Typical Newborn Screenings and Procedures: What, How, When

Whether you give birth in a hospital, birth center, or at home, there are many different newborn screenings, shots, and other procedures that will be offered to you or at least discussed with your care providers sometime prior to giving birth.

Some tests are used to determine how well your baby is adjusting to the world outside your womb or screen for potential health problems; others are preventative against immediate or future health problems.  Depending on where you live, some of the newborn procedures are “mandated” (you still have legal right to informed refusal) by the state, and others are just recommended or standard procedure for the hospital or medical practice.

It’s important to know ahead of time what the procedures are, how they are administered, and if they are required before your baby is born.

Many hospitals will permit you to opt out of some or all newborn procedures, but you may have to fill out a form ahead of time.  If you plan to decline any of the tests or procedures, its important to talk to your doctor or other care provider ahead of time so that its clear before you give birth what your wishes are.  Also, be sure to talk about it with your doula and birth partner so they can make sure everyone is aware while you bond with your new baby.

APGAR Score

One of the very first things that will happen after your baby is born is the administration of the APGAR test. This is a series of actions performed by a nurse or other care provider to immediately determine how well your baby is doing outside of the womb. It is performed at 1 and 5 minutes after birth.  Each segment is graded on a 0, 1, or 2 scale, with a total of 10 possible points. A total score of 0-3 necessitates immediate intervention. APGAR stands for: 

A- Appearance. Skin color is examined. The baby will score a 2 for appearance if the entire body is pink.  Many babies will have a pink body and blue extremities, which would receive a score of 1. 

P- Pulse. The baby’s heart rate is evaluated and if it is over 100 beats per minute it would score a 2. Less than 100 beats per minute would be a score of 1.

G-Grimace. The baby’s response to physical stimulation is analyzed. The baby should grimace and cry from physical contact such as a mild pinch to receive a score of 2. A lack of a cry or only a mild reaction would receive a score of 1.  

A-Activity. The baby’s muscle tone and activity are analyzed.  If the baby is actively moving it would receive a score of 2. Some movement and muscle tone would receive a 1.

R- Respiration. This is primarily anazlyed using the baby’s cry.  A strong cry would receive a score of 2, while irregular or slow breaths would receive a 1.

The test is performed again at five minutes after birth, and again at 10 or more minutes after birth if the baby initially received a low score.  Remember, if your baby has a low APGAR score at 1 or 5 minutes, that does NOT necessarily mean that there is anything seriously wrong.  Many babies have low scores and simply need some additional oxygen support or more time to adjust.

Hepatitis B Vaccine

The first dose of the Hepatits B vaccine will be offered to you and administered shortly after your baby’s birth. This is the first in a series of low-dose shots that can be given to your baby throughout the first year. This vaccine is injected in the thigh and is to prevent a liver infection caused by the Hepatitis B virus (HBV).

Hepatitis B is spread through contact with blood or other bodily fluids of an infected person, and possibly from mother to baby at birth.  For some people, hepatitis B is an acute or short-term illness but for others, it can become a long-term, chronic infection, leading to life-threatening conditions such as cirrhosis and liver cancer. You can learn more about Hepatitis B and the vaccine from the World Health Organization website or from your own trusted medical resources.  

Vitamin K

You will also be offered a Vitamin K shot for your newborn. This shot is administered directly into the thigh shortly after birth. It is given to prevent rare, but life threatening, bleeding within the first eight weeks of life.

Vitamin K is an important vitamin used in the blood clotting process. Newborns are born with a low amount of naturally occurring vitamin K. Severe Vitamin K deficency can result in spontaneous bleeding. While Vitamin K deficiency in newborns is rare, it is extremely serious and could result in long term health complications or death. There are tests that can be done to determine if a baby is deficient, but most care providers recommend the shot be given immediately as the bleeding can occur without warning before the test would be returned from the lab. Read more about the shot and Vitamin K deficiency on Evidence Based Birth.

Erythromycin Eye Ointment

Erythromycin eye ointment is administered shortly after birth to prevent Ophthalmia neonatorum, commonly known as newborn pink eye. This is an antibiotic cream administered directly into the eyes of the baby. This condition is caused by untreated gonorrhea or chlamydia in the mother and can lead to blindness in newborns.

Most women are screened at their first pre-natal appointment for these sexually transmitted diseases and if positive are treated with antibiotics.  It’s important to talk to your doctor if you think that you have been reinfected at any point in your pregnancy and would be positive at the time of birth.  To read more about Ophthalmia neonatorum, as well as how to treat and prevent transmission,  visit Evidence Based Birth.

Newborn Metabolic Screening

This screening test is offered to you prior to leaving the hospital and will use your baby’s blood to test for a variety of congenital disorders. A nurse will administer a small heal prick and draw several drops of blood to send to a lab for analysis.  The number and type of tests included in this screening vary from state to state, but typically include cystic fibrosis, hypothyroidism, phenylketonuria (inability to break down certain foods), galactosemia (inability to break down certain sugars). While you may have had genetic testing earlier in your pregnancy, the diseases included in this screening typically are not detectable until after the baby is born.  For more information on the test, congenital disorders, and in-depth research, visit the American Academy of Pediatrics

Hearing Test

One of the final tests to be performed before leaving the hospital is a hearing test.  An audiologist will put earphones or ear plugs into your baby’s ears. The audiologist will play music and measure the “echo” in the ear; a lack of echo could indicate hearing loss.  Another type of hearing test also involves headphones placed over the baby ears, with additional electrodes attached to the baby’s head to monitor the baby’s response to sound.  

Both tests are relatively non-invasive and are often done when the baby is sleeping or otherwise relaxed. For more information on hearing screens visit The National Institute on Deafness and Communication Disorders

Renee Corbino

Author: Renee Corbino

Renee keeps Balanced Birth Support organized and amazing as the Administrative Manager. She lives in Northern Virginia with her awesome fire fighting husband and two cute little boys. She is a breech birthing mama and supporter of empowering births.

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