Health & Wellness

Delivery: A Baby's Perspective
By Dr. Charlie Rapp and Colleagues

Congratulations in advance on the birth of your baby! This is an exciting time, and it’s about to get even more exciting when your baby arrives.

As pediatricians, we have designed this handout to prepare expectant parents for the routine tests and procedures that many newborns undergo. Specifically, we will cover: the newborn screening test (PKU), hepatitis B vaccination, vitamin K administration, hearing screening, circumcision, and bilirubin/jaundice testing.

After delivery, your nurse will briefly evaluate your baby. The vast majority of babies are then simply placed on mother’s chest, allowed to feed, and do wonderfully.

Occasionally, some babies require immediate pediatrician evaluation after delivery.In addition, both Southwest Washington Medical Center and Legacy Salmon Creek Hospital now have newborn specialists (neonatologists) on staff, to care for infants who are very ill.

Thankfully, most newborns are born healthy. In order to maintain health, there are several recommended procedures/tests, which will be offered during your baby’s hospital stay. The following is a summary of these procedures and tests.

Newborn screening test (PKU, heel stick test):

Prior to discharge your baby will receive a newborn screening test. This test involves pricking baby’s heel and obtaining several blood drops which are placed on an absorbent paper. The sample is sent to the Washington state lab where tests for nine different diseases are performed. Included in the test is a screen for abnormalities in the red blood cells. Most of the tests, however, involve testing for “metabolic disorders” which are deficiencies in production of certain body chemicals.

Importantly, of the nine diseases for which we screen, none are visible at birth. Without the newborn screening test, many of these diseases would take weeks or months to discover. In many cases, irreversible damage would already have occurred. For these reasons, there is a universal consensus among pediatricians that the newborn screen should be performed within several days of birth. Because all tests have a degree of inaccuracy, the states of Oregon and Washington both require a second test performed at the two week visit with your pediatrician.

In 2002, there were 75,000 infants screened in Washington, of which 60 had a significant disease. These infants were treated with special diets or medicines, which will allow them to lead normal lives. Your pediatrician will contact you if there is any abnormality on either test.

More information about the newborn screening test is available through the state health department at www.doh.wa.gov/ehsphl/phl/newborn/default.htm

Vitamin K administration

Soon after delivery your baby will receive an injection of vitamin K into the thigh. This injection dramatically reduces the possibility of developing a severe, life-threatening bleeding disorder, called hemorrhagic disease of the newborn.

Hepatitis B vaccination

Hepatitis B is a serious, lifelong illness affecting many thousands of people in this country. It is a common cause of liver cancer, and cirrhosis of the liver, which leads to liver failure. The Hepatitis B vaccination is required for school entry in the state of Washington.

The vaccine has a proven record of safety and effectiveness for newborns, infants, children and adults. Thimerisol (a mercury containing preservative) was removed from the vaccine in 2001.

We recommend routine vaccination soon after birth, as this provides maximal protection for all neonates. Hepatitis B vaccination is an injection into the thigh.

If you have further concern regarding hepatitis B vaccine or any other vaccines, we recommend the CDC (Center for Disease Control) website at: www.cdc.gov  (Click on the “vaccines and immunizations” category in the left column.)

Hearing screen

At some point during hospitalization your baby will have a hearing screen. Three in 1000 newborns have a mild or greater hearing loss. Furthermore, 50% of babies born with hearing loss have no known risk factors. It is important to recognize hearing loss early so that the family and baby can begin to receive early intervention services.

For the above reasons, the state of Washington recommends screening of all newborns before hospital discharge. At SWMC and Legacy Salmon Creek Hospital, a test called an Evoked Otoacoustic Emission (EOAE) is used. This test is very safe and will not make your baby uncomfortable. A soft rubber earpiece is placed in the ear canal. The instrument makes a series of clicks, and a normal ear will reflect the clicking sounds back to the machine. Your pediatrician or nurse will inform you of the test result.  Abnormal tests are confirmed with a referral to an audiologist, where a different test called a Brainstem Auditory Evoked Response (BAER) is performed.  

Additional information regarding hearing testing in Washington is available at the website: www.newborn-hearing-screening.org

Circumcision

If you are having a boy, you will need to decide whether or not to have him circumcised. This is a personal/parental decision and there are reasonable arguments on both sides of the issue.

In 1999, the American Academy of Pediatrics examined the pros and cons of circumcision, and came to the following conclusion: “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision…[and] parents should determine what is in the best interest of the child.”

Research suggests that circumcision reduces the possibility of your son developing a UTI (urinary tract infection), especially in the first year of life. Recent studies have found that uncircumcised males have a three to seven times greater risk of UTI during the first year of life, versus circumcised males. (AAP Policy Statement, 1999, reaffirmed 2005) It is important to note, however, that the overall risk for UTI in any male is still quite low. Circumcision may also decrease the risk of penile cancer (which is very rare) and sexually transmitted disease.

Nevertheless, circumcision is a surgical procedure and is not without risk. There are known rare complications.

The procedure itself consists of surgical removal of the foreskin at the end of the penis, using one of several types of clamps. Local anesthesia is nearly universally used, though many infants undoubtedly experience some pain. If you decide to have the procedure, your obstetrician or nurse will advise you on home care of the circumcision. Tylenol can be given for especially fussy infants in the days following circumcision.

In Clark County, obstetricians have generally performed the circumcisions. If you decide to have your son circumcised, we strongly advise doing so before leaving the hospital, as the procedure becomes more difficult with increasing age, and insurance companies often do not cover outpatient circumcision.

For additional information on the benefits and risks of this optional procedure, speak with your obstetrician, pediatrician or view the entire American Academy of Pediatrics position statement on circumcision (published 1999, reaffirmed 2005): http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686

Jaundice

Jaundice refers to a yellow discoloration of the skin and eyes which results from a substance called bilirubin. Bilirubin is released from red blood cells in the days following birth. The liver processes the bilirubin and allows the baby to excrete the bilirubin with bowel movements. Most newborns have some degree of jaundice and a low to moderate degree of jaundice is not dangerous. Occasionally, however, very high levels of jaundice can cause damage to the brain.

Thus, if your baby is very yellow, he or she may require a heel stick or blood draw to obtain blood for measurement of bilirubin. In some cases a transcutaneous bilirubin meter will be used, which uses a sensor placed in contact with the forehead. This is slightly less accurate than the blood test, but non-invasive. If bilirubin levels are high, your pediatrician may recommend rechecking the level (usually the next day), or if the levels are very high, your pediatrician may recommend hospitalization. During the hospital stay, special lights are used to decrease bilirubin levels. In some cases, “bili lights” are prescribed for home use.

A Final Note

This is a special time for you, your family, and your new arrival. If you have any questions, please feel free to ask your nurse, pediatrician or obstetrician. We recommend that you select a pediatrician, or at least a specific group prior to hospital arrival. This will allow your pediatrician to examine your baby in the hospital.

Evergreen Pediatrics offers tours of its pediatric office where you can meet with pediatricians prior to delivery of your baby. Generally, these sessions take place on a monthly basis. For more information, or to schedule tour, please call our office at (360) 892-1635