Caring for your newborn at Gunnison Valley Health

Caring for your newborn

Infant Care at the Hospital

• Skin to skin after delivery and thereafter to promote heart rate and temperature regulation, bonding and breastfeeding.

• Bath (immersion or sponge bath) after the first 8 hours of birth.

• Safe sleeping with baby on his back in bassinet or crib.

• Feeding on demand per baby's hunger cues such as rooting, hands to face

• Elimination of urine and stool (meconium stool)
  • Meconium stool is dark and sticky. Stools become more frequent and lighter in color by day 3-4.
  • Change the diaper as soon as it becomes wet or soiled and use a skin barrier cream such as Aquaphor to prevent diaper rash

• Daily weights will be performed starting at 24 hours and will happen every 12 to 24 hours to monitor how much baby’s weight fluctuates. We monitor the amount so that we can ensure that mother’s milk is coming in appropriately and that baby’s latch and suck is sufficient to sustain normal weight gain and create a supply in the mother. We will monitor the baby’s weight loss and discuss the efficacy of the breastfeeding with your baby’s physician.

• Daily bilirubin check with bili-meter to monitor for jaundice.

Understanding baby’s second night: After spending 9 months in the comfort of the womb, there’s a lot of unfamiliarity for a newborn in the world. On the second night, babies often nurse on and off for hours typically between 9 p.m. and 3 a.m., this is called cluster feeding. Many new parents are caught off guard by this pattern, and some assume that their babies are starving. But it’s likely just an awakening, after a nice day’s rest, to the fact that their world is now very different! If you’re home on your baby’s second night, it may also be the first time that your baby and you have some peace and quiet, as research has shown that mothers and babies are interrupted by hospital staff, visitors and phone calls an average of 54 times on the first day, and the average time mothers and babies have alone is 1 minute.

• Sleep tips: When he drifts off to sleep at the breast after a good feed, break the suction and slide your nipple gently out of his mouth. Don’t move him except to pillow his head more comfortably on your breast. Don’t try and burp him – just snuggle with him until he falls into a deep sleep where he won’t be disturbed by being moved. Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every ½ hour or so. If he starts to root and act as though he wants to go back to breast, that’s fine … this is his way of settling and comforting.
• Skin to skin: Babies need to touch – to feel – and even his touch on your breast will increase your oxytocin levels, which will help boost your milk supply! The benefits of skin to skin care do not end when you leave the hospital. So take the mittens off and loosen his blanket so he can get to his hands and be directly tummy to tummy with mom and let them hug your breasts during feedings. He might scratch himself without mits on, but it will heal very rapidly – after all, he had fingernails when he was inside you, and no one put mittens on him then!
• Good alignment is important for a deep latch: During feeding sessions ensure his tummy is facing your tummy to reinforce good posture at the breast that makes it easier for babies to suck and swallow. Remember to ask yourself: Are ears in alignment with shoulders, and aligned with hips? We do not drink a glass of water looking over our shoulder, we drink looking straight ahead.
• So don’t panic, just settle in for that special, second night!
• If on the third night you feel that your baby is still excessively fussy, you can call the lactation team for a weight check and lactation consult.

Protect Your Baby From Bleeds

Talk to Your Healthcare Provider About Vitamin K

Protect Your Baby from Vitamin K Deficiency Bleeding

Before having a baby, most parents don’t give much thought to the vitamin K injection (shot) for their newborn. It’s just not something that is talked about during prenatal checkups, even though babies have been routinely given this important shot at birth since the practice was first recommended by the American Academy of Pediatrics in 1961.

Vitamin K is needed for blood to clot normally. Babies are born with very small amounts of vitamin K in their bodies which can lead to serious bleeding problems. Research shows that a single vitamin K shot at birth protects your baby from developing dangerous bleeding which can lead to brain damage and even death. Ask your healthcare provider about the benefits of vitamin K before your delivery. Protect your newborn by making sure he or she gets the shot after birth.

What is Vitamin K Deficiency Bleeding (VKDB)?

Vitamin K deficiency bleeding or VKDB, is a condition that occurs when the baby does not have enough vitamin K. Without enough vitamin K, your baby has a chance of bleeding into his or her intestines, and brain, which can lead to brain damage and even death. Infants who do not receive the vitamin K shot at birth can develop VKDB up to 6 months of age.

Where can I get more information? www.cdc.gov/ncbddd/vitamink/facts.html

VKDB and Vitamin K FAQs

How Can I Prevent VKDB?

The good news is that VKDB is easily prevented. The easiest and most reliable way to give babies vitamin K is by a shot into a muscle in the leg. One shot given after birth will protect your baby from VKDB.

What is Vitamin K?

Vitamin K is a vital nutrient that our body needs for blood to clot and stop bleeding. We get vitamin K from the food we eat. Some vitamin K is also made by the good bacteria that live in our intestines. Vitamin K is not a vaccine.

Why Does My Baby Need a Vitamin K Shot?

Vitamin K from the mom is not easily shared with the developing fetus during the pregnancy. The intestine of the newborn baby has very little bacteria so they do not make enough vitamin K on their own.

Without enough vitamin K, blood cannot clot well. As a result, bleeding can occur anywhere in the body. This means not only that bleeding from a cut or bruise may continue for a long time, but that uncontrolled bleeding into the brain and other organs may occur.

What are the Warning Signs of VKDB?

In the majority of cases of VKDB, there are NO WARNING SIGNS at all before a life-threatening bleed starts. Babies who do not get a vitamin K shot at birth might develop any of these signs of VKDB:

• Easy bruising especially around the baby’s head and face
• Bleeding from the nose or umbilical cord
• Paler than usual skin color or, for dark skinned babies, pale appearing gums
• Yellow eyes after the baby is 3 weeks old
• Blood in the stool, black tarry stool, or vomiting blood
• Irritability, seizures, excessive sleepiness, or a lot of vomiting may all be signs of bleeding in the brain

Does Your Baby Get Vitamin K from Breast Milk?

Yes, but not enough to prevent VKDB. There is only a little vitamin K in breast milk. Breastfed babies are low in vitamin K for several weeks until they start eating regular foods, usually at 4-6 months, and until the normal intestinal bacteria start making vitamin K.

Where can I get more information? www.cdc.gov/ncbddd/vitamink/facts.html

Erythromycin Eye Ointment

What is the newborn eye medication?

It is standard practice to give preventative treatment to the newborn’s eyes with an antibiotic ointment. The antibiotic most commonly used is erythromycin. The ointment is similar in texture to Vaseline. It is squeezed from a tube directly in the baby’s eyes within an hour after birth, during his/her newborn exam.

Why is this treatment done?

Eye ointment may also protect against other bacteria present in the vagina that can cause eye infections. The purpose of this prophylactic treatment is to prevent eye infections caused by the sexually transmitted diseases chlamydia and gonorrhea. If these bacteria are present in the mother’s vagina during birth, they can be passed onto the baby and lead to infection. Eye infection due to chlamydia is the leading cause of blindness in the developing world (where antibiotics are not readily available).

What are the downsides of treatment?

According to the American Center for Disease Control, after antibiotic prophylaxis 15-25% of infants exposed to chlamydia will still develop conjunctivitis (eye infection or irritation). Treatment will cause blurred vision for a few hours after being given. Because of this, some parents are concerned that the ointment may interfere with bonding by blurring vision or causing the baby to become fussy. To minimize any negative side effects, we delay application for at least the first hour, giving mom and baby time to bond and have their first feeding. If the medication is given just before your baby falls asleep, the majority of it will be absorbed by the time your baby wakes up again. Another concern is exposure to antibiotics, which can cause system imbalance: antibiotic-resistant, infection-causing bacteria continue to grow, while other normal and healthful bacteria are killed. Because of the minimal amount of antibiotics in this treatment, this is not considered a large concern.

What if I know I don’t have a Sexually Transmitted Infection?

You were probably tested for chlamydia and gonorrhea earlier in your pregnancy. Check with your doctor if you are unsure or don’t know the results. Since both of these diseases can be silent, do not rely on being symptom-free as a sign that you or your partner(s) do not have an infection. If you are confident that you have not acquired either of these infections since then, you may decide not to give your baby the eye ointment. This includes being absolutely confident that your sexual partner(s) do not have these diseases either, which they may have passed on to you. We do require that a waiver be signed stating you received education on this topic and have chosen to waive this recommended treatment.

Hepatitis B Vaccination

The best way to protect against hepatitis B is by getting the hepatitis B vaccine. Doctors recommend that all children get the vaccine.

Why should my child get the hepatitis B shot?

The hepatitis B shot:

• Protects your child from hepatitis B, a potentially serious disease.
• Protects other people from the disease because children with hepatitis B usually don’t have symptoms, but they may pass the disease to others without anyone knowing they were infected.
• Prevents your child from developing liver disease and cancer from hepatitis B.
• Keeps your child from missing school or child care (and keeps you from missing work to care for your sick child).

Is the hepatitis B shot safe?

The hepatitis B vaccine is very safe, and it is effective at preventing hepatitis B. Vaccines, like any medicine, can have side effects. But serious side effects caused by the hepatitis B vaccine are extremely rare.

What are the side effects?

Most people who get the hepatitis B vaccine will have no side effects at all. When side effects do occur, they are often very mild, such as a low fever (less than 101 degrees) or a sore arm from the shot.

What is hepatitis B?

Hepatitis B is a contagious liver disease caused by the hepatitis B virus. When a person is first infected with the virus, he or she can develop an “acute” (short-term) infection. Acute hepatitis B refers to the first 6 months after someone is infected with the hepatitis B virus. This infection can range from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. Some people are able to fight the infection and clear the virus. For others, the infection remains and is “chronic,” or lifelong. Chronic hepatitis B refers to the infection when it remains active instead of getting better after 6 months. Over time, the infection can cause serious health problems, and even liver cancer.

What are the symptoms of hepatitis B?

Infants and young children usually show no symptoms. But, in about 7 out of 10 older children and adults, recent hepatitis B infection causes the following:

• Loss of appetite (not wanting to eat)
• Fever
• Tiredness
• Pain in muscles, joints, and stomach
• Nausea, diarrhea, and vomiting
• Dark urine
• Yellow skin and eyes

These symptoms usually appear 3 or 4 months after a person gets the virus.

Is it serious?

Hepatitis B can be very serious. Most people with a recent hepatitis B infection may feel sick for a few weeks to several months. Some people get over the illness. For other people, the virus infection remains active in their bodies for the rest of their life.

Although people with lifelong hepatitis B usually don’t have symptoms, the virus causes liver damage over time and could lead to liver cancer. There is no cure for hepatitis B, but treatment can help prevent serious problems.

How does hepatitis B spread?

Hepatitis B virus spreads through blood or other body fluids that contain small amounts of blood from an infected person. People can spread the virus even when they have no symptoms.

Babies and children can get hepatitis B in the following ways:

• At birth from their infected mother.
• Being bitten by an infected person.
• By touching open cuts or sores of an infected person.
• Through sharing toothbrushes or other personal items used by an infected person.
• From food that was chewed (for a baby) by an infected person.

The virus can live on objects for 7 days or more. Even if you don’t see any blood, there could be virus on an object.

Where can I learn more about the hepatitis B vaccine and my child?

To learn more about the hepatitis B vaccine, talk to your child’s doctor,

call 1-800-CDC-INFO or visit www.cdc. gov/vaccines/parents. For more in-depth information about hepatitis B, visit www.cdc.gov/hepatitis/hbv.

The Centers for Disease Control and Prevention, American Academy of Family Physicians, and the American Academy of Pediatrics strongly recommend all children receive their vaccines according to the recommended schedule.

Pacifier Use

Fact: The use of pacifiers is up to you as parents.

Tip: If your baby is fussy, try feeding again, swaddling, snuggling or skin to skin before resorting to the pacifier.

Arguments for using a pacifier	Cons of using a pacifier
Once breastfeeding, weight gain and feeding routine have been established by 3-4 weeks of age, pacifier use is less likely to interfere with breastfeeding.	According to the American Academy of Pediatrics “the early use of pacifiers may be associated with less successful breastfeeding; pacifier use in the neonatal period should be limited to specific medical situations. These include uses for pain relief, as a calming agent, or as part of a structured program for enhancing oral motor function. Because pacifier use has been associated with a reduction in SIDS incidence, mothers of healthy term infants should be instructed to use pacifiers at infant naps or sleep time after breastfeeding is well established, at approximately 3-4 weeks of age”.
It used to be thought that babies who used a pacifier before they got the hang of nursing sometimes experienced nipple confusion, which interfered with successful breastfeeding. But experts now say the research is conflicting, and there aren’t any studies that conclusively show whether the two are related	Pacifiers can lead to missed feeding cues contributing to poor feeding and challenged weight gain. Pacifiers should not be used unless your baby has been fed and is not exhibiting hunger cues.
There is research that supports pacifier use with sleep in reducing the risk of SIDS.	Don't give a pacifier to a baby who is having problems gaining weight. So if your baby is having difficulty nursing (or if you're having trouble maintaining your milk supply), it's probably best to do without a pacifier, at least for now. You'll also want to consider having your baby go without a pacifier if he's had repeated ear infections. Also make an appointment with a lactation consultant to help you establish a better supply Eventually you will have to go through the process of weaning your child from the pacifier.

This shape pacifier promotes good suck habits for breastfed babies

This shape pacifier promotes a chewing habit, which may not be compatible with breastfeeding

Performed in the Hospital

At Gunnison Valley Hospital we provide a few standard tests to make sure we catch certain congenital abnormalities newborns are unable to tell us they are experiencing.

• Colorado Newborn Screening Program
  • This test is done between 24 - 48 hours after birth, and again at 10 - 14 days after birth. In the back of the binder you will find a brochure that covers all the congenital disorders this test screens for. Most of these remain symptomless until they are critical. This test is a blood test, and consists of a heel prick done by the lab.
• Critical Congenital Heart Disease (CCHD)
  • CCHD represents about 25% of all congenital heart defects. Infants with CCHD have structural heart defects that often are associated with hypoxemia in life. Without screening, some newborns with CCHD might be missed because the signs of CCHD might not be evident before an infant is discharged from the hospital after birth.
  • This test is non-invasive and can be done while your baby is asleep. The nurse places a pulse-ox monitor on their right wrist, and another wrist or ankle and compares the percent of oxygen in their blood. This test is completed after 24 hours of life.
• Newborn Hearing Screen
  • After 12 hours of life, the nurse will test your baby’s hearing. This is important to screen for early as hearing can impact an infant’s development.
  • This test is non-invasive and is usually done while your newborn is sleeping. There is a small probe that sits just inside the ear and bounces off radio waves and monitors if they return back to the probe. If your baby does not pass the hearing screen before discharge, you will follow up with our Lactation Consultant for further testing.

Jaundice in the Newborn

More studies are showing that delayed cord clamping is highly beneficial when a baby is born to allow for that extra “rush” of red blood cells (RBC) and nutrients into the body. Being at a higher altitude we naturally have a higher red blood cell count.

It is normal for the levels to rise and mild jaundice is not harmful. The concerning piece is when it rises too quickly, and reach high levels quickly. High bilirubin levels that are left untreated can result in developmental issues and brain damage. If their levels reach a high amount showing on the sensor used by the nurse, they might need a heel prick to obtain a more accurate level.

The treatment for high bilirubin levels is a simple solution of using photo therapy. Photo therapy converts the bilirubin to water soluble and is then also excreted in urine.

Please see the brochure in the back of the binder for more information regarding jaundice in the newborn.

Every day, the nurse will do a simple non-invasive scan to evaluate how high their bilirubin is (breakdown of RBC).

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