First Check-Ups for Your Baby After Birth

The examination of the newborn baby actually starts from the moment the pediatrician enters the delivery room or operating room before the baby is born. Yeditepe University Bağdat Street Clinic Pediatric Health and Diseases Specialist said that it is very important to get detailed information about the baby, the mother, and the pregnancy period just before the birth, to determine the risk factors, and to predict what can await us after the birth for the next follow-up of the baby.
Your baby has been born, you have smelled his/her scent and now it is time for his/her routine check-ups... After the baby is born, before a detailed physical examination, the vital functions of the baby and whether he/she needs an urgent intervention are evaluated. Whether he/she cries or not and whether he/she is breathing are the first parameters to be evaluated. At the same time, for this purpose, the baby's muscle tone, presence and rate of heartbeat, response to painful stimuli (reflex response), skin color, presence, and speed of respiration are checked. Each of these five parameters is evaluated with a scoring system between 0-2. We call these assessments the Apgar Score.

Apgar Score

The Apgar Score was defined by Dr. Virginia APGAR, an American anesthesiologist, in 1952. This score provides a standardized evaluation of the baby by pediatricians as soon as it is born. The baby is examined twice, at the 1st and 5th minutes after birth, and for the 3rd time at the 10th minute in some special cases. We can say that a baby whose Apgar is between 7 and 10 is in good condition and we can predict that it can be followed up with the mother. If this score is between 4-6, the baby needs intervention and support, and if it is between 0-3, the baby's condition is bad and emergency neonatal resuscitation steps are started. The Apgar score gives us information about the general condition of the baby in the first minutes of birth. It has been shown in recent studies that the Apgar score is not suitable to be used to predict a condition called asphyxia or a neurological problem.
After the first evaluations, the baby's umbilical cord is cut by stroking and the presence of 2 arteries and a vein, which should normally be found in the umbilical cord, is evaluated. After that, a detailed systemic physical examination of the baby begins.

In the head and neck examination, the shape of the head, the presence of trauma findings that may occur during birth (caput succedaneum, cephalohematoma, peripheral facial paralysis), the structure of the eye, the shape and structure of the ears, the integrity of the mouth, the structure of the palate, and together with all of them, whether there is any finding suggesting a congenital anomaly are examined. At the same time, it is checked whether both nostrils are open with the help of a thin probe. After the examination of the heart, lungs, and abdomen, the structure of the arms and legs, their movements, and the number of fingers are checked to see if they are normal. Again, findings related to birth trauma (clavicle fracture, brachial plexus injury) are evaluated. In addition, it is evaluated whether there is a horizontal Simian line specific to Down's syndrome in the palm.

It is Time for Spinal Evaluation

One of the first examination steps is the evaluation of the spine structure. Spinal integrity is checked for any curvature in the spine, which we call scoliosis, as well as the presence of an opening in the spine, especially in the waist and hip region, or the presence of sacral dimple or regional hair growth suggesting that there may be an opening.
After that, a genital area examination is started. First, it is checked whether the anus is open. Then, the vaginal opening and labia are evaluated in female babies, the penis structure in male babies and whether the testicles are in the scrotum, that is, in the sac, are checked.

Silky Skin... 

It is also important to evaluate the skin findings specific to the newborn baby. Especially in babies, a purplish-bluish skin spot, which we call Mongolian spot, can be seen mostly in the back and waist region, it is completely normal and disappears by itself at the latest around 5 years of age. Again, the presence of hemangiomas that we see in the neonatal period, that is, lesions that go away with vascular enlargement, of which follow-up and treatment are performed according to their size and location, are evaluated. After this detailed physical examination, weight, height, and head circumference are measured, which is the part that families are most curious about.
After completing the examination steps, the baby is first given intramuscular vitamin K. Vitamin K is an essential vitamin that plays a role in the synthesis of factors required for blood clotting. Unfortunately, it is not passed from mother to baby and is not found in sufficient amounts in breast milk. Therefore, vitamin K administration is of vital importance in preventing any bleeding and coagulation disorders.
The first dose of the hepatitis B vaccine, which is a serious infectious disease, is also administered with vitamin K administration. Again, antibiotic eye drops are applied to the baby to protect against bacteria that can be transmitted to the baby through the mother's birth canal and cause a serious eye infection.

The baby is born with an oily layer on the skin, which we call Vernix caseosa, which protects it from heat loss. Since heat loss can be very easy in newborn babies, the baby should not be bathed for at least the first 24 hours after birth, except in the presence of an infectious disease (hepatitis, HIV, etc.) that can be transmitted from mother to baby. During the baby's stay in the hospital, regular examination and weight monitoring are performed and necessary support is provided for breastfeeding. The baby is also closely monitored in terms of jaundice. After discharge, weight gain and jaundice are followed up with routine controls.

Which Tests Should Be Applied to Babies When They Are Born, and Which Risk Situations Arise If These Tests Are Not Applied?

In the newborn baby screening program of the Ministry of Health, screening is performed with heel blood for 4 diseases that are common in the community but most importantly do not give any symptoms in the early period and unfortunately leave permanent serious sequelae if not treated, where sequelae can be prevented with early diagnosis and treatment.
These diseases are Congenital Hypothyroidism, Biotinidase Deficiency, Phenylketonuria, and Cystic fibrosis. The most important point here is that these babies are completely healthy when they are born, these diseases do not show any signs in the early period. When the diseases start to show symptoms, it is actually late and irreversible damage has begun to occur. For example, in a completely healthy baby born with congenital hypothyroidism, thyroid hormone deficiency, insufficiency or complete absence of thyroid gland, developmental delay, and most importantly mental retardation is seen over time. If we detect this disease in the early period with this screening program, these children will grow up as completely healthy and normal individuals when we start treatment immediately. That is why it is so important to do these screening tests with the heel blood taken at the end of the 48th hour after the baby starts to feed. Furthermore, within the scope of the Ministry of Health's screening program, newborn babies are usually given a hearing test within the first week after birth. In the first month, a hip ultrasound is performed for congenital hip dislocation.
The eye examination must be carried out regularly at the first examination after discharge and at each follow-up examination until the age of 1 year. In particular, the presence of congenital cataracts or intraocular congenital pathologies is evaluated by performing a red reflection test with an ophthalmoscope. At the slightest doubt, the patient should be referred to an ophthalmologist. Apart from this, it is necessary to apply to an ophthalmologist for an eye examination at the age of 1 year.