up your fluid stores. If you’re still unable to pee for more than 12 hours, a nurse or your doctor may insert a catheter to help.