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Tests after birth

Right after birth, your baby will have a few tests to see if he or she needs special care and to prevent health problems later on. They'll include...

Talk with your health care provider or the hospital staff if you have any questions.

    Apgar score

    Immediately after the delivery the doctors or nurses may mention the Apgar score.

    In 1952, Virginia Apgar, MD, an anesthesiologist, developed a numerical summary of a newborn's condition at birth. She based her score on five signs: heart rate, respiratory effort, muscle tone, reflex irritability and color. The doctor or nurse calculates the score at one and five minutes after delivery and every five minutes thereafter until the baby achieves a score of at least seven.

    Nurses and physicians use the Apgar score to measure the health of an infant immediately after birth. The Apgar scores also guide how much assistance, if any, your baby requires immediately after birth.

    • A score over seven indicates a healthy baby who needs minimal intervention.
    • A score from four to six indicates mild to moderate problems and the need for close observation and some assistance.
    • A score of three or less suggests potentially serious problems and the need for substantial help with breathing and other vital functions.

    Apgar created her score for full-term infants. Premature infants frequently have lower scores than full-term infants even though they are healthy.

    The Apgar score guides the nurses and doctors to provide the help your baby needs right after birth. The Apgar score poorly predicts future development and long-term outcome. Most infants with low Apgar scores grow up normally.

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    Vitamin K shot

    Shortly after birth, most infants are given a shot of vitamin K. This normal procedure provides your baby with additional vitamin K to help the blood clot properly and prevent excessive bleeding.

    Newborn babies have little stored vitamin K. If they are breastfed, they do not receive much vitamin K either. Even formula-fed infants are at risk of having low vitamin K levels in the first few weeks after birth. Later on, the bacteria in the intestine will manufacture enough vitamin K for your baby. Until then, giving your baby a single shot of vitamin K increases your baby's vitamin K level and prevents almost all cases of serious bleeding from vitamin K deficiency.

    There have been erroneous suggestions that vitamin K shots in the newborn period cause cancer and other problems later in life. This has been proven false. If you do not want vitamin K given to your baby, you should discuss this with your doctor before delivery.

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    Antibacterial ointment in the eyes

    Shortly after birth, the nurses will place antibacterial ointment in your baby's eyes. This ointment prevents gonorrheal eye infections acquired from the birth canal. Gonorrhea-causing bacteria can enter the eyes during vaginal delivery and cause a severe infection threatening a baby's sight.

    A woman may have gonorrhea in her birth canal without having any symptoms. It has become standard practice to treat all newborns rather than check every woman for gonorrhea during delivery. The ointment causes no side effects.

    Two alternative treatments are silver nitrate and iodine solutions, which may cause brief irritation of the eyes.

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    Newborn screening for hidden, rare disorders

    All states require hospitals to test newborn babies for certain rare, metabolic diseases. Without blood testing, doctors cannot know if these diseases are present until they have already caused irreversible brain and other injury. Early detection and treatment prevents much of this damage.

    The phenylketonuria (PKU) and other metabolic screening tests identify these diseases in the body's chemistry before they cause serious injury. States vary in the diseases for which they test. All states test for phenylketonuria (PKU) and low thyroid function.

    The hospital where you delivered should obtain a blood specimen from your baby's heel for these tests before discharge. The hospital also receives the results and should pass them on to your baby's primary doctor or nurse practitioner.

    On your baby's first check-up you should ask if the state-screening tests' results have been received. One or more of these tests may have to be repeated if your baby was premature, the tests were obtained in the first 24 hours after delivery, or if the results are inconclusive. Only a single drop of blood is required to perform all the tests.

    If the newborn screening test is positive, then additional testing may be needed. If this occurs, your doctor or nurse practitioner will contact you to arrange for this additional care.

    For more about newborn screening, go to health.state.mn.us/newbornscreening or call 1-800-664-7772 to speak to a genetic counselor.

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    Hearing test

    The American Academy of Pediatrics (AAP) recommends that all newborns have their hearing tested before they are discharged from the hospital.

    Parents and even doctors cannot always tell if a child hears without formal testing. By the time parents or caregivers recognize hearing loss, the infant may be over one year old and have lost a valuable period of speech development. In fact, many children with hearing loss who are not diagnosed and treated until after one year of age never achieve completely normal speech patterns. Therefore, all newborns should be screened for hearing loss.

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    Source: Children's Hospitals and Clinics of Minnesota

    First published: 05/01/2001
    Last updated: 01/10/2011

    Reviewed by: [1/10/2011] Patti Constant, MPH, communication/education supervisor, Minnesota Department of Health Newborn Screening Program; [06/06/2006] Kent Wegmann, MD, Children's of Minnesota Pediatric Clinic - St. Paul