Newborn Hospital Procedures
Newborn Hospital Procedures
Scott Cohen (Pediatrician, Cedars-Sinai Medical Center) gives expert video advice on: What happens if my child has low Apgar scores?; What do I do if my newborn's screening tests are abnormal? and more...
What will happen at my baby's first exam?
The first exam after birth is a lot of fun. I hope parents have as much fun as I do walking in the room. We undress the baby head to toe and we really examine them and point out everything. We also do an overall exam, looking at the general appearance of the child, pointing out things like moulding of the head that happened from being squeezed out, bruises, different types of rashes, and the colour of the baby's skin. We point out different reflexes that the child has that are normal, such as Moro or startle reflexes where the baby shakes and hugs the air. We then listen to the heart and lungs. We feel the belly. We look at their tone and their strength and we do a full physical exam and neurological assessment on the child during that first exam and really every time we see that child.
How will a premature birth alter my baby's first exam?
A premature birth won't alter your baby's first exam. A premature baby will have just the same type of exam. But depending on what special needs your premature baby has, the first exam may happen in an intensive care unit, like a neonatal intensive care unit or the newborn nursery, rather than in the room with the parents.
What are "Apgar scores"?
Apgar scores are an assessment of the baby at that point in time immediately after delivery. And basically the apgar score is based on five things. It's based on the baby's heart rate, breathing, color, tone and motor agitation. And it's scored from zero to two in each category. So, your top score is ten and your low score is zero. Basically it just gives an assessment at that point in time on how the child is doing and if more resuscitation needs should be given.
How are Apgar scores interpreted?
With apgar scores on newborn babies, for heart rate, if your child has no heart rate, they get a 0. If they have less than 100, it's 1 point and greater than 100, it's 2 points. For color, if they are blue, they would get 0. If they have acrocyanosis, which is blue on just the extremities but their body is pink, they get 1 point, and they get 2 points if they are fully pink. For tone, if they are really floppy, you would get 0. If you have a little bit of flextion, you would get 1 point and if you're fully moving around and crying, you would get 2 points. For motor agitation, sometimes they will put a tube or a little suction in the nose and if the baby responds and sneezes, or makes a startle, they would get 2 points. If it is a weak response, it would be 1 and no response, they would get 0. A normal apgar is usually around 7 or above. An intermediate Apgar would be about 4-6 and low Apgars would be 3 and under. They take the Apgar score at 0-1 minute and then again at 5 minutes.
What happens if my child has low Apgar scores?
It doesn't matter if you start off with a low Apgar score; it's all what you end up with. Because the Apgar score not only depends on your child, but things that are going on at that time. So if the mother was on medication that could be affecting the baby, then you may have a floppy baby. But when the medications wear off the child is going to be absolutely fine. Or, if you have a low Apgar score to begin with but you start resuscitation and give oxygen or suction, or warm the baby, and your resuscitation is very good, then the baby may end up absolutely fine as well. So you shouldn't worry about a low Apgar score initially. It all depends on what happens afterwards with the subsequent exams. And Apgar scores alone are not significant for morbidity or mortality later on in life. So Apgar is really just focused on one point in time to help assess our needs at that time. Then we keep evaluating further.
What are "newborn screening tests"?
Newborn screening tests are done for all newborns across the country and we have a wide variety of tests. The old newborn screen just did a couple things and now we have a new expanded newborn screen which tests for many different things. Firstly, it tests for thyroid conditions - low and high thyroid. It tests for blood disorders like sickle cell anemia, and it now tests for a panel of over thirty genetic disorders. These screening tests results are really helpful for doctors to know. In order for a condition to be placed in a newborn screen, it has to fulfill three scenarios. One, it has to be inexpensive for the state and the country to do it. Two, it has to be prevalent enough in the population that it's going to be worthwhile to do the screen test on everybody. Three, it has to be fixable. The nice thing about the newborn screen is, if something is positive, with a simple dietary change or a medication, your child will be treated and be absolutely normal, even if, in some cases, they have to take that medication or that special diet for the rest of their lives. These are results that, if they're positive, we find out within a day or two of the test. Otherwise, we usually get the newborn screen test results back a couple weeks later just to reassure the families everything was normal. It's great to have at our disposal for a wide variety of illnesses.
What do I do if my newborn's screening tests are abnormal?
If your newborn's screening test is abnormal the state department will contact that doctor. They'll usually also contact a local genetics counsellor and department at their local university, as well, and what they usually ask is for us to repeat the screening test because sometimes in the first 24 to 48 hours the screening tests could be off for one reason or another. So we usually repeat the screening tests and then we follow that baby closely and if they need a specialist like a geneticist or an endocrinologist, we would send them to that doctor for more specialized treatment. Often, at least in the children I have seen with positive screening tests, usually the repeat screening tests have come back negative and there has been nothing to worry about.