Cheryl Martin (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Your baby was delivered successfully. Now what? Here to talk about some of the standard interventions for newborns, is Dr. Anika Larson. She's a Pediatrician at Skagit Regional Health. This is Be Well with Skagit Regional Health. I'm Cheryl Martin. Dr. Larson, thanks for coming on.

Anika Larson, MD: Thank you for having me.

Host: So, let's start with the basics. What are the standard interventions that newborns typically receive shortly after birth in the hospital?

Anika Larson, MD: So, when we say newborn interventions, we're typically talking about three things. An injection of vitamin K to prevent dangerous bleeds, erythromycin eye ointment to prevent blindness from gonorrhea and the hepatitis B vaccine that prevents hepatitis B, and specifically we're trying to prevent the more serious complications of hepatitis B, like liver cancer.

With some rare exceptions, all babies are recommended to receive all three of these soon after birth. I think it's important to say that we're focusing on these three things that are typically called the newborn interventions. But there are other things that are happening shortly after birth that are also so important.

Bonding, skin to skin, establishing early feedings and these are just three things that are happening alongside everything else.

Host: Let's talk about the three that you mentioned, and you touched on this, but why is the vitamin K given in newborns and what can happen if it's declined?

Anika Larson, MD: Yes. Vitamin K is exactly what it sounds like. It's a vitamin. Throughout our lives, our bodies need vitamin K for blood clotting and to prevent dangerous bleeding. As adults, we can absorb enough vitamin K through our food and with the help of our mature microbiomes, however babies start out with very low levels of vitamin K.

And that's just because it is not transferred well through the placenta. And then their brand new immature guts are also not able to absorb enough vitamin K to protect them for the first months of their life. And this is particularly true for babies that are exclusively breastfed, because vitamin K is just not transferred very well through breast milk. So when vitamin K is not given to babies at birth, they can have dangerous bleeds. We're thinking about three different types of vitamin K deficiency bleeding. Bleeding that happens in the first 24 hours is called early bleeding, and that's generally related to specific conditions that the pregnant person has or medications that they're taking that ideally, we knew about before the baby arrived. Then in the first week of life, we call vitamin K deficiency bleeding, classical bleeding, and this is often visible. An example of this would be bleeding from the umbilical cord when the cord falls off that doesn't stop. Now the late Vitamin K deficiency bleeding is happening after the first week of life, and it can happen anytime through about the first six months of life.

This is particularly dangerous. It typically starts inside the body, so inside the brain or inside the gut. And as a result of that, it's not initially visible and it can be very dangerous. Vitamin K deficiency bleeding can lead to serious long-term effects on the baby or death. So that's why we think it's so important to give that vitamin K injection as soon as possible after birth.

A baby who has gotten the vitamin K injection after birth is 81 times less likely to get a case of that serious late bleeding than a baby who hasn't gotten that vitamin K.

Host: Dr. Larson explain then the purpose of a hepatitis B vaccine at birth, especially if the mother tested negative.

Anika Larson, MD: The purpose of the hepatitis B vaccine is to protect against hepatitis B. To start with, hepatitis B is a virus that infects the liver. In adults, this is often a temporary infection and only sometimes turns into a chronic form of hepatitis B that can progress to liver cancer and death.

However, in babies and children, it is more aggressive. So, 90% of newborns who are infected with the hepatitis B virus will develop that chronic lifelong form of hepatitis B, which we can treat, but it cannot be cured. We are very, very motivated to make sure that no baby is infected with hepatitis B.

 The hepatitis B vaccine protects all babies. So, it will reduce the risk of transmission from a patient who is infected, and then it will help prevent babies from getting hepatitis B even if the pregnant person tested negative. And this is the question that I would say we get the most is, my test was negative in pregnancy, so why is the hepatitis B vaccine still recommended?

 For multiple reasons. One, so our hepatitis B testing in pregnancy is good, but it isn't perfect. And the hepatitis B vaccine will help protect babies in the case that the hepatitis B test was missed or that the pregnant patient was infected after being tested. Also, and I would say this is often the most surprising thing for families or even for healthcare professionals who are more used to caring for adults. Babies and children can get hepatitis B from what we call horizontal transmission. So that's contact with blood or bodily fluids from other people who have hepatitis B, such as just close contact with family members or even with other kids. We test the pregnant person, but we don't test other members of the family and certainly not other members of the community for hepatitis B. And many people who have chronic hepatitis B don't know it. So this protects the baby once they're out of the hospital, going out into the world and interacting with other people who may not know that they're carriers.

Host: Thank you. Let's talk about the standard intervention erythromycin eye ointment, and the role and why is it considered so important?

Anika Larson, MD: So the role of erythromycin eye ointment and why that's considered so important is that erythromycin eye ointment prevents newborn eye infections from gonorrhea. Eye infections from gonorrhea can cause blindness in the baby that progresses very quickly after birth, which is why this is one of our early interventions. And it can also turn into a dangerous infection of the blood or spinal cord.

Host: Are there some parents who are hesitant about these interventions, and if so, what concerns do you hear most often and how do you respond to them? You've talked about, the hepatitis B vaccine at birth, but any other concerns?

Anika Larson, MD: So I think it's important to know that there's a really wide variety of how families approach this. We see many loving, caring, wonderful families who are ready to give their newborn baby whatever is recommended by the healthcare team to keep them healthy, and don't have questions necessarily.

And then we see other loving, caring, wonderful families who have questions, who may be hesitant for a variety of reasons, who may want to really fully understand everything that is going to their newborn's body. And there is absolutely no judgment from us either way. We're very happy to work with families on any questions and hesitations that they might have.

So, some common things that come up is, one, are these interventions safe? And the answer is yes. All three of these interventions have been used for decades or more in the United States, around the world, and they are very safe. Another concern that often comes up are around side effects. So, kind of going through piece by piece, erythromycin ointment carries a small risk of eye irritation.

 I will say that is quite rare. I have personally never seen it on a baby. Both vitamin K and the hepatitis B vaccine are also injections. I think it's important that families tend to know that this is going to be painful for their baby and we try to mitigate that as much as possible.

So, having family cuddling with their baby right after, feeding their baby right after, and really doing what we can to make that quick and over with. And then you can also, because they are injections, you can get some bleeding or a local injection site, like a little bit of bruising, swelling, redness, at the site where the injection was performed.

Host: Now, are these interventions required or can parents decline them? And if so, what's your approach if they do?

Anika Larson, MD: The short answer is that no, these interventions are not required. And yes, parents can decline them or they can choose other approaches that might reduce some risk. There's also a question that comes up, which is, are there any alternatives?

So when it comes to all of these interventions, the first step when a family declines or has questions, is always to try and understand their individual concerns. And I'll say that this is something that, in thinking about this podcast, was absolutely the biggest thing that I would love to improve in my own practice.

 Because, consistently when families decline, we want to give information and we want to make sure that the family really understands the benefits of this intervention and the risks of declining it. And sometimes really the hardest thing is to have that conversation and make that family feel comfortable sharing what their concerns are or what they may have heard about these interventions.

Going through the interventions piece by piece, when it comes to declining vitamin K, we do ask that families sign a declination form. And then one thing that will often come up with vitamin K is some families will be interested in doing oral vitamin K. So I think it's very important to know here that the vitamin K injection is the most effective way to give the vitamin K and the way that's most effective in terms of helping that baby and making sure that they get that dose.

However, there is an option to give oral vitamin K to the newborn and this can also meaningfully reduce the risk of vitamin K deficiency bleeding. So in the case that a family opts for that, we'll help them get that and help them complete the series. Because you do need, with the dosing schedule that we use, you do need three different doses and we will help make that happen for families.

 In terms of hepatitis B and the erythromycin ointment, there are really no good alternatives. We will ask families again to sign a declination for the erythromycin eye ointment, just confirming that they have heard and understand the risks and the benefits. And then what I will do is we will have reviewed all of the pregnant patient's prenatal labs when their baby comes to us.

But I will go back and I will triple check that they've gotten all of the testing that was recommended in pregnancy. Because I have had the case come up where someone chose not to get the erythromycin eye ointment for their baby, but we realized that their gonorrhea test had been missed in pregnancy and could go ahead and do that and kind of have that added layer of reassurance that there was no gonorrhea at the time of delivery.

 So that is another, another thing that we can do in that case.

Host: Now if a parent has more questions or is on the fence about these treatments, what resources or advice do you recommend they turn to for reliable information?

Anika Larson, MD: I always want families to feel comfortable reaching out to their pediatrician, to their baby's doctor, so that they can really have a conversation about their individual child and their individual concerns. Every family will be different and I am very certain that all of us really want to have these conversations and help families feel comfortable.

For general resources, I would say the best resource is healthychildren.org. This is a website of the American Academy of Pediatrics, and they have very helpful resources, question and answers on all three of the newborn interventions.

Host: Dr. Anika Larson, thanks so much for sharing some vital information for the parents of newborns. Very informative. Thank you.

Anika Larson, MD: Thank you for having me.

Host: To learn more, visit skagitregionalhealth.org. If you found this podcast helpful, please share it on your social media and be sure to check out our podcast library for other topics of interest to you. Thanks for listening to be Well with Skagit Regional Health.