September 20, 2018
NCH has been delivering babies since 1959, providing a full range of medical services to ensure mom and baby have a safe and healthy childbirth experience. According to NCH Clinical Nurse Manager Nenette Cacal, one of the first screenings on a newborn involves observing the amniotic fluid when mom’s water breaks.
“If meconium (the first feces) is present in the water, it likely means the newborn may have inhaled some of it,” Nenette says. “Meconium is safely removed after delivery using a bulb syringe by the neonatologist, who will be present, if meconium is observed in the amniotic fluid.”
The nurse performs the head-to-toe assessment to ensure that the baby is healthy.
“This includes, but is not limited to: examination of the fontanelles for bulging, checking the spine for any mass or abnormality, checking for normal genitalia and checking abnormalities on the newborn’s toes or fingers,” Nenette says.
Ballard maturational assessment (BMA)
The Ballard Maturational Assessment, also called the Ballard Score or Ballard Scale, is commonly used to test gestational age. There are scores given for both physical and neurological categories to help the physician determine the age.
A pulse oximeter test is a non-invasive test that detects if the baby has any cardiac anomalies by checking blood oxygen levels.
“We place a strap around the right wrist and measure the oxygen in the blood before it goes through the heart,” explains Mary Schubert, Acute Care Staff Nurse on the Mother/Baby Unit. “Then we put a strap around either foot to measure the oxygen in the blood after it goes through the heart.”
After 24 hours of birth, the baby’s bilirubin level is tested.
Newborn jaundice is the yellowing of a baby’s skin and eyes. It’s very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during normal breakdown of red blood cells.
“A newborn’s still-developing liver may not be mature enough to remove bilirubin,” says Nenette. “It doesn’t break down the bilirubin (yellow pigmentation) so it goes under the skin resulting in the newborns having the yellow tinge to their skin.”
Treatments to lower the level of bilirubin in the baby’s blood may include light therapy (phototherapy).
NCH is excited to start using a non-invasive screening tool called Bilicheck. It uses a scanner placed on the baby’s forehead, which provides blood results without a heel prick blood test. Note: a prick still may be needed if the reading is high.
“We will begin training staff in October on the use of the Bilicheck device,” Nenette says. “We will start to use the device in the beginning of November.”
State-mandated newborn screening
Blood is collected after 24 hours of age to test for various illness/diseases including but not limited to: phenylketonuria (PKU), congenital hypothyroidism, galactosemia, sickle cell disease, congenital adrenal hyperplasia, cystic fibrosis, toxoplasmosis and severe combined immunodeficiency.
“These are the main things that the blood draw can pick up,” says Mary, adding that the test is sent to the state and results are given to the pediatrician.
Within the first 24-hour period, a nurse will place an order for a lactation specialist to visit a breastfeeding mother and help her to begin the process and observe any potential problems. “The lactation consultants will follow up with patients every day, as needed,” Mary says.
NCH provides hearing screenings for all infants.
Car seat safety
“Parents should know how to use their car seat before they have their baby,” Mary says. “Although we don’t put the baby into the car seat, we can look it over to make sure the baby is snug enough.”
We’re in the business of happy ‘birth’ days
From great comfort to expert care, NCH has everything you need for a happy ‘birth’ day. To learn more about NCH’s Women’s Center or to find an OB-GYN, visit nch.org/birthday.
Follow us on Facebook and Instagram at #NCHbirthday as we celebrate NCH ‘birth’ days in the coming months.