Newborn shots at birth
What parents should know about newborn tests and vaccinations | Your Pregnancy Matters
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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Your baby's first hours of life
Right after birth, babies need many important tests and procedures to ensure their health. Some of these are even required by law. But as long as the baby is healthy, everything but the Apgar test can wait for at least an hour. Delaying further medical care will preserve the precious first moments of life for you, your partner, and the baby. A baby who has not been poked and prodded may be more willing to nurse and cuddle.
So before delivery, talk to your doctor or midwife about delaying shots, medicine, and tests. At the same time, please don't assume "everything is being taken care of." As a parent, it's your job to make sure your newborn gets all the necessary and appropriate vaccines and tests in a timely manner.
The following tests and procedures are recommended or required in most hospitals in the United States:
Apgar evaluation
The Apgar test is a quick way for doctors to figure out if the baby is healthy or needs extra medical care. Apgar tests are usually done twice: one minute after birth and again five minutes after birth. Doctors and nurses measure five signs of the baby's condition. These are:
- Heart rate
- Breathing
- Activity and muscle tone
- Reflexes
- Skin color
Apgar scores range from zero to 10. A baby who scores seven or more is considered very healthy. But a lower score doesn't always mean there is something wrong.
Perfectly healthy babies often have low Apgar scores in the first minute of life.
In more than 98 percent of cases, the Apgar score reaches seven after five minutes of life. When it does not, the baby needs medical care and close monitoring.
Eye care
Your baby may receive eye drops or ointment to prevent eye infections they can get during delivery. Sexually transmitted infections (STIs), including gonorrhea and chlamydia, are a main cause of newborn eye infections. These infections can cause blindness if not treated.
Medicines used can sting and/or blur the baby's vision. So you may want to postpone this treatment for a little while.
Some parents question whether this treatment is really necessary. Many women at low risk for STIs do not want their newborns to receive eye medicine. But there is no evidence to suggest that this medicine harms the baby.
It is important to note that even pregnant women who test negative for STIs may get an infection by the time of delivery.
Plus, most women with gonorrhea and/or chlamydia don't know it because they have no symptoms.
Vitamin K shot
The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K in their bodies. This vitamin is needed for the blood to clot. Low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.
Newborns probably feel pain when the shot is given. But afterwards babies don't seem to have any discomfort. Since it may be uncomfortable for the baby, you may want to postpone this shot for a little while.
Newborn metabolic screening
Doctors or nurses prick your baby's heel to take a tiny sample of blood. They use this blood to test for many diseases. All babies should be tested because a few babies may look healthy but have a rare health problem. A blood test is the only way to find out about these problems.
If found right away, serious problems like developmental disabilities, organ damage, blindness, and even death might be prevented.
All 50 states and U.S. territories screen newborns for phenylketonuria (fee-nuhl-kee-toh-NUR-ee-uh) (PKU), hypothyroidism, galactosemia, (guh-LAK-tuh-SEE-mee-uh) and sickle cell disease. But many states routinely test for up to 30 different diseases. The March of Dimes recommends that all newborns be tested for at least 29 diseases.
You can find out what tests are offered in your state by contacting your state's health department or newborn screening program. Or, you can contact the National Newborn Screening and Genetics Resource Center.
Hearing test
Most babies have a hearing screening soon after birth, usually before they leave the hospital. Tiny earphones or microphones are used to see how the baby reacts to sounds. All newborns need a hearing screening because hearing defects are not uncommon and hearing loss can be hard to detect in babies and young children.
When problems are found early, children can get the services they need at an early age. This might prevent delays in speech, language, and thinking. Ask your hospital or your baby's doctor about newborn hearing screening.
Hepatitis B vaccine
All newborns should get a vaccine to protect against the hepatitis B virus (HBV) before leaving the hospital. Sadly, 1 in 5 babies at risk of HBV infection leaves the hospital without receiving the vaccine and treatment shown to protect newborns, even if exposed to HBV at birth. HBV can cause a lifelong infection, serious liver damage, and even death.
The hepatitis B vaccine (HepB) is a series of three different shots. The American Academy of Pediatrics and the Centers for Disease Control (CDC) recommend that all newborns get the first HepB shot before leaving the hospital. If the mother has HBV, her baby should also get a HBIG shot within 12 hours of birth. The second HepB shot should be given one to two months after birth.
The third HepB shot should be given no earlier than 24 weeks of age, but before 18 months of age.
Complete checkup
Soon after delivery most doctors or nurses also:
- Measure the newborn's weight, length, and head.
- Take the baby's temperature.
- Measure that baby's breathing and heart rate.
- Give the baby a bath and clean the umbilical cord stump.
What vaccinations are waiting for the baby in the hospital?
Should the baby be vaccinated, and if so, which ones, when, with what drug, is it dangerous - every mother asks such questions. To vaccinate or not to vaccinate is the choice of the parents and it must be done already in the maternity hospital, where the first vaccinations will await the newborn. You can read about the expediency of vaccination yourself, and we have prepared answers to your most frequently asked "vaccination" questions.
We remind you: while in the maternity hospital, do not hesitate to ask questions to specialists, speak out your desires, fears, expectations.
Neonatologists examine babies daily, and you have the opportunity to get the most valuable information about caring for a baby within a few days.
What vaccinations are given to a newborn in the hospital?
Babies receive two vaccines at the maternity hospital. On the first day after birth, children are vaccinated against viral hepatitis B, on the third day they are given anti-tuberculosis BCG.
Where are babies vaccinated?
BCG - intradermally in a place on the border of the upper and middle third of the left shoulder. Hepatitis B - intramuscularly in the anterior outer part of the thigh.
What is the vaccine production in the maternity hospital?
Domestic vaccines are used in our maternity hospital.
Can I bring my own vaccines to the maternity hospital for my baby?
No, you can't. We have organized our own "cold chain" - a strict system that provides the necessary conditions for the storage and transportation of immunobiological preparations from the manufacturer to our maternity hospital and directly to each baby.
This is a great responsibility.
What reactions of the body of newborns are acceptable to vaccinations against hepatitis B and BCG?
Babies tolerate both vaccines well. A short-term local reaction is possible in the form of reddening of the injection site, a slight induration. From BCG, as a rule, a small scar remains, it will form later.
What is "Vikasol" - it must be done in the maternity hospital?
"Vikasol" is not a vaccination, but vitamin K (more precisely, its synthetic analogue), which is responsible for the blood coagulation system. It is used to prevent bleeding and to prevent hemorrhagic disease of the newborn. It is injected immediately after birth into the anterior part of the thigh.
We left the maternity hospital, but I forgot what vaccinations the child was given? Where to find out?
Information about the vaccinations that the child received in the maternity hospital is in the extract - , it is handed out.
I gave my consent for vaccinations at the maternity hospital, but they were not given, why?
Babies are examined by a neonatologist before vaccination. If the health status of the child raises doubts in the doctor or any disease is diagnosed in the newborn, then a medical disqualification will be given from vaccination.
If the baby was not vaccinated at the maternity hospital, where should they be given later?
Next, the vaccination will be monitored by the local pediatrician. He will promptly notify you of the vaccination dates according to the national vaccination schedule, examine the child and refer him to the procedures.
Is it possible to refuse vaccinations at the maternity hospital?
Yes, you can refuse vaccinations. It is necessary to notify specialists about this in advance (already being in the maternity hospital) and sign a written refusal.
More information about vaccination can be found on the website of the Moscow Health Department.
Vaccinations for children in the maternity hospital: why are they needed?
In the maternity hospital, a newborn is given two vaccinations: BCG against tuberculosis and hepatitis B. Let's figure out what these vaccinations are and why they are needed.
Why BCG is given
WHO recommends mass vaccination of newborns against tuberculosis in all countries where the disease is prevalent. Russia unequivocally belongs to such countries, therefore, on the 3rd-5th day after birth, even in the maternity hospital, all newborns are vaccinated with BCG-M free of charge.
What does the BCG-M vaccine protect against?
Importantly, the BCG-M vaccine does not protect against TB infection. Her task is somewhat different. If an unvaccinated child younger than 2 years of age is infected with TB, they are very likely to develop TB meningitis and generalized forms of TB, which can lead to death very quickly.
BCG-M quite reliably protects the child from these forms.
The effectiveness of BCG-M in newborns averages 82%: vaccination five times reduces the risk of generalized tuberculosis and meningitis. It is not known how much BCG-M protects children from pulmonary tuberculosis: studies in different countries show conflicting data. British studies show that in school-aged children, the effectiveness of protection against pulmonary tuberculosis can be 64%.
We are an ordinary family, among our acquaintances there are no patients with tuberculosis. How likely is it that a small child will become infected?
It is very large.
Tuberculosis in Russia is so widespread that by the age of forty 70-90% of the inhabitants of our country are infected with it. This does not mean that they are sick: after infection, the immune system of most people copes with the bacterium. The probability of getting sick is on average 8% in the first two years after infection, then it gradually decreases, and acquired cellular immunity is formed. Among adults, people who are weakened, living in poor conditions, with a lack of light and fresh air, malnourished (migrants, prisoners) or those who are in constant contact with the sick (for example, family members) are more likely to get sick.
However, for a small child, with his immunity not yet formed, a single accidental contact with a sick person in transport or a store may be enough.
Each patient with an active form of tuberculosis excretes from 15 million to 7 billion Koch bacilli per day with sputum, which spread within a radius of 1-6 meters. Koch's stick is very stable: it withstands freezing down to minus 269 ° C, remains viable in dried sputum on clothes for up to 3-4 months, in dairy products - up to a year, on books - up to six months.
On average, one patient with an active form of tuberculosis can infect 10-15 people per year. From these data it is clear that BCG-M vaccination is really relevant in Russia today.
BCG-M - what is this vaccine?
BCG-M is a live vaccine, that is, it is prepared from a strain of a weakened tuberculosis bacillus. This is one of the oldest vaccines, but there are no analogues to it all over the world yet.
What are the possible complications of BCG-M vaccination?
- Cold abscess - as a rule, in violation of the injection technique, more often in children who are vaccinated in the clinic.
- Lymphadenitis (incidence 0.35 cases per 1 million vaccinations).
- Generalized BCG infection (BCG) - usually in children with congenital immunodeficiencies.
Why should BCG-M be vaccinated in the maternity hospital?
- Firstly, to protect the child from the first days of life.
- Secondly, the effectiveness of BCG-M decreases over time (it must be administered up to a year, but some pediatricians believe that after 6 months it no longer makes sense).
- Thirdly, the younger the child, the lower the likelihood of complications - inflammation of the lymph nodes or cold abscess.
Reduces the likelihood of complications and skillful administration of the vaccine. The BCG-M vaccine is administered strictly INSIDE THE SKIN! Nurses in the maternity hospital vaccinate BCG daily, constantly and massively: they, as they say, “have their hands full”, and in polyclinics this vaccination is done infrequently and therefore they “miss” more often.
What if I want to leave the hospital for 2-3 days?
BCG-M vaccination can be given earlier than on the 3rd-5th day of the baby's life. If you want to leave the hospital for 2-3 days, you can ask the medical staff to reschedule the vaccination for 2 days.
Are there any contraindications for BCG-M vaccination?
Yes. These are:
- Prematurity of a newborn, intrauterine malnutrition III-IV degree. Babies weighing less than 2000 grams should not be vaccinated until they reach the correct weight.
- Acute diseases and exacerbations of chronic diseases. In this case, vaccination is delayed until recovery or stabilization of the condition.
- If the mother is HIV positive, vaccination of the child is delayed until 18 months (until the child's status is finally determined).
- Primary immunodeficiency, malignant neoplasms in a child.
Why do you need to do a Mantoux test, Diaskintest and fluorography?
Sooner or later, 70-90% of Russians are faced with tuberculosis bacteria.
One in ten falls ill as a result of this encounter. We remember that BCG-M does not protect against tuberculosis; that is why each of us must test ourselves and our children. Tests, such as Mantoux, Diaskintest, T-spot, reveal whether the child has already encountered the tuberculosis bacterium or not. When infected, the so-called "turn of the tuberculin test" occurs, and then the child or adolescent forms his own cellular immunity. The likelihood that he will get sick at the same time is lower if the BCG-M vaccine was given (we talked above about the effectiveness against tuberculosis in schoolchildren, which, although not very high, is still present).
Why is hepatitis B vaccinated?
Hepatitis B is a deadly danger for a small child. If an adult, having become infected, can live in remission for decades and not even know about the disease, then in children this virus very quickly causes cirrhosis of the liver and cancer.
The hepatitis B virus lives in the environment for 7 days.
Thus, it can live not only on medical instruments, but also on hygiene items, clothing, etc. Microcracks in the skin or mucous membrane are enough to transmit the virus. Thus, there is a risk in any medical manipulation, not to mention blood transfusion in the event of a burn or an accident.
In addition, 30% of virus carriers are unaware of their illness. A mother can pass on hepatitis B to her baby even if she was tested during pregnancy, and especially if she was not tested. Therefore, it is very important to give the baby hepatitis B vaccine within the first 24 hours after birth.
What is the next schedule for hepatitis B vaccination?
It is usually carried out according to the scheme 0-1 months - 6 months, but other vaccination schemes are possible depending on the drug.
How long does the hepatitis B vaccine protect?
Previously, it was thought that protection lasted no longer than 5-7 years, but later it turned out that even 25 years after the completion of vaccination, protection is still preserved.
Thus, vaccination in infancy protects, among other things, from infection as a result of risky sexual behavior in adolescents and young adults.
Can hepatitis B be vaccinated if the newborn has "jaundice"?
You can. There is no connection between vaccination and neonatal jaundice.
- First, the hepatitis B vaccine does not affect liver function in any way. All processes associated with vaccination occur only in the immune system.
- Secondly, neonatal jaundice is also associated not with the liver, but with the fact that there is a replacement of fetal hemoglobin with adult. Breaking down, hemoglobin turns into bilirubin. It is excreted by the liver of a newborn, but the organ itself does not suffer in any way.
What complications can occur after hepatitis B vaccination?
Hepatitis B vaccines almost never cause a noticeable reaction. This is one of the most easily tolerated vaccines for both children and adults.
Immunizations at the maternity hospital are very important.
