Newborn screening and newborn exams

Once the newborn baby's umbilical cord has been cut, a rubber band or clamp is used to secure the cord stump. Your baby is wiped dry and wrapped in warm and dry towels.

Peace and quiet for mother and baby before any assessments and exams
It is well known now that to get breastfeeding off to the best start mother and baby need peace and quiet just after the birth until the baby has suckled for the first time. Your baby should be given a chance to root for and latch onto the breast unaided.

This is why many hospitals and clinics wait to test and examine a newborn until it has had a chance to bond with its mother, to root for and ideally latch on to the breast for the first time. In some situations, the initial exam and assessment have to be done before mother and baby have had this time to themselves. However, a quick initial assessment is always done to make sure baby is doing well.

Apgar Score assessment
The midwife assesses the baby, giving it an Apgar Score one, five and ten minutes after it is born. The Apgar Scale rates the baby's:
• A=Appearance (colour)
• P=Pulse (heartbeat)
• G=Grimace (behaviour)
• A=Activity (muscle tone)
• R=Respiration (breathing)

A maximum of 2 points is given for each of these baby health criteria. The usual Apgar Score after an uncomplicated birth is 9-10-10 with a deduction made for appearance (colour) after one minute, which is entirely normal. Once the baby has been breathing a while, it will often be given a top score. For a complete picture of the baby's state of health, blood from the umbilical cord is pH-tested.

The first exam
The initial examination by the midwife is usually done two hours after delivery.
The midwife examines the baby's mouth, touching the roof of the mouth with a finger to check that it is closed so that the baby can suckle. Next, the whole body is examined. The midwife checks the eyes and ears, and counts fingers and toes. The soft spots on the baby's head (fontanelles and sutures) will be gently examined.

A thermometer may be inserted in the baby's bottom to check that the rectum is open, and to take the baby's temperature. In baby boys, the scrotum is checked for two testes.

All babies are given a vitamin K injection to improve blood clotting and prevent bleeding in the early postnatal period. The baby's length, weight and head circumference are recorded.

The newborn baby is also normally examined by a paediatrician within the next day or two after the birth. This exam assesses the baby's general appearance and any skin changes. The paediatrician listens to the lungs and heart, examines the hips, eyes, back, the scrotum in boys, and assesses the head, belly and reflexes. A hearing test will also be performed.
Further reading: development of the baby's senses and brain.

Newborn screening after two days
As soon as possible after the second day, a PKU test/newborn screening will be performed. This is a blood test done on all newborns. The aim is to detect a number of rare but serious congenital diseases which are treatable if caught early.

The test is done by a tiny puncture to draw a spot of blood, often from the hand or the heel, when the child is at least 48 hours old. The original PKU test takes its name from a disease called phenylketonuria, and is now performed under a national newborn screening programme in most countries.
The PKU test/newborn screening tests for up to 24 rare, but hereditary congenital metabolic diseases. Early treatment is vital in order to prevent the damage otherwise caused by these serious conditions. In some cases, the blood test may be done at a return appointment at the hospital if the mother was discharged before 48 hours had passed.
The test results are usually available within a week. In Sweden, for example, only 70 of the 110,000 babies born each year are found to have a metabolic disease.

Further reading:
The first days at home with your newborn baby
Baby care