Checking out

Before you take him home, your newborn will undergo a series of evaluations to make sure he’s healthy and strong.
By Jennifer Torres Siders

You counted 10 tiny fingers and 10 sweet toes. In your eyes, your newborn is as flawless as he is precious. Rest assured, you’re probably right. But doctors still will want to look a bit closer to be sure all is well with your new arrival.

Prior to leaving the hospital, expect your little one to undergo an array of screenings and evaluations (including prods and, yes, pokes) all designed to ensure he has the healthiest possible start. “Parents are normally very anxious,” acknowledges Deborah Campbell, MD, director of the Division of Neonatology at the Children’s Hospital at Montefiore in New York. The mere possibility that something might be wrong with your infant can be a scary thought to entertain. But most disorders are relatively rare, and early testing makes it possible to address potential problems right away. Charles Shubin, MD, director of pediatrics at Mercy Family Health in Baltimore, Maryland, explains, “This is an opportunity to address problems before they become apparent.”

Use this guide to understand the tests your newborn will experience in his first day or two of life.

newborn-doctor

Apgar
In what’s likely the first health evaluation your child will receive, an Apgar score, ranging from 0 to 10, is assigned just after birth. It’s designed to help determine whether a newborn needs immediate medical attention.

What’s involved
The delivery room doctor will evaluate your baby at one minute after birth and again at five minutes after birth to determine his Apgar scores. To obtain a score, the doctor will consider the baby’s complexion (is his skin bluish or a healthy pink?), pulse rate, reflex irritability (does he grimace or cry when poked?), activity and breathing.

Why it matters
An Apgar score of 10 is rare because most babies are born with slightly dusky palms and feet, notes Alex Espinoza, MD, medical director of the Newborn Intensive Care Unit at Alta Bates Summit Medical Center in Berkeley, California. Scores of seven and higher are considered normal. “If it’s less than five, then there is some concern, so we’ll monitor that baby more closely,” says Tiffany McKee-Garrett, MD, assistant medical director of the Mother Baby Unit at Texas Children’s Pavilion for Women in Houston. But, she adds, “If your baby is healthy enough to leave the delivery room with you, there isn’t a problem. You don’t need to worry.”

Heel stick test
Each year, millions of babies are routinely screened, using a few drops of blood, for dozens of genetic, metabolic and other types of disorders that aren’t otherwise detectable at birth. While rare, these disorders have potentially serious consequences, including brain damage or even death. But in many cases, treatments are available and highly effective. “These screenings help to identify problems, diseases and issues that, if addressed early, can have improved outcomes,” says McKee-Garrett. “The sooner we know, the better.”

What’s involved
Between 24 and 48 hours after birth, a medical professional will use a lancet to prick your baby’s heel, then apply several drops of blood to a special card. This blood-spot card will be sent to a state laboratory for analysis. “It’s amazing what you can do with a couple drops of blood,” Espinoza says. In some states, the test will be repeated at a doctor’s office or clinic two weeks after birth. If results raise concerns, the lab will contact your child’s doctor, who, in turn, will call you for further testing and treatment, if necessary. “Make sure the contact information you provide is correct,” Espinoza advises. “If there’s a problem, we want to get in touch with you quickly.”

Why it matters
Among the many disorders tested for in newborn blood screening is phenylketonuria, or PKU. Babies with this disorder lack an enzyme needed to metabolize a certain amino acid. Untreated, the acid accumulates and can cause seizures, brain damage and other serious problems. But treatment is fairly simple and effective: a special infant formula prepared without the problematic amino acid. Treatments also exist for most of the other disorders that can be detected using a heel stick test, explains Barbara True, RN, a labor and delivery nurse at Texas Health Arlington Memorial Hospital. “These tests are very important,” she says. “These diseases can cause mental retardation, and the treatment might be a simple diet change.”

Bilirubin test
Bilirubin is a substance created when red blood cells are replaced, and normally, it is broken down by the liver and removed from the body. A newborn’s liver doesn’t remove bilirubin from the blood very effectively, though, which can lead to a buildup result-ing in jaundice, a yellow color in the skin and eyes.

What’s involved
Most newborns have mild jaundice that disappears on its own within about two weeks. But in some cases, jaundice is severe and requires treatment. About 24 hours after your baby is born, medical professionals will check his bilirubin level. They might use blood drawn in the heel stick test or a bilimeter, a tool in which a sensor is pressed to the skin, to estimate bilirubin levels. “We know that babies who are born preterm are at higher risk,” says Campbell. “Exclusively, breastfed babies are at higher risk because their colostrum intake is a very small amount, which is perfectly adequate nutritionally but can mean a higher percentage of initial weight loss, which concentrates the bilirubin.” If tests show bilirubin levels are too high, your little one might be placed under special blue lights that help break down bilirubin in the skin. This treatment, called phototherapy, usually lasts a day or two.

Why it matters
Parents should note that in rare cases, too much bilirubin can cause brain damage, hearing loss or cerebral palsy, McKee-Garrett explains. Fortunately, it’s completely and easily treatable.

Weight loss evaluation
Your little one will be weighed several times while you’re in the hospital to help doctors assess his overall health and to check whether he’s well-fed and well-hydrated.

What’s involved
All babies lose weight after birth, according to True. A loss of up to 10 percent of birth weight can be normal. But, she goes on, “Anything more than that becomes something we are concerned with.”

Why it matters
By keeping track of your baby’s weight, doctors can prevent dehydration and address any potential feeding problems. “It could mean working with mom to ensure that the baby is nursing effectively, that there’s a good latch and good suck,” Campbell notes. In other cases, doctors might recommend supplementing with formula or ask you to visit a clinic for daily weigh-ins after you leave the hospital until your baby’s weight is back on track.

Hearing test
Hearing loss is one of the most common problems identified in newborn health evaluations, affecting 1 to 3 of every 1,000 babies, according to the American Academy of Pediatrics. Overwhelmingly, newborns with hearing loss have parents whose hearing is normal.

What’s involved
The newborn hearing test, which the American Academy of Pediatrics recommends all babies have before they go home from the hospital, is painless. Your baby might even sleep through it. Tones or clicks are played through small earphones, and your little one’s responses to those sounds are measured and recorded. Babies who don’t pass the initial test are rescreened and usually pass the second time around. If hearing loss is detected, you’ll be referred to specialists who can help identify the cause and develop a treatment plan.

Why it matters
Your baby is learning from the time he is born, and hearing is one of his most important learning tools, especially when it comes to developing language. Children whose hearing loss isn’t detected through a newborn screening test often aren’t diagnosed until they are almost 2-years-old, notes Espinoza. By then, speech and language delays are already apparent. “We want to see screening by one month, diagnosis by three months and therapy by six months,” adds Campbell. “When that has happened, by 18 months, the baby’s language development is comparable to that of hearing children.”

Screening for heart disease
In 2011, the U.S. Secretary of Health and Human Services approved the addition of a test for critical congenital heart disease (life-threatening defects that usually require surgery) to the list of officially recommended newborn screenings. Since then, a growing number of states have passed laws requiring that heart screenings be administered to babies before they leave the hospital. If the test is not required in your state, you might have to ask for it.

What’s involved
About a day after your baby is born, he’ll be evaluated for heart defects using a painless test called pulse oximetry. Small sensors are attached to his hand and foot to measure the oxygen level of his blood. If oxygen levels are too low after several screenings, the baby will receive further testing, including an echocardiogram, and should be seen by a cardiologist.

Why it matters
Critical congenital heart disease affects about 8 in every 1,000 newborns, but babies with heart defects can seem healthy at first. Within days, however, life-threatening complications can develop, putting affected babies at risk of disability or death, reports the U.S. Centers for Disease Control and Prevention. According to Espinoza, “Heart screening helps save babies who would have died without immediate attention.”

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