Right after birth babies need many important tests and procedures to ensure their health. Some of these are required by law. Check with your healthcare provider to determine which of the following tests are required by law, essential for your child's well-being, or necessary only in some newborns.
Key Points
- Your baby's doctor will perform a battery of tests to assess their health.
- Your newborn will receive a Vitamin K shot to help prevent a dangerous bleeding problem.
- You'll need to take your baby to six additional wellness checks before they turn one year old.
What to Expect Right After Birth
The following tests and procedures are recommended, or many times required in most hospitals in the United States:
- Apgar Evaluation
- Eye Care
- Vitamin K Shot
- Newborn Metabolic Screening
- Hearing Test
- Hepatitis B Vaccine
- Complete Check-up
Apgar Evaluation
The Apgar test is a fast way for doctors to find out if the baby is healthy or if he or she needs extra medical care. Apgar tests are almost always done twice, one minute after birth and then again five minutes after birth. A doctor or nurse measures five signs of the baby's condition. These signs are:
- Heart rate
- Breathing
- Activity and muscle tone
- Reflexes
- Skin color
Apgar scores range from 0 to 10. A baby who scores seven or more is considered to be very healthy. A lower score doesn't always mean something is wrong. Many healthy babies often have low Apgar scores in their first minute of life.
In more than 98% of cases, the Apgar score reaches seven after five minutes of life. When it does not reach that, the baby needs medical care and close monitoring. The following chart shows how each sign is rated.
Sign | 0 points | 1 point | 2 points |
Activity (muscle tone) | Absent | Arms and legs flexed | Active movement |
Pulse | Absent | Below 100 beats per minute | Above 100 beats per minute |
Grimace (reflex irritability) | Grimace | Below 100 beats per minute | Sneeze, cough, pulls away |
Appearance (skin color) | Blue-gray, pale all over | Normal except for extremities | Normal over entire body |
Respiration | Absent | Slow, irregular | Good, crying |
Eye Care
The Centers for Disease Control and Prevention (CDC) recommend that all newborns receive eye drops or ointment to prevent infections they can get during delivery. Sexually transmitted diseases are a main cause of newborn eye infections. These infections can cause blindness if they are left untreated.
Silver nitrate, erythromycin, and tetracycline are the three medicines used in a newborn's eyes. These medicines can sting or blur the baby's vision. You can choose to postpone this treatment for a little while. Some parents question whether this treatment is necessary at all. Many women at low risk for STDs choose not to have their newborn receive eye medicine. However, there isn't any evidence to suggest that this medicine harms the baby.
It is important to note that even pregnant women who test negative for STDs have the possiblity of getting an infection by the time of delivery. Also, most women with gonorrhea or chlamydia don't know it because they do not have symptoms.
Biotinidase Deficiency
Biotinidase deficiency is a blood test to determine whether the baby has insufficient biotin due to a deficiency in the enzyme biotinidase. When your baby has this condition, their body is unable to reuse and recycle biotin. This will inhibit your baby's ability to process nutrients, which can cause delays in growth and other complications. This is an inherited disorder, but can be treated by administration of biotin throughout life. About one in 60,000 newborns have this condition.
Vitamin K Shot
The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K. This vitamin is needed for the blood to clot, which means that low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns. Dangerous bleeding levels can cause brain damage and death, so this is a simple but very important step that doctors will take to protect your newborn. An infant that doesn't receive a vitamin K shot can develop these bleeding complications as late as six months old.
Newborn Metabolic Screening
Doctors or nurses prick your baby's heel to take a tiny sample of blood; this is used to test for many diseases.
All fifty states require testing for at least two disorders: phenylketonuria and congenital hypothyroidism. Phenylketonuria will require your baby to adhere to a strict diet for the rest of their lives. Congenital hypothyroidism is treatable, but it requires a fast response to prevent neurological complications.
Many states test for up to thirty different diseases, all of which are impossible to spot without a blood test. If left untreated, these diseases can cause cognitive issues and even death. The March of Dimes recommends that all newborns be tested for at least twenty-nine diseases. If you're concerned about your newborn being tested for the right diseases, have a conversation with your doctor prior to their birth. Your doctor can provide you with all of the information you need to know about what diseases your baby should and will be tested for.
Hearing Test
Many hospitals offer newborn hearing tests. Tiny earphones or microphones are used to see how the baby reacts to sounds. Newborn hearing tests can spot hearing problems early. This can help cut the risk of serious language and speech problems. This is the fastest and easiest way for doctors to tell if your child suffers from hearing loss or deafness. If this is determined to be the case, then doctors can fit your child for hearing aids and discuss further treatment with you.
Galactosemia
This is a test to determine whether the baby can digest the sugar found in milk. Untreated galactosemia can lead to cataracts, liver damage, cognitive issues, and death. Substituting a special formula for milk starting in the first weeks of life helps to avoid these problems. Galactosemia is discovered by testing a blood sample.
Hypothyroidism
Infants are tested for hypothyroidism at the time of discharge from the hospital or before transfer to another hospital or on the fifth day of life. Undetected hypothyroidism can lead to a variety of developmental disabilities, one of which is cognitive issues. This blood test is not routine in every state. An affected baby can be treated with supplemental thyroid hormone.
PKU
Phenylketonuria (PKU) is a genetic disorder, and it is routinely tested for during the first few days of life. In many states the test is required and is frequently done in conjunction with several other tests such as galactosemia and thalassemia. The test involves taking a sample of blood from the foot of the child. It is accurate only when the baby has been receiving a diet that contains phenylalanine, in both human milk and artificial formulas, for 24 hours. For this reason, a breastfed baby should not be tested until at least 7 days after birth to give your breastmilk a chance to come in and the baby to nurse.
Many healthcare providers do the test before you leave the hospital and then ask you to return in a week to have the test repeated. Consult your pediatrician/family physician about having this test done only once, when the results are most likely to be valid. Left untreated, PKU can cause severe cognitive issues. It can be prevented quite readily if detected before symptoms develop and the child is treated with a special diet.
Sickle Cell Disease
Sickle cell disease is caused by an unusual shape of the red blood cells that can lead to anemia, infections, pain, poor growth, and even death. Medical care begun early in life increases the chances of avoiding these problems, which is why early detection is important. The test is performed by examining the red blood cells from the baby's blood sample. This disorder is much more common in African Americans (1 in every 400 babies) and in Hispanics (1 in every 1000-1500 infants). One out of 10 African Americans is a carrier of the gene for sickle cell disease. This condition may also be diagnosed by prenatal analysis in some cases.
Hepatitis B Vaccine
Most hospitals now suggest that newborns get a vaccine to protect against the hepatitis B virus. hepatitis B can cause a lifelong infection, serious liver damage and even death.
The hepatitis B vaccine is a series of three different shots which The American Academy of Pediatrics and the Centers for Disease Control recommend the first shot soon after birth or before leaving the hospital. If the mother does not have hepatitis B, the first shot can be postponed for 2 months. The second shot and the third shot should be given before 18 months of age.
Complete Check-up
Soon after delivery most doctors or nurses also:
- Measure the newborn's weight, length, and head.
- Take the baby's temperature.
- Measure his breathing and heart rates.
- Give the baby a bath and clean the umbilical cord stump.
You can rest assured knowing that your newborn's doctors will perform a battery of tests to make sure they're as healthy as possible.
Will My Baby Need Further Check-Ups?
Your baby will certainly need further check-ups once you've taken them home! Your baby will need to go through six check-ups before they reach their first birthday. While this may seem like a lot, your baby is going to go through numerous changes throughout their first year. It's important that any developmental issues are caught early, so that they can be addressed. The sooner developmental issues are addressed, the better off your baby will be.
Your baby's first check-up after their newborn assessment will be when they're just a few days old. After this, check-ups will occur at one month, two months, four months, six months, and finally nine months. After this, your child's pediatrician will walk you through next steps for your baby's wellness checks.
Of course, if you have any concerns or notice anything off about the way your child is developing, it is incredibly important that you consult their doctor immediately. Don't wait until their next wellness check to say something! Your baby can't speak for themselves, so they need you to be their advocate.
The information in this article should not be taken as professional medical advice. Always seek the advice of a doctor for any medical questions or concerns. Moms Who Think is not responsible for any outcomes that may arise as a result of actions taken based on information we provide. It is your responsibility to do your own research and to take the appropriate measures to protect your health.
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