Most infants are born healthy, but it's still critical that they receive important screening tests. American Baby investigates the latest recommendations so you know what to advocate for.
Baby names, registry must-haves, birth plan decisions: Moms-to-be are already used to juggling several checklists. But you probably haven't thought about the list of essential health screenings that your baby needs in his first hours of life. In fact, ask any veteran mom about this and she'll likely be stumped. "After giving birth, you're exhausted, overwhelmed, and your priority should be bonding with your new baby," says Anjana Ali Solaiman, a registered nurse and spokesperson for the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). "You shouldn't have to worry about what tests are happening and why." But you also can't afford to miss these first health checks, because they are designed to spot congenital defects and inherited disorders as early as possible. And although the incidence of most of these conditions is rare, about 1 in 300 newborns screened is eventually diagnosed with one of them. "These tests catch problems that may not have any immediate symptoms -- a baby can look healthy," says Solaiman. "But if there is an issue, it often requires immediate treatment, so early detection is critical."
We've broken down what newborn tests you should expect and which ones you may need to speak up for.
This observation test is performed twice, at one and five minutes after your baby is born, to determine whether he needs help breathing or is having heart trouble. His heart rate, breathing effort, muscle tone, reflexes, and skin color will each get a score of 0, 1, or 2. Those scores are added together for a total of up to 10.
What the results mean: A score of 7, 8, or 9 is normal and means your newborn is in good health (scores of 10 are very unusual because almost all babies lose 1 point for blue hands and feet, which are common after birth). A score below 7 can be the result of a difficult birth and may mean your baby needs supplemental oxygen or other help to stabilize her.
Will your baby get it? Yes. This test is standard practice in the United States.
One to three of every 1,000 babies are born with some degree of hearing loss, but without a screening, it can be very difficult for parents to spot the problem in a baby's first few months of life. Your baby should receive one of two versions of the newborn hearing test. With an Otoacoustic Emissions (OAEs) test, tiny earphones and a microphone are placed in your baby's ears and then sounds are played; if hearing is normal, the microphone should pick up an echo reflected back into the ear canal. With an Auditory Brainstem Response (ABR) test, electrodes are placed on your baby's head that can confirm her brain responds to sounds. Either way, testing takes about ten minutes and your baby may snooze through it.
What the results mean: Because these tests are so sensitive, most babies who fail the hearing screening still have normal hearing. But you will be referred to a specialist for a more thorough evaluation.
Will your baby get it? Yes. A hearing test is performed in all U.S. hospitals.
Many newborns are born with a mild form of jaundice (yellowing of the skin or whites of the eyes) because the immature liver has a hard time processing a by-product of red blood cells called bilirubin. Jaundice usually resolves in a week or two, but if a bilirubin level gets too high, it can cause deafness, cerebral palsy, or other forms of brain damage in some babies. So even if your baby looks perfectly fine, most hospital nurseries will check her bilirubin count through a simple blood test or by using a light meter, which is able to detect bilirubin through the skin.
What the results mean: A mild to moderately elevated bilirubin count usually resolves on its own, but if the count is too high or continues to rise (particularly in babies who are born prematurely or are small for gestational age), your baby will probably stay in the hospital for a few extra days to receive phototherapy. Special lights alter the bilirubin so it's easier for your baby's liver to clear it out. Frequent breastfeeding or formula supplementation can also help babies pass it in their stool.
Will your baby get it? Most likely. Although the American Academy of Pediatrics recommends this test, it's not required everywhere, so some hospitals will only perform it if your baby shows symptoms. Check with your pediatrician.
Newborn screening panel
Commonly known as the "heel prick test" because a nurse will stick a tiny needle in your baby's heel to collect a few drops of blood, this screens for inherited health conditions. Many of these are fatal if they aren't detected early; the list includes metabolic disorders and deficiencies, endocrine issues like congenital hypothyroidism and hyperplasia, as well as sickle-cell anemia and other blood disorders.
What the results mean: For each of the conditions tested, your baby's blood sample will either be "in range" (the test was negative) or "out of range" (a positive result). Remember that a positive result is not a diagnosis -- it means your baby has a genetic marker or other risk factor for a condition. You will be referred to a specialist for diagnostic testing.
Will your baby get it? Yes, but contact your hospital for the conditions it screens for. Recommendations are set by the Secretary of Health and Human Services's Advisory Committee on Heritable Disorders in Newborns and Children. Currently, it lists a screening panel of 32 core conditions and reporting of 26 secondary conditions. Because of these recommendations, "every birthing center and delivery hospital knows that screening needs to take place," explains Natasha Bonhomme, the founder of Baby's First Test, a nonprofit clearinghouse for info on newborn screenings. "But it's still up to each state to mandate which of the conditions your hospital is required to include." For instance, every state tests for congenital hypothyroidism, galactosemia, and phenylketonuria (PKU) -- three of the core conditions in the screening panel. But not all states cover amino acid disorders, which, although rare, are still core conditions.
Pulse oximetry screening
The "pulse ox" test checks your baby's blood oxygen levels, because low or fluctuating O2 can be an early warning sign of Critical Congenital Heart Defect (CCHD), which often has no symptoms but can be deadly without immediate intervention. The test takes less than ten minutes and is not painful; one sensor is placed on your baby's right hand and another on one of his feet to find out how much oxygen is in his blood.
What the results mean: A normal blood oxygen level is around 100 percent (every red blood cell has an oxygen molecule attached). If the oxygen level is low or the test shows different readings at Baby's hand and foot, her heart may be having trouble pumping enough oxygenated blood throughout her body. You'll then be referred to a pediatric cardiologist.
Will your baby get it? Not necessarily. More than 40 states have adopted the test, but you should request it if it's not part of your hospital's protocol; CCHD accounts for 24 percent of infant deaths due to birth defects, because these babies appear healthy at first. "We are seeing more cases of CCHD where there is no known family history," says Solaiman.
When to Worry: Jaundice
Originally published in the September 2015 issue of American Baby magazine.
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