Pediatrician Clay Jones describes the rituals preformed by medical staff in the newborn nursery:
When a baby is born, there are a number of rituals that parents and medical professionals take part in. Some are largely ceremonial, more rites of passage than anything medically necessary, such as the first bath or the assignment of APGAR scores. As a physician, I play my part in some of these rituals, the baby’s first exam being the most important. Unlike many medical examinations that pediatricians perform, the newborn exam involves a good deal of showmanship. It’s the only exam where I make a point of talking through each aspect with the parents, showing them all the normal but sometimes surprising (at least to new parents) things that babies do and common physical exam findings that many folks don’t know about and might lead to unnecessary concern. Really hammering home how healthy a new baby is can go a long way towards relieving parental anxiety. And anticipating and addressing common newborn issues during the exam helps save me a lot of time on the back end as well.
Care in the newborn nursery is a team effort:
Nursing plays the largest role in the rituals of caring for a newborn baby. They give the first bath, change the first dirty diapers and typically assist with the first latch if a mom is breastfeeding. They perform common procedures, such as heel sticks for newborn screening and jaundice assessments if necessary. They really do a lot, providing a great deal of vital education for parents while doing it, and their role in the care of the newborn far outshines my contribution for the majority of healthy babies.
Another ritual that nursing plays a major role in, and one that has significant medical benefits associated with it, are vitamin K injections.
Dr. Jones provides an excellent review of vitamin K — what it is, what it does, and why it’s so critical to a young baby’s health. Without giving a newborn a shot of vitamin K, they run the very real risk of vitamin K deficient bleeding. VKDB can occur soon after birth, or later, in a 3-month-old:
Without supplementation, as many as 1.7% of babies would be expected to have some kind of bleeding complication during the first week. This is known as “early VKDB” or classic hemorrhagic disease of the newborn, and it can be easily prevented by an intramuscular vitamin K injection on day one of life. It can also be prevented with oral supplementation. The evidence to support the efficacy and safety of these interventions is rock solid, but there are problems with oral supplementation when it comes to bleeding after the first week.
When there is a bleeding complication from vitamin K deficiency that occurs between 2 and 12 weeks of life, this is called “late VKDB.” This happens almost exclusively in babies fed primarily breast milk who did not receive adequate vitamin K prophylaxis, or who have some other major risk factor such as liver disease or cystic fibrosis. Late VKDB, as it did in the children treated at Vanderbilt Children’s Hospital, where I completed my pediatric training and a fantastic facility by the way, tends to present as unexpected bleeding into the brain.
Bleeding in the brain is bad. Very bad. It’s preventable, however, by giving newborns an injection of vitamin K. 100% preventable. (Even vaccines don’t prevent diseases at that rate!) Dr. Jones wonders, then, why a small (but apparently growing) number of parents are refusing vitamin K prophylaxis — the standard of pediatric care for more than 50 years after the discovery that vitamin K could prevent this not-rare catastrophe:
Why do parents do it? Why would a parent reject an intervention that is so effective at preventing such a devastating consequence as bleeding into the brain of their baby and a potential lifetime of seizures, developmental delay and cognitive impairment? And one that is virtually risk free to boot!
Dr. Jones highlights some reasons why parents are making such a reckless decision by refusing vitamin K prophylaxis — reasons that echo those who endanger their own children, and other children and adults, by refusing vaccines. The difference is that refusing vitamin K doesn’t endanger anyone but the baby, just like it did more than 50 years ago; refusing vaccines most certainly impacts everyone in the “herd.” (That’s you and me.)
Read Dr. Clay Jones article at Science-Based Medicine here.