Your newborn: Medical tests and terms
Congratulations! Now that you have delivered your baby, you may well have a new appreciation of the term "labor." You also may have questions about the terminology and tests you observed in the hospital. These quick summaries offer some answers.
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. Many infants with low Apgar scores grow up normally.
Vitamin K shots
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.
All hospitals administer vitamin K to newborns.
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.
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.
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 newborn 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.
Can your baby hear?
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.
Newborn screening tests
Return to Vol. 1: The first few days
Pregnancy Condition Center: Your newborn
Source: American Academy of Pediatrics; Children's Hospitals and Clinics of Minnesota; Committee on Fetus and Newborn, Controversies concerning vitamin K and the newborn, Pediatrics, Vol. 112 No. 1 July 2003; M. A. Klebanoff, J. S. Read, J. L. Mills, and P. H. Shiono, The Risk of Childhood Cancer after Neonatal Exposure to Vitamin K, New England Journal of Medicine, Sept. 23, 1993
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