Delivering Your Baby
Tiger Pediatrics physicians see their newborn patients at Boone Hospital Center every day until the mother is discharged from the hospital. When you are admitted to deliver your baby, you will be asked who your pediatrician is going to be, and we are notified when your baby is born. It is likely that the pediatrician you choose will be seeing your baby, however, we cover for each other on weekends, holidays, and in the evenings. If your baby is born at Women’s & Children’s Hospital or another facility, the pediatrician at that hospital will recommend an appropriate day to schedule a follow up appointment with your pediatrician at Tiger Pediatrics. To make that appointment, call our office and ask for Jessica.
The newborn period is an exhilarating time. You will be overwhelmed with the joy of the greatest gift you’ve just received, and challenged by all of the baby’s needs and cues for care. Our role during this time is to examine your baby and follow important data like your baby’s weight changes and jaundice, as well as provide answers to specific questions you will have.
What Do Newborns Need In The Hospital?
It may seem like a lot of things are happening to your baby upon his or her arrival. Knowing what to expect and understanding the reason for our interventions can make these things less stressful. You can expect to hear your pediatrician or nurse recommend the following during your baby’s hospital stay:
- Hepatitis B Vaccine
Prior to 1991 when the hepatitis B vaccine was recommended to all newborns, tens of thousands of children were infected with hepatitis B every year. Many people who are infected with hepatitis B are unaware of it, and therefore unaware they could be contagious to others who are not immunized. The younger a person is at the time of contracting the infection, the more potential there is for chronic damage to the liver. The hepatitis B vaccine is safe for your newborn. Booster doses are given at 2 months and 6 months of age.
- Vitamin K Injection
This has been a regular practice since 1961. By injecting vitamin K, we can prevent a devastating problem called hemorrhagic disease of the newborn. Without this intervention, babies are at risk of bleeding in the brain, the gastrointestinal tract, and umbilical area, and this bleeding can occur within the first day of the baby’s life, or as late-onset as up to 6 months of age. Transfer of vitamin K across the placenta is minimal, and therefore maternal vitamin K supplementation is not sufficient to prevent this condition.
- Erythromycin Eye Ointment
This is applied to the eyes of every newborn in the delivery room to prevent a condition called ophthalmia neonatorum, a potential outcome of gonorrhea transmission from the mother to the baby. If this infection occurs in the newborn’s eyes, it can lead to ulceration and visual impairment. Because of the chance for development of blindness in the baby, and because some mothers are not aware they have a gonorrhea infection, it is mandated by the State of Missouri that all newborns receive this medication regardless of maternal medical history.
- Bilirubin Levels
Bilirubin in the bloodstream is what causes newborns to be jaundiced. It forms as red blood cells break down. It is important to follow in the first week of life because an excessive amount of bilirubin in the bloodstream can actually harm a newborn’s brain. A bilirubin level will be checked within the first 24 hours of life, and at least daily thereafter until discharge. It is initially checked with a device that scans the skin, however, some circumstances require that a small blood sample is drawn to check the level. Treatment for jaundice is done with a blue light called phototherapy.
- Newborn Screen
At 24 hours of life, a small blood sample is taken from the baby’s heel and sent to the state lab. This test screens for about 50 disorders including metabolic problems in the liver, cystic fibrosis, adrenal problems, and thyroid problems. Outcomes are improved in these diseases with early detection. We usually get those results within a week of the sample being drawn and we would contact you if there is an abnormality. At Tiger Pediatrics, we also order this screen at your baby’s two week appointment because some of the diseases have a lower likelihood of being detected in the immediate newborn period.
A noninvasive screening test for Critical Congenital Heart Disease is done after 24 hours of life by measuring pulse oximetry in the baby’s right hand and one foot. Not all heart disease can be detected by prenatal ultrasound, or even by physical exam in the newborn period. This simple screening test helps identify some infants who should have a more thorough evaluation for heart disease with an echocardiogram, an ultrasound of the heart, and thus allow early intervention for serious heart defects.
- Hearing Screen
Babies start learning from the time they are born, and hearing is an important part of the way they learn. If there’s a problem with a baby’s hearing, we want to know and figure out the best treatment as soon as possible so that language development can be optimized. Every baby gets a hearing screen prior to discharge from the hospital. If the baby fails the hearing screen in one or both ears, a follow up audiology evaluation will be done at four weeks of age.
If you choose to have your newborn boy circumcised, this procedure will be performed in the nursery. If your baby’s doctor doesn’t perform circumcisions, another pediatrician from Tiger Pediatrics will do the procedure. In 2012, the American Academy of Pediatrics released a policy statement on circumcision and concluded, “Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.”
The timing of a baby’s discharge from the hospital is often only dependent on the mother’s discharge plan. A healthy baby born by vaginal delivery will usually spend one or two nights in the hospital; a healthy baby born by c-section is likely to stay two to four nights in the hospital. Some circumstances, such as feeding difficulties, excessive weight loss, need for jaundice treatment, or infectious concerns, may require extra days in the hospital. If a baby requires a longer hospital stay than the mother, the mother will be discharged as a patient but will continue to room in and care for the newborn.
Upon discharge, your pediatrician will discuss with you a follow up plan for your baby. It is important that your baby have an appointment within one to three days of going home from the hospital. The timing of this depends on how many days old your baby is when you go home, how feeding is going, how high the baby’s bilirubin levels have been, and any other factors affecting their well being.
It is not common for first-time parents to schedule a prenatal consult with their pediatrician prior to having their baby, but most of our pediatricians welcome you to do so. If you would like to become more familiar with Tiger Pediatrics and get a chance to meet a few of our pediatricians, call us to sign up for one of our evening classes about caring for your newborn.