Newborn Options
Newborn Options: Eye Ointment Prophylaxis, Blood Spot Screen, Hearing Screen, CCHD
Eye Ointment Prophylaxis : Erythromycin - immediately after birth
The antibiotic eye ointment applied after birth is meant to kill bacteria that can cause eye infections from gonorrhea or chlamydia. Due to antibiotic resistance erythromycin is not longer as effective as it used to be.
The way a baby can get an eye infection from gonorrhea or chlamydia is if the mother has an untreated infection at the time of vaginal birth. Gonorrhea has a higher risk of blindness in babies than chlamydia. Both gonorrhea and chlamydia can tested for in pregnancy and an infection can be treated during pregnancy.
Normally, I don’t try to sway people one way or another when it comes to newborn exams or informed consent issues. Though with erythromycin, if you know you don’t have gonorrhea nor chlamydia, I suggest not applying the eye ointment. Over use of antibiotics have caused antibiotic resistance. AND, it’s helpful for the baby’s eyes to be unobstructed for bonding and breastfeeding.
Not all eye infections are from gonorrhea or chlamydia. If a newborn develops an eye infection it can be cultured and treated with antibiotics the appropriate antibiotics.
Evidence based birth article and audio: Is Erythromycin Eye Ointment Always Necessary for Newborns?
Newborn Blood Spot Screening (NBS) - 24 to 48 hours after birth
This screening is to see if the newborn is at risk of rare and often “hidden” disorders.
The NBS screens newborns for more than 50 disorders that affect metabolism, hormones, the immune system, blood, and digestion.
By identifying these disorders early interventions, medication and/or dietary changes can help prevent some of the health problems caused by the disorders.
If you choose to do this screening: at the 24 to 48 hour visit we do a heel poke and fill 6 circles completely with the baby’s blood. We let it dry fully then send it to the state for testing. The state will give the results to your midwife. Then you can decide if the state keeps what’s left of the blood samples or destroys them.
State of MN blood spot screening information sheet.
Newborn Hearing Screening - 3 days to a week old
Checking for hearing loss in the range where speech is heard.
About 1 in 300 MN babies are born with some hearing loss.
When your baby is asleep or very relaxed a little probe is placed in one ear at a time. A small screening device will play soft sounds and measure the newborn’s internal response. Both ears are checked. If one or both ears don’t pass we will recheck. If ears don’t pass again the baby will be referred to have a diagnostic evaluation.
Early identification and treatment can prevent or alleviate many of the problems that result from impaired hearing. The goals of this hearing screen is that all babies have:
-Hearing screened by 1 month of age
-Diagnostic evaluation by 3 months of age if needed
-Early intervention services by 6 months of age if needed
State on MN hearing screen fact sheet.
MN early hearing detection and intervention page.
CCHD - Critical Congenital Heart Defect Screening - after 24 hours. Tested at the 24 to 48 hr visit
A.K.A. Pulse Oximetry Screening is done on the right hand and either foot.
We are looking at the baby’s oxygen saturation levels to screen for a problem with structure and function of the heart at birth. Babies who have CCHD can appear okay to the eye at first but after being a few days old, when the heart valve closes, then they can start to struggle. We want to find the anomaly before the anomaly becomes dire. This is done with the CCHD screening.
Babies having low oxygen levels in their blood are referred to a health practitioner who can check for a heart issue. The goal is to screen and find babies with hidden heart issues before there are outward signs of a heart condition.
According to the state of MN: 1% of newborns have a congenital heart defect and of these babies ⅓ have a critical kind of heart defect that requires intervention to stop serious consequences.
When testing we look for blood oxygen levels:
95% to 100% = pass
90% to 94% = retest in an hour In an hour: 95% to 100% = pass. 94% or less = fail
Below 90% = fail Refer for Echocardiogram - pediatric cardiologist
>3% differential between either foot and right hand = repeat screen
