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The Newborn After Delivery

Newborn Physical Examination
Soon after delivery your baby will receive a full head-to-toe physical examination.
Soon after delivery your baby will receive a full head-to-toe physical examination.
©2006 Publications International, Ltd.

Now that your baby has had some time to get used to you, the hospital will want to perform some critical health checks. There are many conditions that can potentially affect a baby's health. These are typically temporary conditions that will cause no lasting damage, but only if they are detected and treated early.

Besides the Apgar score, which is determined right after birth, a more thorough physical examination of the baby is done a few hours later. The newborn exam is a thorough check of all the baby's systems. A midwife, family physician, pediatrician, or nurse practitioner may carry out this exam. You may ask that it be done in your presence, so you can learn more about your baby.

From head to toe, the examiner checks such features as the fontanels (soft spots at the top and back of the head); eyes, ears, nose, mouth, and throat; ability to suck and swallow; size of the head; weight and length; breathing pattern; size of the liver and spleen; heart tones and sounds of the lungs; genitals; hip joints; overall appearance of the baby; and the baby's reflexes. The baby's ability to pass urine and move his bowels is also noted.

Some babies are further assessed for their actual gestational age; a test called the Dubowitz examination helps determine whether your baby was born early, on time, or late.

In the hospital, babies receive identification bracelets, sometimes on both wrist and ankle, and mothers receive a matching wrist bracelet; this is to prevent mixing up of babies in the nursery. Footprints and handprints are also taken. Immediately after the umbilical cord is cut, a sample of blood is taken from the cord, labeled, and stored, in case it is needed later for blood-typing or other laboratory tests.

The baby's temperature, feeding patterns, activity levels, breathing and heart rate patterns, and urination and bowel movement patterns are observed for the next several days. If at home, the parents make these observations after receiving instructions from their caregiver. In the hospital, nurses usually make these observations.

Within an hour or so after birth, your baby receives vitamin K to help prevent bleeding problems. Vitamin K helps in the clotting of blood; since babies do not have vitamin K in their systems for the first few days after birth, its administration is considered an important preventive treatment. Vitamin K can be given by means of injection in the thigh or by mouth. At present, most doctors prefer to give it by injection.

Your baby undergoes a number of laboratory tests. The skin is also examined for any marks or other important signs. Several days after the baby is born, a sample of blood is drawn from the heel of each newborn.

The one test given to all newborns is a test for phenylketonuria (PKU). PKU is an inherited disorder that can be very serious if not detected very soon after birth. A baby with PKU cannot properly process protein and needs a special diet low in phenylalanine, the component of protein that she cannot handle well. If PKU is detected and the baby receives this special diet, she will grow up normally. If it is not detected and treated, however, PKU can cause mental retardation.

Because of the seriousness of PKU, all states and Canadian provinces require that all babies be tested for it. Once performed before the baby left the hospital, the PKU test is now more often performed at a physician's office during the baby's first examination.

The same blood sample is checked for another condition, congenital hypothyroidism. Some people do not make enough thyroid hormones for normal development. If this condition is discovered early, a baby can be treated and grow up without any problems.

Blood may be drawn from newborns for other purposes both during their hospital stay and at other times. Many babies develop jaundice within the first weeks of birth (indicated by yellowing of the skin and the whites of the eyes). Your doctor may draw some blood to analyze your baby's bilirubin level. Bilirubin, a yellow substance, forms when red blood cells break down; the presence of excessive amounts gives a yellow tinge to the baby's skin. If the bilirubin reaches a certain level, your doctor may treat the baby to lessen the jaundice.

While jaundice in a newborn is rarely a serious condition, it is important to keep track of bilirubin levels in jaundiced babies and to determine the cause. The usual treatment, phototherapy, involves keeping the baby in a brightly lit bassinet, except for feedings. On rare occasions, a blood transfusion is given. Jaundice rarely occurs in the first 24 hours after birth, so blood specimens are obtained after that.

Blood glucose (a form of sugar) levels are also checked in some babies -- those who are very large or very small, those whose mothers have diabetes, and those with other possible problems.

Urination and Bowel Movements

Many babies urinate within minutes after birth. This is an important milestone and is recorded in your baby's medical chart when it happens.

The first bowel movements of a newborn baby are called meconium, which forms in the intestine long before birth. In fact, some babies pass some meconium while still in the uterus. It mixes with the amniotic fluid.

While this is usually harmless, when your doctor spots meconium in your amniotic fluid during labor, he or she will be concerned the baby might inhale it deeply with the first breaths after birth. If meconium is breathed deep into the lungs, it can cause breathing problems. If meconium is present, deep suctioning with the mucus trap is done before the baby breathes.

Many parents are unprepared for their babies' strange bowel movements. Your baby will have a meconium bowel movement within a few hours after birth. Meconium is black and sticky and difficult to clean off. Some parents think ahead and rub olive oil on their new baby's bottom before the bowel movement happens. Meconium is then much easier to clean off.

As the baby begins to feed, the bowel movements become runny and greenish-brown. Once the colostrum has changed to milk, a breast-fed baby's bowel movements become yellow and liquid (often described as mustardy) and nearly odorless. Breast-fed babies normally move their bowels anywhere from once a week to once each feeding. Formula-fed babies move their bowels less frequently, and their bowel movements are dark, firm, and strong smelling.

If you've had a boy, you now have a decision to make. See what to do whether or not you choose to circumcise your son in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.