Cheryl (Host): This podcast is for informational purposes only
and is not intended to be used as personalized medical advice.
Your baby was delivered successfully.
Now what here to talk about some of the standard interventions for newborns is Dr.
Anika Larson.
She's a pediatrician at Skagitregionalhealth.org
This is Be Well with Skagitregionalhealth.org.
I'm Cheryl Martin, Dr.
Larson, thanks for coming on.
Anika Larson, MD: Thank you for having me.
Cheryl (Host): So let's start with the basics.
What are the standard interventions that newborns typically receive
shortly after birth in the hospital?
Anika Larson, MD: so when we say newborn interventions, we're
typically talking about three things.
An injection of vitamin K to prevent dangerous bleeds,
erythromycin eye ointment to prevent blindness from gonorrhea And the
hepatitis B vaccine that prevents.
Hepatitis B, and specifically we're trying to prevent the more serious complications
of Hepatitis B, like liver cancer.
With some rare exceptions.
All babies are recommended to receive all three of these soon after birth.
I think it's important to say that we're focusing on these
three things that are typically called the newborn interventions.
But there are other things that are happening shortly after
birth that are also so important.
Bonding skin to skin, establishing early feedings.
and these are just three things that are happening alongside everything else.
Cheryl (Host): So let's talk about the three that you mentioned, and
you touched on this, but why is the vitamin K given in newborns And
what can happen if it's declined?
Anika Larson, MD: Yes.
So vitamin K is exactly what it sounds like.
It's a vitamin.
throughout our lives, our bodies need vitamin K for blood clotting
and to prevent dangerous bleeding.
As adults, we can absorb enough vitamin K through our food and with the help
of our mature microbiomes, however.
Babies start out with very low levels of vitamin K.
and that's just because it is not transferred well through the placenta.
And then their brand new immature guts, are also not able to absorb
enough vitamin K, to protect them for the first months of their life.
And This is particularly true for babies that are exclusively breastfed,
because vitamin K is just not.
Transferred very well through breast milk.
So when vitamin K is not given to babies at birth, they can have dangerous bleeds.
we're thinking about three different, Types of Vitamin K deficiency, bleeding,
bleeding that happens in the first 24 hours is called early bleeding, and
that's generally related to specific conditions that the pregnant person has
or medications that they're taking that ideally we knew about before the baby
arrived then in the first week of life.
We call vitamin K deficiency, bleeding, classical bleeding,
and This is often visible.
An example of this would be bleeding from, the umbilical
cord when the cord falls off.
Uh, that doesn't stop.
Now the late Vitamin K deficiency, bleeding is happening after the first week
of life, and it can happen anytime through about the first six months of life.
This is particularly dangerous.
It typically starts inside the body, so inside the brain or inside the gut.
And as a result of that, it's not initially visible and
it can be very dangerous.
Vitamin K deficiency, bleeding can lead to serious long-term
effects on the baby or death.
So that's why we think it's so important to give that vitamin K injection
as soon as possible after birth.
a baby who has gotten the vitamin K injection after birth is 81 times
less likely to get a case of that serious late bleeding than a baby
who hasn't gotten that vitamin K.
Cheryl (Host): Dr.
Larson explained then the purpose of a Hepatitis B vaccine at birth,
especially if the mother tested negative.
Anika Larson, MD: So the purpose of the Hepatitis B vaccine is
to protect against hepatitis B.
to start with, hepatitis B is a virus that infects the liver.
in adults, This is often a temporary infection and only sometimes turns into
a chronic form of hepatitis B that can progress to liver cancer and death.
However, in babies and children, it is more aggressive.
So 90% of newborns who are infected with the Hepatitis B virus will
develop that chronic lifelong form of hepatitis B, which we can
treat, but it cannot be cured.
so we are very, very motivated to make sure that no baby is
infected with hepatitis B.
The Hepatitis B vaccine protects all babies So, It will reduce the risk
of transmission from a patient who is infected, And then it will help prevent
babies from getting Hepatitis B even if the pregnant person tested negative.
And This is the question that I would say we get the most is, my test was
negative in pregnancy, so why is the Hepatitis B vaccine still recommended?
for multiple reasons.
one, so our Hepatitis B testing in pregnancy is good, but it isn't perfect.
And the Hepatitis B vaccine will help protect babies in the case
that the Hepatitis B test was missed or that the pregnant patient
was infected after being tested.
also, and I would say This is, often the most surprising thing for families
are even for healthcare professionals who are more used to caring for adults.
babies and children can get hepatitis B from what we call horizontal transmission.
So that's contact with blood or bodily fluids from other people
who have Hepatitis B, such as just.
Close contact with family members or even with other kids.
We test the, the pregnant person, but we don't test other members of the
family and certainly not other members of the community for Hepatitis B.
And many people who have chronic Hepatitis B don't know it.
So this protects the baby once they're out of the hospital, going out into the
world and interacting with other people who may not know that they're carriers.
Cheryl (Host): Thank you.
So let's talk about the standard intervention, erythromycin eye ointment.
The role and why is it considered so important?
Anika Larson, MD: So the role of erythromycin eye ointment and why
that's considered so important is that erythromycin eye ointment prevents
newborn eye infections from gonorrhea.
Eye infections from gonorrhea can cause blindness in the baby that progresses
very quickly after birth, which is why This is one of our, early interventions.
and it can also turn into a dangerous infection of the blood or spinal cord.
Cheryl (Host): are there some parents who are hesitant about these interventions,
and if so, what concerns do you hear most often and how do you respond to them?
You've talked about, the Hepatitis B vaccine at birth, but any other concerns?
Anika Larson, MD: So I think it's important to know that
there's a really wide variety of, how families approach this.
So we see many loving, caring, wonderful families who are ready to give their
newborn baby, whatever is recommended by the healthcare team to keep them healthy,
and don't have questions necessarily.
And then we see other loving, caring, wonderful families.
Who have questions, who may be hesitant for a variety of reasons, who may want
to really fully understand everything That is going to their newborn's body.
And there is absolutely no judgment from us either way.
We're very happy to work with families on any questions and hesitations
that they might, might have.
So, some common things that come up is, one, are these interventions safe?
And the answer is yes.
All three of these interventions have been used for decades or more
in the United States, around the world, and they are very safe.
another concern that often comes up are around side effects.
so, kind of going through piece by piece, erythromycin ointment carries
a small risk of eye irritation.
I will say That is.
Quite rare.
I have personally never seen it on a baby.
both vitamin K And the Hepatitis B vaccine are also injections.
So I think it's important that families tend to know that This is gonna be
painful for their baby And we try to mitigate that as much as possible.
So, having family cuddling with their baby right after feeding their baby
right after, and really doing what we can to make that quick and over with.
Um.
And then you can also, because there are injections, you can get some bleeding or
a local injection site, like a little bit of bruising, swelling, redness, at the
site where the injection was performed.
Cheryl (Host): Now, are these interventions required or
can parents decline them?
And if so, what's your approach if they do?
Anika Larson, MD: The short answer is that no, these interventions are.
Required.
and yes, parents can decline them or they can choose other approaches
that might reduce some risk.
there's also a question that comes up, which is, are there any alternatives?
so when it comes to.
all of these interventions.
the first step when a family, declines or has questions is always to try and
understand their individual concerns.
And I'll say that This is something that, in thinking about this podcast,
was absolutely the biggest thing that I would love to improve in my own practice.
Because, consistently when families decline, we wanna give information
And we wanna make sure that the family really understands the
benefits of this, intervention And the risks of declining it.
and sometimes really the hardest thing is to have that conversation and make
that family feel comfortable sharing what their concerns are or what they may,
have heard about these interventions.
going through the interventions piece by piece.
when it comes to declining vitamin K, we do ask that
families sign a declination form.
And then one thing that will often come up with vitamin K is some families will
be interested in doing oral vitamin K.
So I think it's very important to know here that the vitamin K injection is the
most effective way to give the vitamin K And the way that's, most effective
in terms of helping that baby and making sure that they get that dose.
however.
there is an option to give oral vitamin K to the newborn And this
can also meaningfully reduce the risk of vitamin K deficiency bleeding.
So in the case that a family opts for that, we'll help them, get that
and help them complete the series.
because you do need, with the dosing schedule that we use, you do need
three different doses And we will, help make that happen for families.
in terms of the Hepatitis B And the erythromycin ointment, there
are really no good alternatives.
we will ask families again to sign a declination for the erythromycin
eye ointment, just confirming that they, have heard and understand
the risks And the benefit.
And then what I will do is we will have reviewed all of the pregnant patient's
prenatal labs when their baby comes to us.
but I will go back and I will triple check that they've gotten all of the
testing that was recommended in pregnancy.
because I have had the case come up where, someone.
Chose not to get the erythromycin eye ointment for their baby, but we realized
that their gonorrhea test had been missed in pregnancy and could go ahead
and do that and kind of have that added layer of, reassurance that there was
no gonorrhea at the time of delivery.
so That is another, another thing that we can do in that case.
Cheryl (Host): Now if a parent has more questions or is on the fence
about these treatments, what resources or advice do you recommend they
turn to for reliable information?
Anika Larson, MD: So I always want families to feel comfortable reaching out
to their, pediatrician, to their baby's doctor, so that they can really have
a conversation about their individual child and their individual concerns.
every family will be different and, am very certain that, all of us really
want to have these conversations and, help families feel comfortable.
for general resources, I would say the best resource is healthy children.org.
This is a website of the American Academy of Pediatrics, and they have very helpful
resources, question and answers on all three of the newborn interventions.
Cheryl (Host): Dr.
Anika Larson, thanks so much for sharing some vital information
for the parents of newborns.
Very informative.
Thank you.
Anika Larson, MD: Thank you for having me.
Cheryl (Host): To learn more, visit skagitregionalhealth.org
dot org.
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