What parents should know about newborn tests and vaccinations

Vitamin K and eye ointment and vaccinations — oh my!

Your newborn likely will get all of these shortly after birth. Surprised? If so, you’re not alone. Many new parents are unaware of how many tests and treatments their newborns will receive.

Before you start to panic when a doctor gives your brand new baby a shot in the thigh, learn why these medications and vaccinations are important and some of the evidence behind the recommendations. Let’s take a look at what tests and shots to expect late in pregnancy, in the delivery room, and before you take your little one home.

Late in Pregnancy: Vaccines and Tests for Mom

Babies get their first vaccinations and preventive care before they’re even born. They get this protection through you.

Tdap Vaccine

Every woman should get the Tdap vaccine between 27 and 36 weeks of every pregnancy. It doesn’t matter if you had the vaccine as a child, had a booster as an adult, or if you got one with your last baby. Get it again. The Tdap vaccine protects you against three diseases: tetanus, diphtheria, and pertussis (whooping cough).

Whooping cough is especially dangerous for babies. Most whooping cough deaths are in infants too young to get the vaccine themselves. When you get the vaccine during pregnancy, it has a two-fold effect:

• Your immunity is boosted, reducing the chance that you catch the illness from another person and pass it on to your baby after birth.
• It allows you to pass on antibodies through the placenta and breast milk, giving your baby short-term protection until their immune system develops enough to receive the first vaccination.

Whooping cough is transmitted through respiratory droplets produced from talking, sneezing, or coughing. There were nearly 33,000 cases of whooping cough diagnosed in 2014. That’s no small number, and it highlights why it’s also important to make sure siblings and family members who will be around the baby are up to date with their immunizations and boosters. In fact, according to an October 2015 study in the journal Pediatrics, the most common source of transmission of whooping cough to infants was siblings.

Flu Vaccine

All women without a medical contraindication to the vaccine should get a flu shot if they are pregnant during influenza season, no matter how far along they are. Pregnant women are at an increased risk of complications from influenza, including pre-term labor and even death.

Like Tdap, it also provides your baby protection after birth. A July 2016 study published in JAMA Pediatrics showed that a flu shot during pregnancy protects a newborn for about two months after birth. Babies shouldn’t get their own flu shot until they are 6 months old. So in the interim, they must rely on people around them being vaccinated.

Gonorrhea and Chlamydia Test

Some Ob/Gyn practices recommend routine testing at 32 weeks for gonorrhea and chlamydia. Texas is among the states with the highest rate of these sexually transmitted diseases. You may not even know you have these diseases because they don’t always present with symptoms. However, the diseases can be passed to the baby during delivery and can cause an infection called ophthalmia neonatorum that may lead to blindness.

If you have been in a long-term, mutually monogamous relationship, you may feel comfortable declining this test. There is a chance the test will return a false-positive result, meaning it may show you have one of these diseases when you actually don’t. Remember this before you panic that your partner is cheating on you.

Group B Strep Test

Between 35 and 37 weeks of pregnancy, you’ll be tested for Group B Strep (GBS). This is not the same bacteria that causes strep throat. One in four women have this bacteria in their vagina or rectum. Group B Strep often does not cause symptoms. It also can come and go. This means you could test positive one month and negative the next. Or you could have it during one pregnancy but not the next.

Group B Strep can be passed to babies during a vaginal delivery or by contact with someone with Group B strep. It can cause problems such as pneumonia and meningitis. Before our current testing and prophylaxis strategy, this was one of the leading causes of death or severe disability among healthy newborns.

If you test positive for GBS, you’ll receive antibiotics through an IV during labor. If you have a planned cesarean section, we’ll still perform the test so we have a result in the event you present in labor or with ruptured membranes prior to your scheduled date. If you have had a baby affected by Group B Strep in the past or if you have had a urinary tract infection with GBS (this is associated with higher bacterial colonization) we will just plan to give you antibiotics during labor – there’s no need to have the screening test done.

One note: Don’t believe everything you read on the internet. There are plenty of websites that tout natural remedies to cure Group B Strep, from rinsing your vagina with apple cider vinegar to placing a clove of garlic in your vagina. There is no evidence these actions will work. Keep your baby safe and allow your doctor to give you antibiotics during delivery if needed.

In the Delivery Room: Eye Ointment, Vitamin K Shot

Shortly after your baby is born, they’ll get what’s often called “eyes and thighs.” This refers to a vitamin K shot and an antibiotic eye ointment.

Erythromycin

Texas law requires that a health care provider apply erythromycin to babies’ eyes within two hours of birth. This may be drops but usually is an ointment applied across the eyelids that melts into a baby’s eyes. The ointment won’t cause pain or long-term vision problems.

Erythromycin kills germs such as chlamydia and gonorrhea, which can cause blindness in babies. We’ll give it to your baby even if you tested negative for these infections during pregnancy, just in case you were infected after testing or your test was falsely negative. This is not a personal insult or assumption about you; we just want your baby to be as healthy as possible.

You can refuse the erythromycin, but we strongly urge you to allow us to apply it. We can wait up to two hours before applying the erythromycin, so you’ll have time to bond with your baby and let them see you. Just remember, babies don’t see very well immediately after birth anyway, so the ointment won’t affect their vision that much!

Vitamin K Shot

Shortly after birth, we’ll give your baby a vitamin K shot in the thigh muscle. Vitamin K is pivotal in the production of clotting factors, and a deficiency increases the risk of bleeding. Babies are born with very little vitamin K because only a small amount of it passes through the placenta and a minimal amount is in breastmilk. It can take weeks for a baby to develop a healthy supply.

It’s a quick injection, so it will only hurt for a moment.

I’ve noticed more questions from parents about refusing the vitamin K shot. A small study in the 1990s connected this shot with childhood leukemia, but this has been disproven time and again. Unfortunately, this myth persists, and it increases the risk of preventable problems.

When making a decision about the vitamin K shot, be aware that many health care providers require it before they perform a circumcision. Even if you are not planning an elective or indicated surgical procedure, one of the primary risks of vitamin K deficiency is spontaneous intracranial bleeding, which can lead to long term disability.

Before You Take Baby Home: Vaccine, Blood Tests, Screenings

You’ve fed and bathed baby for the first time and hopefully gotten a little sleep. But before you leave the hospital, there are a few more things baby needs.

Hepatitis B Vaccine

Your baby’s vaccination schedule will be busy for the first couple years. And it begins right away. Texas law recommends babies get the first of three Hepatitis B vaccines at birth and requires them before they start school. Hepatitis B is passed through blood and bodily fluids and can cause liver failure.

If you are positive for Hepatitis B, your baby will receive a dose of hepatitis B immune globulin along with the vaccine to prevent the disease from passing to the baby.

Texas Newborn Screening Program

Often referred to as the “heelstick” because blood is taken from the baby’s heel, these panels screen for diseases that range from common, such as sickle cell or cystic fibrosis, to much less common, such as phenylketonuria (PKU) or congenital hypothyroidism. As of 2015, Texas’ program includes 53 diseases on its panel.

The first test is performed 24 to 48 hours after birth, and a second at one to two weeks at the pediatric care provider’s office. As with any screen, the goal is to find as many babies at risk as possible. When we detect these conditions early, it allows us to provide appropriate medical care such as altering the diet or providing medicine.

It’s important to keep in mind that a positive screen will need to be confirmed with more specific testing.

Car Seat Test

Babies who are born before 37 weeks or who weigh less than 5.5 pounds are at risk for adverse cardiac and respiratory events when in a semi-upright position, like a newborn car seat. Babies in this group who are considered ready to go home may be required to do a car seat test.

We’ll place the baby in the intended car seat for 90 minutes to two hours. A machine will measure the baby’s heart rate and oxygen level and a nurse or respiratory technician will observe. As many as 50 percent of babies in this group will have an event during the test. In those cases, further evaluation and possible treatment may be needed.

Hearing Test

Finally, we’ll test your baby’s hearing to identify whether follow-up testing or intervention is necessary. There are a several types of hearing screenings, but all are quick and painless. They simply measure your baby’s response to sounds.

If your baby fails the hearing screening, it doesn’t necessarily mean they have hearing loss. That’s what follow-up testing will determine, along with next steps should they be needed.

Talk to your doctor about which tests, medications, and vaccinations you can expect for your baby. It’s important to understand the benefits of each and the potential complications of declining them before the whirlwind of late pregnancy and delivery are upon you.

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