Newborn Procedures

Common Newborn Procedures: Erythromycin


What is It?

Erythromycin ophthalmic ointment is routinely given to newborns to prevent an infection of the tissue surrounding the eye (conjunctivitis), which if not treated, can lead to blindness. Conjunctivitis can be caused by both normal bacteria or bacteria associated with a sexually transmitted disease such as Gonorrhea or Chlamydia that may be present in the birthing woman’s reproductive tract without her having any symptoms of infection. Most women will experience some kind of symptoms with both of these infections, but risk factors such as multiple sexual partners can increase the chance of undiagnosed vaginal infections. The primary signs of an eye infection in a newborn are redness and swelling of the lids and sclera of the eye.


What are the benefits of treatment?

Erythromycin is effective against certain strains of staphylococcus, streptococcus, pneumonia, influenza, syphilis, gonorrhea, and chlamydia.


What are the risks of treatment?

There are studies that show that routine administration of eye ointment does not confer significant reduction of eye infections as opposed to no treatment. It also does not provide complete protection against chlamydia, and only IV antibiotics can prevent gonorrhea blindness in an active neonatal infection. Risks include redness, blurred vision, and plugged tear ducts.


Are there alternative treatments?

Most babies are born with their tear ducts still closed. Without tears, they are unable to rinse their eyes of dust and other irritants. It soften recommended to use a few drops of your breast milk as a “rinse” of the crusty discharge that often develops in your baby’s eyes during the first few weeks of life. This discharge can be clear or yellow and does not indicate an infection is present. Good hand washing (especially after diapering) is an important component of reducing exposure to unfriendly bacteria. If your baby does develop an eye infection, antibiotic treatment is still an option, as well as herbal rinses of chamomile or echinacea tea, goldenseal, and homeopathic euphrasia.

Common Newborn Procedures: Vitamin K


What is the vitamin K injection?

Vitamin K is a naturally occurring vitamin in humans that helps the blood to clot, and is created by bacteria in the intestinal tract. At birth the baby’s intestinal tract is sterile, containing no bacteria to manufacture the vitamin, but after the first weeks of life bacteria levels and vitamin K levels naturally increase. Newborn infants are therefore considered to be universally deficient in vitamin K, and consequently their ability to stop bleeding is decreased. Reasons for this are not known, however, many researchers believe that because this is a naturally occurring physiological deficit that happens worldwide, there must be a good reason for lower vitamin K levels in newborns, although evidence is not conclusive.


Newborns are routinely given a 0.5-1 mg vitamin K injection in the first hour of life to prevent Vitamin K Deficiency Disease (also known as Vitamin K Deficiency Bleeding or Hemorrhagic Disease of the Newborn), a rare but deadly bleeding condition that can occur up to 6 months after birth. If VKDB occurs in the first 2 weeks of life, it is know as “Early VDKB.” If VKDB occurs at 2-12 weeks of life, it is known as “Late VKDB.” Late VKDB occurs most commonly between 3-8 weeks of life, but up to 6 months. It is very serious, can lead brain damage and even death if undetected. Early onset VKDB can occur in approximately 0.25-1% of newborns who do not receive supplementation. Late onset VKDB can occur in approximately .04% newborns who do not receive supplementation. 


Signs of VKDB:

- bleeding from the umbilicus, nose, mouth, ears, urinary tract or rectum

- any bruise not related to a known trauma

- pinpoint bruises called petechiae

- black tarry stools after meconium has already been expelled

- black vomit

- bleeding longer than 6 minutes from a blood sampling site even after there has been pressure on the wound

- symptoms of intracranial bleeding including paleness, glassy eyed look, irritability or high pitched crying, loss of appetite, vomiting, fever, prolonged jaundice.


Newborns can be at increased risk for VKDB with the following factors:

- Breastfeeding (because formula is fortified with Vitamin K)

- Preterm delivery or low birth weight

- A forceps or vacuum extraction delivery

-  Mother’s use of antibiotics, anticoagulants, anticonvulsants, aspirin, and some other medications during pregnancy

-   Undetected liver disease in the newborn

-   Extremely fast, or extremely prolonged labor, or long pushing phase

-   Breathing difficulties at birth

  • Delivery by C-section

  • Bruising, especially around the head or face


Babies who are born physiologically, or without undue trauma, are at the very lowest risk of developing VKDB. But, of course, there is always risk.


Risks of the injection include:

1. The recommended daily allowance (RDA) for infants 0-6 months is 2mcg of vitamin K per day. When the newborn is given a 1mg injection, they are receiving 5,000 times the RDA of vitamin K. Vitamin K is a fat-soluble vitamin. Because the newborn’s immature system has limited ability to detoxify large doses of the synthetic vitamin, it can accumulate in the tissues.

2. The injection often contains preservatives and other potentially dangerous ingredients that can be toxic for baby’s delicate immune system.

3. An injection creates an opportunity for infection at the injection site because the baby’s immune system is still immature.

4. There is a failure rate of 1 in 400,000 with the injectable Vitamin K.


Oral Vitamin K Supplementation

Another way to raise vitamin K levels in newborns is to give vitamin K drops orally. K-Quinone (vitamin K1) is an extract of alfalfa, nettles and green tea in a base of olive and soy oil. Recommended dosage is 4 drops (2 mg) at birth, and 2 drops (1 mg) starting at 1 week and continuing once per week for 12 weeks. A single oral dose does not provide the sustained elevation in serum vitamin K concentrations needed to prevent late bleeding, therefore, continued use is necessary in order to help prevent late VKDB. Oral vitamin K decreases the incidence of bleeding problems, but is not as effective as the injection, and it is not the standard of care approved by the American Academy of Pediatrics. Any baby treated with oral vitamin K, or not treated at all, should be watched carefully for any bruising, unusual discoloration, or lesions. These may occur up to 3 months after birth. If this occurs the baby should be evaluated immediately and the pediatric care provider informed that the baby did not receive a vitamin K injection. if parents would like to utilize Oral Vitamin K, it is the parents’ responsibility to obtain the drops and administer them. 

Common Newborn Procedures: Newborn Screening


What is the Newborn Metabolic Screen?

Newborn Screening is the process of testing for certain potentially severe disorders. The three general types of disorders tested are: Metabolic Disorders (where the body does not produce an enzyme required by the body, and substances normally metabolized build up in dangerous, even lethal amounts), Endocrine Disorders (where the baby does not produce certain hormones required by the body), and Hemoglobin Disorders (where the body does not correctly construct the hemoglobin in red blood cells, thus affecting how oxygen is used by the body, whether enough oxygen is usable by the body, or other problems). All of these disorders are rare but they are usually serious. In all of these disorders there are no symptoms at birth, and in most of them by the time symptoms occur, irreversible damage has been already been done. Some disorders may be life threatening. Others may cause delayed physical development, mental retardation, or other problems. All of these disorders can be managed or treated (usually by changing the childʼs diet) if detected early, although some have better treatments available than others.


How is the test done?

Only one blood sample is required to test for all of these disorders. Blood is obtained by pricking your babyʼs heel at the 24-48 hour postpartum checkup, then allowing the blood to dry on a piece of special filter paper, which is then sent to a screening laboratory for testing. The heel-prick procedure is generally uncomfortable for your baby, but you may hold your baby, or even nurse your baby, during the procedure.


What are the benefits of screening?

All of these disorders can be tested for by using a single blood sample from your baby. This screening may be the only way to know if your baby has one of these rare disorders before he/she becomes sick. Early treatment can help your baby grow up as healthy as possible. Refusing the screen could result in no or late detection of one of these disorders if your baby has one.


What are the risks of screening?

A test result may suggest a disorder when a baby does not have the disorder, which can cause parents to worry. An abnormal result does not mean that your baby has a disorder. Further testing will be required if a test result is abnormal. Furthermore, these screening tests may not catch all cases of these disorders. Even if the results of these screening tests are normal, there may be other medical problems that cannot be detected by these methods. With more disorders being screened for, there is also the possibility of finding out your child is a carrier for a disorder that will not directly affect your childʼs health but could be passed on to their offspring. This may be useful information but may also cause additional stress or worry for you and your family. Please be aware that all newborn DNA received for screening is warehoused by Newborn Screening Saves Lives Act , as per federal law passed by Congress in 2007.