MEDICAL CARE AND YOUR NEWBORN

By the time you hold your new baby in your arms for the first time, chances are you have already chosen one of the most important people in your infant’s early life: your baby’s doctor. Your baby will probably visit the doctor more often during the first year than at any other time.

You may have had a prenatal visit with your baby's doctor-to-be to discuss your health and to identify any conditions or risk factors which could affect your newborn. In addition you also may discuss when he or she will see your newborn for the first time, office hours and on-call hours, who fills in for your doctor when he or she is out of the office, and how the office handles after-hours emergencies. You may ask your baby’s doctor about his or her views on issues that are important to you. In this way, you've begun to forge a relationship with your baby's doctor that should last through the bumps, bruises and midnight fevers to come.

What Will Happen Right After Birth?

Depending on your desires and the rules of the hospital or birth center where your baby is delivered, your baby’s first exam will either take place in the nursery or at your side. Weight, length and head circumference will be measured; body temperature will be taken; and breathing and heart rate will be checked. The doctor or nurse will monitor the color of your baby’s skin and your baby’s activity. He or she will receive special eye drops to ward off infection and a shot of vitamin K to prevent excessive bleeding. When your baby is given his or her first bath, the umbilical cord stump will be cleaned.

Most hospitals and birthing centers provide personal instructions (and sometimes videos) to new parents that cover feeding, bathing and other important aspects of newborn care. It is also important that your baby sleep on his or her back since the prone position is a risk factor for sudden infant death syndrome.

When Will We See the Doctor?

The hospital or birth center where you deliver your baby will notify your child’s doctor of the birth. If you have had any medical problems during pregnancy, or if any medical problems for your baby are suspected, the doctor may be alerted about the birth ahead of time and be standing by.

The doctor you have chosen for your newborn will probably give your baby a full physical examination within 24 hours of birth. While exact requirements differ, all states require newborn blood testing to check for the possibility of inherited defects in metabolism such as congenital hypothyroidism and phenylketonuria (PKU). While these diseases are rare, early intervention for these conditions may allows an infant to lead a normal life.

Most infants have a hearing screening before leaving the hospital, and all infants should have their hearing screening before they are 1-month-old. Mild jaundice (a yellowing of the skin) is common in newborns and is often due to an immaturity of the baby to metabolize the breakdown products of hemoglobin. Your doctor may need to do tests to confirm that the jaundice is physiologic (not pathologic) and to determine if the baby needs treatment to reduce the level of jaundice.

If the baby is male your doctor will discuss circumcision with you. Circumcision is the elective surgical removal of the penile foreskin. There is no true medical indication for circumcision although it has been demonstrated that there is a decreased incidence of urinary infections in the first year of life in circumcised males. Many individuals choose to have their babies circumcised because of religious reasons or social preference. There are contraindications to circumcision such as a bleeding disorder or penile abnormality. If a contraindication is present your doctor should discuss this with you.

At the hospital, you and your baby’s doctor will have the chance to talk about your new baby and the many aspects of parenting. This is also a good opportunity to ask any questions you have about your new baby's care. Find out when the doctor would like to see your newborn again. Most healthy newborns are routinely examined at the doctor's office when they are about 2 weeks old.

What Happens at the First Office Visit?

During the first office visit, your doctor will assess your baby in a variety of ways to see how he is doing. The first office visit will differ from doctor to doctor, but you can probably expect:

• Measurement of your baby's weight, length and head circumference to assess how he's been doing since birth.
• Testing of your newborn's vision, hearing and reflexes.
• A total physical examination to check for any abnormalities of the body or organ function.
• Questions about how you are doing with the new baby and how your baby is eating and sleeping.
• Advice on what you can expect in the coming month.
• A discussion of your home environment and how it might affect your baby's health. For example, smoking in the house can negatively affect your baby in a number of ways.

Also, if the results of screening tests performed on your newborn after birth are available, they may be discussed. Bring any questions or concerns you have up to your baby’s doctor at this time. Make sure to write down any specific instructions he or she gives you regarding special baby care. Keep a permanent medical record for your baby that includes information about growth, immunizations, medications and any problems or illnesses.

What Immunizations Will My Baby Receive?

A baby receives some natural immunity against many infectious diseases from his mother. A mother's infection-preventing antibodies are passed to her baby through the umbilical cord before the baby is born. This immunity is only temporary, but your baby will develop his own immunity against many infectious diseases. Breast-fed babies receive antibodies and enzymes in breast milk that help protect them from some infections and even some allergic conditions.

Most infants will receive their first artificial immunization, a hepatitis B vaccine (HBV), at birth or shortly after. This immunization is given in a series of three shots and may be given as part of a combination vaccine. Although no other routine immunizations are usually given before 6 weeks of age, it's not too early to familiarize yourself with the standard immunization schedule.

When Should I Call the Doctor?

Since small problems can indicate big problems for newborns, don't hesitate to call your pediatrician if you have concerns. There are some difficulties that you should be aware of during this first month:

• Excessive drowsiness can be hard to spot in a newborn since most sleep so much. But if you suspect your infant is sleepier than normal or less active, call your doctor. Sometimes this could mean there is an infection present in a baby's system.
• Eye problems can be caused by blockage of one or both tear ducts. Normally the ducts open on their own before too long, but sometimes they remain clogged, which can cause mucus-like tearing of the eyes. The white discharge can crust up on a baby's eyes, making it difficult to open them, and the blockage can lead to infection. If you suspect an eye infection, such as pink-eye (conjunctivitis), call your baby’s doctor immediately. If your baby has an infection, the doctor will need to examine him or her and may prescribe special drops and a special method of cleaning your baby's eyes with sterile water.
• Fever in a newborn (temperature above 100.4 degrees Fahrenheit rectally) should be reported to your doctor right away.
• Extreme floppiness or jitters in a baby could be a sign of underlying problems. Report them to your doctor immediately.
• A runny nose can make it difficult for a baby to breathe, especially when he's feeding. You can help ease your baby's discomfort by using a rubber bulb aspirator to gently suction mucus from his nose. Be sure to call your doctor – even a common cold can be dangerous for a newborn.

While breast-fed newborns generally have loose, mustard-colored stools, very loose and watery stools could indicate illness. The danger here for a baby is dehydration, which can show up as a dry mouth and a noticeable reduction in urine output (fewer than six wet diapers in 24 hours). Call your doctor if your newborn's stools seem watery or loose or if they often occur at other times besides after feeding.