The procedures listed here are routinely done with hospital births. Most of them are required by state law. As parents you have the opportunity to research the procedures available to your baby and make these choices for them. Because these are required by law and because they are viewed as highly effective with few, if any, side-effects, we will ask you to sign a waiver for any procedures you wish to decline.
Vitamin K is essential to allowing blood to clot properly. While all babies are born with low levels compared to adults, a rare few will not be able to clot adequately with these levels. The result is uncontrolled bleeding. Exact incidence risks are impossible to determine because preventative measures have been implemented for about 60 years. Estimates range from 1 in 150 to 1 in 10,000.
Although rare, this bleeding disorder is very serious and often results in permanent brain damage or death. Since the 1950s, standard of care has been for babies to receive an injection of vitamin K at birth. This injection is very effective at preventing this disorder, reducing it to about 1 in 400,000. This vitamin is fat soluble and remains in the system for several weeks which provides protection until the baby is able to produce adequate vitamin K in his own gut.
Right now the only known side-effect of the vitamin K injection is a slightly more rapid breakdown of the baby's red blood cells. Red blood cell breakdown is a normal part of a newborn's transition and results in a mild degree of jaundice. It is possible that the vitamin K injection might make this jaundice slightly worse although the research indicates that the increase is not clinically significant.
It is not known if there are any benefits to the low vitamin K levels that babies are born with naturally or if there are any harms from the relatively high levels caused from the injection. However, it is very unlikely that any research will be done in this area as vitamin K injections appear to have been used for many decades with no obvious harms.
Standard of care is to give a 1mg dose as an injection into the baby's thigh in the early hours after birth. Most babies are well fed and relaxed and sleep through it.
Antibiotic Eye Ointment
Utah law requires that every baby receive an antibiotic eye ointment to prevent transmission of gonorrhea and chlamydia from mother to baby during birth. If these bacteria are passed on, they cause very severe eye infections that can cause blindness if they are left untreated.
A thin strip of the antibiotic erythromycin in a clear gel is placed inside the baby's eyelid. This dissolves over about 30 minutes. It doesn't burn or sting and does not usually disturb the baby at all. If they are awake, it does make their vision blurry for a little while until it dissolves. Because of this, we prefer to wait until the baby has already finished the face-to-face bonding and breastfeeding time and has gone to sleep.
Although the legal requirement is for chlamydia and gonorrhea, the antibiotic is also effective against other bacteria that may cause other, less serious infections. Some research shows a benefit from this and other research does not.
Here is an indepth article about eye ointment.
Utah law requires all infants to have their hearing checked by 3 months of age, and preferably within 2 weeks. Although most parents feel they would know that their baby could not hear, research shows that even most profound hearing loss is not usually detected without testing before a child is nearly 18 months old. Early interventions allow the baby to be exposed to language and possibly sound during critical developmental periods.
The hearing screening is done by placing a small probe in each ear. The transmitter sends very soft sounds of different frequencies into the ear and analyses the sound waves that are bounced back. Depending on the patterns received, the analyzer can determine if the ear structure and function is normal.
A failed screening does not necessarily mean that a baby cannot hear. Sometimes birth debris in the ear canal blocks the sound waves. If this happens, we will repeat the screening in a few days. If that test fails, we will refer you to an audiologist for more sophisticated testing.
Utah state law requires all babies to be screened for 37 genetic disorders. Most of these are metabolic, meaning that there are genetic errors that cause problems with the way food is broken down or necessary cell components are made. Other diseases tested for include hormone disorders, red blood cell disorders and cystic fibrosis. All of the disorders are treatable but not curable.
The test is done by collecting 7 drops of blood from the baby's heel on a special filter paper. The samples are tested at the State Newborn Screening Lab. The first test should be done between 24 and 48 hours of age before the milk is in when they are at their peak weight loss. All of the diseases are tested for at this time but some of them are only accurate at this time, such as fatty acid oxidation disorders. A second screen, done between 1 and 4 weeks, repeats some of the tests that may not exhibit high enough levels to alert illness such as thyroid levels and some of the other metabolic disorders.
We do our best to make this test as comfortable as possible for the baby. We wait until the baby is very relaxed at the end of a feeding, warm the foot well and use special lancets designed to minimize pain. We encourage you to nurse your baby during the test.
Utah Health Department Information for Families.
Includes a list of all the diseases screened for including specific information about them and the available specialists and resources.
Critical Congenital Heart Defect Screening
Utah state law requires all babies to receive critical congenital heart defect screening. After babies are born, several changes happen in their heart, major blood vessels and lungs as they adapt to life outside the uterus. Some types of heart defects result in sudden, severe loss of oxygen when these changes can result in sudden death in the first week of life. This screening allows these severe heart defects to be detected so that treatment or surgery can be started before the transition and life-threatening lack of oxygen occurs.
The test is non-invasive and involves measuring oxygen levels with a pulse oximeter. Levels in the right hand (measures blood straight out of the heart) are compared to the oxygen levels in one of the feet (blood that has to be pumped through other parts of the body).
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