The first hours of the newborn’s life are key to assessing their general condition . That is why during the time you stay in the hospital – if everything has gone well it is usually between two and three days depending on the type of delivery – you will undergo the first medical check-ups.
If there have been no complications during pregnancy and delivery and the baby is apparently healthy, it is best to place it on its mother’s breast as soon as it is born, so that early skin-to-skin contact helps to establish the link between the mother and her baby, and start breastfeeding. But this situation does not have to interfere with most tests or procedures that will be done on your baby.
We explain what these tests and routine postnatal care are that will be performed on your newborn .
Clamping and cutting the umbilical cord
The World Health Organization recommends that whenever possible, what is known as “delayed cord clamping” be carried out , which consists of waiting one to three minutes for the newborn to receive more blood from the placenta and thus there is less risk of anemia.
Early clamping and cutting of the umbilical cord (less than one minute after birth) is not recommended, unless the newborn suffers from hypoxia and must be transferred immediately for resuscitation.
Cord blood collection
Once the umbilical cord has been cut , two blood samples will be taken to measure the blood group and Rh of the newborn, and to perform a blood gas, which will indicate the level of oxygenation at birth. In the case of suspected Rh incompatibility or if the mother is Rh negative, a test called Rh-Coombs will also be performed.
Identification of the newborn
According to the Commission of the Spanish Association of Pediatrics for the Identification of the newborn, the most reliable method of identification consists of a combination of:
- Neonatal encoder : mother’s bracelet and newborn’s bracelet, and cord clamp with the same number and with an identical and exclusive barcode for each newborn,
- Collection of a sample of maternal blood and another of umbilical cord blood for DNA analysis in case exclusively of doubt of identity
Newborn identification practices can be carried out while the baby is on the mother’s breast.
Apgar test
One minute after birth, an assessment of the general condition of the newborn called the Apgar test is carried out, which is repeated after five minutes. This assessment can be done perfectly by maintaining skin-to-skin contact.
The test is named after Dr. Virgina Apgar, who in 1953 devised this way of evaluating the newborn, scoring its general condition from 1 to 10, according to five parameters. Each of the parameters is scored from 0 to 2, which when added together reaches a maximum score of 10 points. The five parameters are:
- Heart rate : there is no 0 points. If it is less than 100 beats per minute, 1 point. If it is greater than 100 beats per minute, 2 points.
- Respiratory movements : there are no 0 points. Choppy and irregular movements, 1 point. Regular movements and loud crying, 2 points.
- Muscle tone : if the baby suffers atony they are 0 points. If you have slow and reduced movements, 1 point. If you have strong movements and flexion of the limbs, 2 points.
- Response to stimuli : there is no 0 points. If the baby only grimaces, 1 point. If you cough, sneeze and cry, 2 points.
- Skin coloration : if the skin is blue or white, it is 0 points. If it has a pink trunk and blue extremities, 1 point. If you have an overall rosy hue, 2 points.
Most newborns score between 8 and 10 points. If it is less than 7 points, the baby should be transferred to the care area for assessment and stabilization. When the result is less than 5 points, it is usually due to difficulties that may have arisen during delivery or cardiorespiratory problems.
General assessment of the newborn
Although in most hospitals the first general assessment of the newborn is usually done right after birth, the El Parto es Nuestro Association recommends doing it without haste during the first 24 hours.
In this comprehensive assessment, the pediatrician will measure the baby’s weight, length, head circumference, and chest circumference. He will also check the head, hips, chest, genitals, spine, and extremities to make sure everything is normal and no abnormalities or malformations are detected.
Typically, a full-term newborn has a size between 46 and 53.5 cm and weighs between 2,500 kg and 4,300 kg if it is a boy, and if it is a girl, its size is between 45.5 and 53 cm and weighs between 2,400 and 4,200 kg.
Neonatal conjunctivitis proxylaxis
In order to avoid neonatal conjunctivitis, and as indicated by the Spanish Pediatric Association, a prophylactic treatment is applied to the newborn based on drops or ocular antibiotic ointment of 0.5% erythromycin or, failing that, 1% terramycin.
Administration of vitamin K
As prophylactic treatment of hemorrhagic disease of the newborn, the American Academy of Pediatrics (AAP) recommends intramuscular administration of a single dose of vitamin K , as this form of administration has been shown to protect more than when it is administered by orally.
The WHO advises the administration of this injection after the first hour after birth, in which the infant should be in skin-to-skin contact with the mother and breastfeeding begins. That is, it is not justified to separate the newborn solely to administer vitamin K
The hemorrhagic disease of the newborn is a very serious condition (it can even cause the death of the baby) that occurs due to a deficiency of vitamin K. It has an incidence of 1.7% in cases in which this measure is not carried out , reducing the risk of prevalence to 0.24-3.2 cases per 100,000 newborns, when the vitamin is administered.
Hepatitis B Vaccine
The Hepatitis B vaccine is administered in different ways depending on the autonomous community. Thus, in some communities four doses are administered, the first to the newborn, and the others at two, four and 11 months.
However, some communities have decided to suppress the first puncture to the newborn, given the scientific evidence that supports that, thanks to the knowledge of the serology of the pregnant mother and the immune control during pregnancy, the transmission of this disease is currently prevented in the baby and, therefore, it is not necessary to administer this first dose. Newborn vaccination will be administered exclusively when the mother is a carrier of the disease or when serology is unknown .
Second check-up at 24 hours
At 24 hours after birth, the pediatrician will return to do a check-up of the newborn in which he will assess his general appearance again through a more exhaustive review. He will ask the parents if the baby has peed, if he is nursing and if he has had his first bowel movement, called meconium.
It will explore the spine, head, eyes, mouth, genitals, ears, extremities, and especially the hips . They will perform some maneuvers, known as Ortolani and Barlow maneuvers, which consist of a series of movements that flex and open the legs to check if the joint is correct or could present an abnormality such as hip dysplasia.
A neurological examination will also be done to assess the newborn’s reflexes, which are: the search reflex, the sucking reflex, the tonic reflex, the Moro reflex, the plantar and palmar pressure reflex, the Babinski reflex or the Koch, the Galant reflex, the automatic gear, the crawling reflex, and the climbing reflex.
If the baby is not weighed again in this second check-up, it will be done on the day of discharge, in order to assess whether the physiological weight loss is within normal limits.
Heel test or neonatal screening
The heel test is performed 48 hours after birth, by pricking the baby’s heel with a lancet to impregnate with a few drops of blood a special absorbent paper that will be sent to the laboratory for analysis. Its objective is the early detection of certain congenital metabolic diseases , such as hypothyroidism, adrenal hyperplasia, cystic fibrosis or hyperphenylalaninemia.
The test can be uncomfortable for the baby, so pain can be alleviated if the test is performed while it is on its mother’s breast.
Neonatal screening for hearing loss
According to the Spanish Association of Pediatrics, there are two tests to detect hearing loss in the newborn, which are performed before discharge. One is otoacoustic emissions, which explores the peripheral auditory organ, and another is trunk auditory evoked potentials.
But it is important to know that although these tests give results within normality in those first hours of life, throughout childhood there could be certain causes that cause hearing loss in the child, so it is essential to know the warning signs and consult with the pediatrician any questions in this regard.
Procedures that are not necessary
As we have mentioned, whenever possible tests should be performed with the baby in skin-to-skin contact with its mother to prevent hypothermia, promote lactation and ensure the well-being of the newborn.
Likewise, the WHO recommends waiting at least 24 hours to bathe the baby, and not performing aspiration of the mouth and nose in neonates born with clear amniotic fluid who begin to breathe on their own at birth.
In the past, routine aspiration of oral and pharyngeal secretions was common, as well as passage of probes to rule out esophageal or anal atresia, and routine gastric lavage. However, and as we can read in the report ‘Care from birth’ of the Ministry of Health, all these procedures do not currently make any sense.
Photos | iStock
Via | Spanish Association of Pediatrics
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