Newborn Medications and Screenings

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​My baby is finally here! Now what?

Well done, you have made it through labour! You and your baby are enjoying the first hour after baby’s birth skin to skin, bonding and recovering. As long as you and your baby are both well, this first hour will have minimal interruptions.

At the birth of your baby

Generally, after the baby is 1 hour old, your midwife will do the baby’s initial newborn exam and administer any medications you have previously agreed to (see below). Occasionally, these steps are completed before the baby is 1 hour old. For example, if you need to get stitches and don’t feel able to hold your baby until they are finished. In this example, your backup midwife will do the newborn exam/medications and then have your partner do skin-to-skin with the baby if they feel comfortable. Once you feel ready, your baby will be placed back skin-to-skin with you.

  • Newborn Exam: During the initial newborn exam, your midwife will check your baby’s anatomy and reflexes. The general categories of the exam are listed below. For a detailed list of what is included in the newborn exam see the AOM’s list of Newborn Exam Components.
    1. General Assessment
    2. Reflexes
    3. Skin
    4. Head
    5. Eyes
    6. Ears
    7. Nose
    8. Mouth
    9. Neck
    10. Chest
    11. Heart
    12. Abdomen
    13. Genitalia and Rectum
    14. Arms and Hands
    15. Hips, Legs and Feet
    16. Spine
    17. Measurements
  • Vitamin K: Vitamin K is essential in the formation of blood clots. Babies are born with low levels of vitamin K and do not receive sufficient amounts from breast milk or formula. Without sufficient amounts of vitamin K, a newborn is susceptible to serious bleeding known as vitamin K deficiency bleeding (VKDB). To prevent babies from developing VKDB, all babies are offered a once-off intramuscular injection of vitamin K within the first few hours after birth. Alternatively, babies can receive 3 doses of oral vitamin K (at baby’s first feed, at 2-4 weeks of age, and 6-8 weeks of age). All three doses must be given. The Canadian Paediatric Society recommends vitamin K be administered by injection, as oral vitamin K is not absorbed as well and does not last as long, increasing the risk of VKDB for these babies (Canadian Paediatric Society, 2023). As always, parental consent is gained before the administration of any vitamin K.
  • Hepatitis B Vaccine: Hep B vaccination at birth is recommended for any baby with a parent or parents who have immigrated to Canada from a hepatitis B endemic country. A hepatitis B endemic country is described as having an 8% or higher rate of hepatitis B prevalence. These babies have a greater chance of being exposed to hepatitis B from visiting family and friends in Canada, in addition to exposure during travel. To prevent transmission of hepatitis B to these babies, vaccination at birth, 4 weeks of age and 6 months of age is recommended. Check the following list of hepatitis B endemic countries.
  • Erythromycin Eye Ointment: This is an available treatment for babies who may have been exposed to gonococcus (gonorrhea) during pregnancy or at birth. All midwifery clients are tested for active gonococcal and chlamydia infection during pregnancy. Ask your midwife if you have concerns about gonococcal infection and if treatment is necessary for your baby. For the past few years erythromycin eye ointment has been in short supply, as thus, it is generally only administered to babies at high risk for gonococcal infection. An additional use of erythromycin eye ointment is for the prevention of chlamydia conjunctivitis, however, it has been shown to have limited to no effect on chlamydia conjunctivitis (Canadian Paediatric Society 2019). Please see the additional resources below for more information.

After your baby is over 24 hours old

Additional screenings are done for your baby after they are 24 hours old, with your consent. If you are still at the hospital, these screenings will be carried out by the nursing staff. If you are at home, your midwife will come to your house to do the screenings. Below are descriptions of each screening and what they involve.

  • Newborn Screen (aka. blood spot screening): It is a test performed to detect treatable diseases which have no symptoms in the early newborn phase. The 29 diseases tested fit into 6 categories: metabolic diseases, endocrine diseases, sickle cell disease, cystic fibrosis, severe combined immune deficiency, and spinal muscular atrophy. Check a full list of the diseases tested in newborns. The screening is performed by making a small puncture in the baby’s foot (similar to how a diabetic pricks their finger) and collecting the blood drops into 5 circles on absorbent paper. This sample is then sent to the lab for testing. If your baby is screened positive for one of the conditions you will be contacted directly within 48 hours of the test being received by the lab.
  • Critical Congenital Heart Disease Screening (CCHD): CCHD is a condition involving the malformation of a baby’s heart and/or major blood vessels around the heart. Any baby with this condition will most likely require surgery or other interventions. By screening for CCHD between 24 to 36 hours of the baby’s life, this condition can be detected early and timely interventions can occur. The screening for CCHD is non-invasive and involves the use of pulse oximetry to detect oxygen saturation levels in a baby’s body. Please see the additional resources below for more detailed information on CCHD screening.
  • Hyperbilirubinemia (aka. Jaundice): Hyperbilirubinemia is an accumulation of high levels of bilirubin within a baby’s system. This is what causes the baby’s skin to turn yellow and potentially affect some of the baby’s other organs. It is normal for most babies to have a moderate to low level of jaundice in the first few weeks of life. This is an expected part of the baby’s transition from living in the uterus to now living in the outside world. Screening for hyperbilirubinemia after 24 hours of the baby’s life means we can identify the babies who need intervention quickly and provide treatment when required. Please see the additional resources below for more detailed information on hyperbilirubinemia screening.
  • Vitamin D Supplement: Vitamin D drops are recommended for babies to prevent vitamin D deficiency. When a baby’s vitamin D levels are very low they are at risk of developing rickets (affects bone growth and development). To prevent any deficiency, most babies are recommended to have 400IU of vitamin D daily, starting in the first few days of life. Some formula-fed babies may not need additional supplementation. Ask your midwife if you have questions about vitamin D drops for your baby.