Vitamin K
Vitamin K prevents potentially life-threatening bleeding from vitamin K deficiency that occurs between 0.25% and 1.7% of healthy babies. Both a single injection (0.5 – 1.0 mg) at birth and a series of oral doses (1 – 2 mg) at birth, one week, and 3-4 weeks of life are available.
There are specific times in a newborn's life when bleeding due to vitamin K deficiency tends to occur. Early vitamin K deficiency bleeding, within the first 24 hours after birth, is very rare. It is usually related to a maternal vitamin K deficiency which can be caused by medication. Giving the baby vitamin K after birth usually can't prevent this type of bleeding. It is best treated by correcting the mother's vitamin K levels before the birth.
Classic vitamin K deficiency bleeding occurs two to seven days after birth and is most commonly seen in exclusively breastfed babies. Most infant formulas contain vitamin K supplements. Supplementing mother's intake of vitamin K does increase levels in breastmilk. Delayed cord clamping and avoiding cuts and bruises minimize the loss of clotting factors that contain vitamin K.
Late onset vitamin K deficiency bleeding occurs one to six months after birth and is usually associated with liver problems or medications. Sometimes, however, in Asian breastfed infants, it occurs for reasons that are not understood. The vitamin K injection given in hospitals is directed at preventing classic and late onset types of bleeding.
Most hospitals automatically provide a single injection of vitamin K at birth. You can also postpone the injection until after the initial period of
alertness. You can also arrange to have the vaccine done at your
pediatrician’s office or obtain a prescription for the oral doses to be given at home.
Antibiotic Eye Ointment
Both gonorrhea and chlamydia infections of the birth canal can be passed on to the baby at the time of birth. Because infections may have mild or no symptoms, women with infections may not know it. In the United States, chlamydial infections are more common than gonococcal infections.
Testing can be done during prenatal care by gently wiping the vagina or cervix with a cotton-tipped swab and sending it to a lab. Treatment is oral antibiotics for seven days and repeat testing later in pregnancy. 30 – 40% of babies born to moms with an active gonorrhea or chlamydia infection will develop an eye infection. Although chlamydial eye infections are generally less severe, gonococcal eye infections can lead to blindness or death without treatment. Before the use of 2% silver nitrate eye drops by Dr. Carl Crede in 1888, gonorrhea was the leading cause of blindness.
Today, hospitals automatically treat babies’ eyes with a single application of antibiotic ointment (erythromycin 0.5% or tetracycline 1%) as soon as they are born. Once the membranes have ruptured, even babies born by cesarean section risk infection. So they are also routinely treated in a hospital. Unless an antibiotic-resistant strain is present, the risk of gonococcal eye infection after antibiotic ointment preventative treatment is less than 1 out of 1000.
Chlamydial eye infections are not as responsive to antibiotic ointment prevention. Some researchers are now recommending povidone-iodine 2.5% solution. This treatment is also less irritating to baby’s eyes than silver nitrate drops or antibiotic ointments. There are no documented cases of resistance to povidone-iodine and it is also effective against gonorrhea.
You may choose to delay eye treatments until after baby goes to sleep to avoid blurring baby’s vision. Or you may choose to decline the treatment. If you do not want the treatment, remind the hospital staff as close to the time of birth as possible since this is not their usual routine.
Hepatitis B Vaccine
Hepatitis B is a virus that attacks the liver. Some people who are infected have no symptoms. Some people develop cirrhosis, liver failure, or liver cancer. With your permission, a blood test to check for infection can be done during pregnancy. Health care providers are required to report positive cases to the local health department.
Hepatitis B virus is transmitted through blood, semen, vaginal secretions or saliva. A mother with hepatitis can transmit the virus to her baby during birth. Approximately 5-6% of mothers with hepatitis B will transmit hepatitis to their baby. The risk is higher for mothers who have both hepatitis and HIV. Cesarean section has not been shown to decrease this risk.
The hepatitis B vaccine is a series of injections that can prevent a baby from becoming infected after exposure during birth. It is most effective when the first dose is given within 48 hours of birth.
Most hospitals automatically give the vaccine immediately after birth. You can also postpone the injection until after the initial period of alertness. You can also arrange to have the vaccine done at your pediatrician’s office.
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