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Newborn Shots, Etc.

I’m pregnant with my first child and have heard that a newborn in the hospital needs to get all kinds of shots and things within hours of being born. I’ve been following a very careful diet, avoiding additives in my food, and I’m hoping to have a natural childbirth with no medications. So I wonder how necessary all these injections are and if they pose risks to my infant. Why do new babies need vitamin K, eye drops and a hepatitis B inoculation right after birth? Are there any other standard care measures that I should know about?

baby cry

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A: Congratulations on the upcoming birth of your child. While it is true that your newborn will have certain procedures done upon his arrival into this world, I’m hesitant to say he’ll get “all kinds of shots and things.”  

The complement of injections and
procedures he will be given includes:

• Antibiotic ointment in the eyes

• Vitamin K shot in the thigh

• Hepatitis B shot in the thigh

• Hearing test

• Blood sample taken to check for
congenital disease

• Test to measure the level of bilirubin  

You know, you’re right. There are a lot of “shots and things.”

You are certainly to be commended for eating well, avoiding additives, and, I’m sure, getting plenty of exercise and not smoking. I presume your child will also get the only “natural” food without any additives: breast milk!

Let’s go over the shots and procedures little Bubba will undergo.

Antibiotic eye ointment is given to prevent newborn conjunctivitis (think very severe pinkeye) from gonorrhea or chlamydia, two sexually transmitted bacterial diseases that could be very dangerous to your child’s eyes, possibly even resulting in blindness. Prior to preventive treatment, up to 10 percent of infants developed this disease. Although better obstetrical care and improved sexual education has decreased sexually transmitted diseases in pregnancy, infections still exist.

In the past, silver nitrate eye drops were used to prevent infection. These drops frequently caused significant eye irritation and swelling that could last for several days. Silver nitrate has been abandoned and erythromycin ointment is now used instead. Erythromycin does not cause irritation. 

Although I’m sure you do not have any sexually transmitted diseases, many people do, and may be without symptoms and therefore at risk of unknowingly transmitting the disease to their newborn. Present-day antibiotic ointment is effective, safe, and without significant side effects.

Vitamin K is given as a shot in the thigh muscle to prevent bleeding in the first weeks of life. Vitamin K tends to be low in newborns, particularly in breast-fed infants. Bleeding can occur in the first days of life, or somewhere between two and 12 weeks. This late onset form can include dangerous bleeding into the brain. 

A vitamin K shot given immediately after birth is effective in preventing early or late onset bleeding. This has been the standard form of preventive treatment since 1961. Oral vitamin K does not seem to be as effective, and requires several doses. Requiring multiple doses unfortunately decreases the chance that a full course of medication will be given. In 1990, concern arose that vitamin K shots could be associated with forms of cancer or leukemia in children. Further studies since that time have not established any such relationship. I am unable to answer the question of why breast milk should be low in an essential component such as vitamin K. Further research is being conducted into the use of oral vitamin K.

Hepatitis B is a type of hepatitis (an infection of the liver) that is typically transmitted by blood, intravenous drug use or maternal transmission to the newborn. The Centers for Disease Control and Prevention (CDC) estimates that each year approximately 20,000 women infected with hepatitis B give birth in the United States. 

In an ideal world, all pregnant women would be accurately screened for hepatitis B prior to delivery. Ours, however, is not an ideal world. In addition, not all infections are transmitted by blood. It is possible for infected caregivers or relatives to infect a newborn. Infants and children infected with hepatitis B are at greater risk of developing chronic hepatitis, which can cause much more serious liver problems. 

Full protection results from three shots during the first year of life. Giving the first shot at the time of birth guarantees that all children have at least some degree of protection, and also safeguards infants whose mother or other caretakers may be unknowingly infected. Reactions to the shot are infrequent, and almost always very mild. hepatitis B immunization for children is only about 20 years old. Only more time and study will show if immunity will be lifelong. 

Screening for congenital diseases (diseases present at birth) began in New York in 1965. Originally one illness, phenylketonuria, was screened for. In 2009 your child will be checked for more than 40 different diseases as well known as sickle cell disease, hypothyroidism, AIDS and cystic fibrosis, and as esoteric as citrullinemia or maple syrup urine disease (hopefully you’re not reading this at a pancake breakfast). 

An extremely small amount of blood is taken from the newborn’s heel, analyzed in Albany, and reported back to your doctor in about one week. Newborn screening is a fine example of the good your taxes can accomplish.

Hearing screening is a remarkable program that checks your child’s hearing within the first few days of life. Estimates show that anywhere from 4,000 to 12,000 infants are born each year in the United States with some degree of hearing loss. Painless, non-invasive screening can identify these children and allow for early correction or therapy. Remarkably, only 38 states have a universal screening program. You, fortunately, live in one of those states.

Bilirubin testing: Many babies develop jaundice (yellow skin) in the first few days of life. This may result from certain differences in the blood type of mother and child, or sometimes from serious illness. Most of the time, however, it is simply the result of a relatively immature liver, unable at first to adequately do its job. After a few days it matures and resolves the problem. In recent years a device has come into use that can measure bilirubin, the chemical that causes jaundice, without need for blood testing. Using the device, a simple, quick and painless procedure is performed on all babies prior to discharge.

Clearly the first three topics are those that most concern parents. Eye ointment, vitamin K, and hepatitis B immunization are each topics that could take up a whole column. If you have further questions, you know where to find me. Better still, have a conversation with your doctor.

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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