What is the Nurse Doing?

Even though your nurse(s) may not be in your hospital room, she is constantly busy. She is coordinating all the care for you and your baby while you are in the hospital. She is responsible for keeping records of everything that happens to both of you and checking that you and your baby are adjusting to birth normally. Before you leave the hospital, she goes through a check-list-of-check-lists to make sure everything is done properly before you leave.

The amazing thing about your nurse is that she is doing all of this for you and several other families all at the same time. And, unless she is having a really bad day, she is cheerful, cooperative, accommodating, and energetic. She really does want to help you, even if she can't help every time, quite as quickly as you would like.

Checking ID Bands

ID Bands

Almost as soon as your baby is born, a nurse puts ID bands on you, your significant other, and your baby. These bands help the hospital staff make sure that no baby ever goes to the wrong parent. Every time your baby is brought to your room, or you pick up your baby in the nursery, the nurse checks to make sure the names and numbers on your bands match.

This process can get pretty tedious for parents. "Geeze, doesn't the nurse know who I am by now?" Hospital workers understand this, but checking the bands every single time is a good habit. By doing the same thing every time, the same way, we are less likely to make a mistake.

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Vital Signs

Temp Check

It is important to assess your baby's adaptation to his new environment by checking his vital signs. When the nurse checks your baby she goes through a systematic process. If you watch her, you will notice she is using her watch, and she seems to be concentrating. She is counting your baby's heart rate and respiratory rate. She checks his temperature. She checks that his stomach is soft, that the arms and legs are moving symmetrically, and that he responds readily to her exam.

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Your Baby's First Bath

Bath

When your baby is about six to eight hours old, she will get her first bath.

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Giving the Hepatitis B Vaccine

Hep B

Your baby should get a hepatitis vaccine before going home from the hospital. It is the first of a series of three vaccines that will protect your baby from Hepatitis B infection. Hepatitis B vaccines have been given to newborns for over 20 years. They are very safe.

Hepatitis B is a terrible infection that can cause severe liver damage, cancer, and be unknowingly passed on to loved ones. In newborn infants, it is often fatal.

You can only get hepatitis B by being in contact with the body fluid of another person (i.e. sex, IV drugs). The reason the vaccine is given to brand new infants is that they are exposed to their mother's body fluids at birth. If mom somehow got Hepatitis B infection between the time she was tested for Hepatitis B and when her baby is born, her baby is protected from the infection with that first shot.

Hepatitis B was the first vaccine given to babies for a disease that rarely occurs in infants. Twenty years ago, public health officials knew the vaccine worked to prevent Hepatitis B infection, but they couldn't figure out how to get the vaccine into the teenagers and adults who most needed the protection the most.

Since we know how to vaccinate babies in the US, the decision was made to vaccinate all of us when we are babies, so when we grow up and start doing things we don't tell our parents about, we will be protected against a bad disease.

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The Newborn Screening Test (PKU)

Newborn Screen

The nurse will take a blood sample from your baby's heel when she is about 24 hours old. This is the Newborn Screening Test. The blood is tested for 29 rare metabolic diseases. These diseases are very hard to diagnose. They can make a baby critically ill before doctors can figure out what special diagnostic tests to order.

Every state in the union pays for this blood test on every baby. Each state handles the newborn screening differently. New Mexico, several other western states, Alaska, and Hawaii send their blood samples to a specialized metabolic laboratory in Oregon run by the Northwest Regional Newborn Screening Program.

After your baby has been fed for about two weeks (between ten and fourteen days) her blood is drawn again, and the tests are repeated. The repeat tests are necessary to pick up diseases that don't show up on the first first blood sample.

We used to call the Newborn Screening Test a PKU test. That's because the very first metabolic disease babies were tested for was phenylketonuria (PKU). Since babies are now tested for 29 diseases, the name was changed to the more generic "Newborn Screening Test."

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Thanks to Janelle Aby MD, Stanford School Of Medicine, Newborn Nursery, and Lucille Packard Children's Hospital for the use of occasional photographs.