The time has finally come to take your little one home, but before you can go, many tasks must be completed. What are these tasks you ask? Let's take a look.
Generally speaking, circumcisions (which is the surgical removal of foreskin) will usually be performed the day before discharge by your OB-GYN or in some instances your pediatrician or pediatric surgeon depending on the hospital that you deliver at. This procedure is completely optional and requires a signed informed consent from you. The doctor performing the circumcision should come and explain the procedure and potential risks to you. These risk include (but are not limited to) injury to the penis, infection, and potential loss of blood. Your nurse will show you how to care for your baby's freshly circumcised penis. Circumcision care involves applying petroleum jelly, vitamin A & D, or Earth Mama Angel Baby's Baby Bottom Balm to the penis every diaper change. This should be continued until the penis is cured which takes approximately 7-10 days. Your baby's nurse will be observing the site for bleeding or for signs of infection and will also be waiting for your baby to urinate after the circumcision. Be sure to notify your nurse or pediatrician (once discharged from the hospital) if excess bleeding and / or signs of infection are noted.
The law requires a metabolic screening (also known as PKU or newborn screen) on every newborn after 24 hours of life and again at 2 weeks of life. This test screens for a multitude of metabolic abnormalities (ex. Thyroid function, sickle cell disease, phenylketonuria, galactosemia, etc.). Do not panic if the state sends you an official letter that states your baby's first PKU test was abnormal. This occurs frequently with the first test and can be due to insufficient protein take priority to the test, improper collection procedure, or damaged PKU collection paper. This test will be repeated in your pediatrician's office and if those results come back abnormally, your pediatrician will advise you on further testing.
Bilirubin levels are drawn on any baby that appears to be jaundice (especially within the first 24 hours after birth) or on those babies who blood type differs from mom's blood type. Jaundice is the yellow discoloration of the skin and high levels can be very dangerous for a newborn. If your baby's bilirubin level is high enough (which varies on many factors such as gestational age, hours of life when level was drawn, baby's weight, and the presence of other risk factors), your baby will be placed under phototherapy. Phototherapy uses blue lights to help eliminate excess bilirubin from your baby's bloodstream. During phototherapy, your baby will remain in an isolette (to prevent heat loss), dressed only in his / her diaper (to maximize exposure to the bililights), and with eyes covered (to protect eyes) until feeding time. The goal is to maximize exposure time to the bililights to assist in the excretion of bilirubin from the bloodstream. Frequent feedings and / or formula supplementation help flush out the bilirubin from the blood and into the urine and stool. Once phototherapy has been discontinued, a follow-up bilirubin level (often referred to as rebound bilirubin) is drawn to ensure safe levels of bilirubin prior to discharge from the hospital. Some pediatricians will also request an earlier follow-up visit to ensure jaundice has not worsened.
A hearing test will be performed on your baby prior to discharge. Most hospitals use a machine that tests your baby's brain responses to sound (called ABR-automated brain response). This test is conducted while your baby sleeps and is safe and painless. Babies who fail the hearing test will need to be retested on an outpatient basis. Just because a baby fails the hearing test at the hospital does not mean that he / she is deaf. Other causes include (but are not limited to), fluid present in the baby's ear, noise in the testing room, and / or movement of the baby during the test. There are also instances in which a baby passes the first hearing screen and loses hearing later due to illness, injury, medications, and / or heredity. Be sure to let your baby's know know if there is a history of hearing loss in your or your husband / significant other's immediate family.
Be sure to bring clean clothes, a hat and blankets for your baby for discharge. Prior to discharge, you will have the opportunity to have your baby's picture taken. This is completely optional. Also, be sure to have the car seat with you and know how to use it. Nurses no longer secure your newborn in the car seat for liability reasons. If your baby was born less than 37 weeks gestation, a car seat test may be required to ensure that your baby can ride safely in a reclined position. During a car seat test, your baby is secured into the car seat (by you or dad) and monitored for 1 hour for apnea (cessation of breathing), bradycardia (drop of heart rate below 100 beats per minute), and desaturations (drop in oxygen saturation
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