In the first days after the birth, you will be offered various tests to make sure your baby is healthy. The doctor or midwife will discuss the tests with you beforehand and will be happy to answer any questions you may have. Although these tests are recommended, it’s up to you whether you decide to have them done.
You will be offered two physical examinations of your baby after she is born. The first is carried out immediately after the birth. The second is called the routine examination of the newborn and usually takes place 24 hours after your baby is born – although it can be any time between 6 and 72 hours after birth.
This examination will be carried out by a children’s doctor (paediatrician), a specially trained midwife or a neonatal nurse. They will examine your baby from top to toe, and in particular will examine her head, heart, hips, eyes and genitalia.
It is important that you inform the person carrying out the examination of any problems that run in the family – both on your side, and the baby’s father’s side – such as dislocated hips as a child, heart conditions, or sight or hearing defects. They also need to know about any difficulties you experienced during pregnancy or at your antenatal scans – or if your baby was lying breech. If a problem is found, your baby might need further tests, or to be seen again at an outpatients’ clinic after she has been discharged from hospital.
If you are told your baby’s heart makes an additional sound, called a ‘murmur’, you may feel worried, but in fact the condition is very common. One estimate is that 50% of babies have a heart murmur in the first week. Within a few weeks, most murmurs are not heard any more.
Developmental dysplasia of hips
The midwife or doctor will examine each hip joint to check that the head of the thigh bone (femur) moves as it should do within the socket at the hip, and that it doesn’t slip out.
For baby boys, the midwife will examine the scrotum to ensure that the testes (testicles) have travelled down from the abdomen. The testes usually move down into the scrotum two months before birth, but in some baby boys this does not happen. The ‘undescended’ testes may still descend in the first six months or up to one year after birth. If there is any concern about the testes at your baby’s 6-8 week check your health professional will arrange for your baby to be reviewed again. If you have any concerns about your baby’s testes, for example a swelling, please seek medical advice.
Tests, checks and screening
A few routine checks for minor health problems will be carried out in the days and weeks after your baby is born. These are designed to set your mind at rest and to give your baby a good start in life.
The usual check is just to observe the skin, which is yellowish if the baby is jaundiced – many new babies have mild jaundice. If the yellow colour of the skin doesn’t go away in a few days a blood check is done to see whether the jaundice is severe. Babies who are still jaundiced at 14 days will always be referred to a paediatrician for further investigations. There are other less common causes of jaundice which need to be ruled out. Most babies, however, are perfectly well.
Group B streptococcus (GBS)
If a baby develops GBS infection less than seven days after birth, it's known as early-onset GBS infection. Most babies who become infected develop symptoms within 12 hours of birth. If your baby is considered at increased risk of GBS infection, he or she will be monitored for signs of infection immediately after birth and before discharge. This will include assessing your baby’s general wellbeing, feeding, temperature, heart rate and breathing rate. Babies with GBS infection may be very sleepy, be floppy and not feed well. If you are worried about your baby contact NHS 24 on 111 or your health visitor or GP. If you cannot contact any health professionals within four hours then access Emergency Departments. Find out more about this infection.
Newborn hearing screening
A simple hearing screen will be done within the first few weeks after your baby is born, maybe even before you leave the maternity unit, to check if your baby has a hearing loss. This is important for your baby’s development and, if you need it, it means that you can get support and information at an early stage. If your baby’s hearing has not been checked within 4 weeks of getting home from hospital, ask your midwife or health visitor to make an appointment.
The newborn bloodspot test
Although most babies are born healthy, a few may have problems. All babies are examined carefully after birth so that these can be picked up as early as possible. Some problems which can’t be picked up in this way will show up in the bloodspot screening test.
The bloodspot test or ‘heel prick test’ is usually carried out when your baby is five days old. The midwife takes several spots of blood from the baby’s heel and places them on a special card which is sent to the lab for testing for nine rare but serious conditions. If you, your partner, or a family member already has one of these conditions (or a family history of it), please tell your health professional straight away.
All newborn babies in Scotland are eligible for a blood spot test. Your midwife will explain the test in detail, and ask for your permission to carry it out.
Sickle cell disease (SCD)
SCD affects the quality of the red blood cells that carry oxygen in the blood. This can cause pain and damage to your baby’s body, serious infection and in some cases it can be fatal. Early treatment of SCD can help prevent long-term complications of the disease. Antibiotics and immunisations will be given to prevent serious illness and improve quality of life for your baby.
Cystic fibrosis (CF)
CF affects many parts of the body. The lungs and the pancreas are most affected, leading to regular chest infections and problems digesting food and absorbing the nutrients your baby needs. One in every 2,500 babies born in Scotland has the condition. Early diagnosis and treatment can lead to better health for children with this condition.
Congenital hypothyroidism (CHT)
Babies with CHT are unable to produce enough of the hormone thyroxine. This hormone is important for normal mental and physical development. Early treatment, which includes giving thyroxine as a medicine, will help your baby to develop normally. Without early diagnosis and treatment, it can lead to slower than normal growth and severe learning difficulties. It can also be fatal in some cases.
Inherited metabolic disorders
Inherited metabolic disorders mean that certain substances in food can’t be broken down in the baby’s body.
The blood sample will test for whether your baby has any of the following six inherited metabolic disorders:
MCADD (medium-chain acyl-CoA dehydrogenase deficiency)
maple syrup urine disease
IVA (isovaleric acidaemia)
GA1 (glutaric aciduria type 1)
Babies with MCADD deficiencies may have problems breaking down fat to make energy under certain circumstances. Babies born with five of the six disorders find it harder to break down certain amino acids.
Amino acids are fundamental parts of all foods except pure fat and sugar. When we eat foods containing protein, including when babies drink milk, we break the protein down into individual amino acids. Most of these are used to make new body proteins. Any leftover amino acids have to be broken down more and used for energy or removed as waste.
For babies with inherited metabolic disorders, certain leftover amino acids can build up in their blood and other organs, such as the brain, and cause serious problems.
These disorders all carry a very high risk of delayed development and irreversible learning disabilities, which can be severe if they’re not detected early. Some of these disorders can also cause life-threatening illness, even coma in certain circumstances, and they can be associated with other medical problems. Without treatment, babies can become suddenly and seriously ill.
For more information about these diseases you can speak to your midwife, or visit NHS Inform.
Your midwife will explain the test and ask you for signed consent to carry it out. Most blood spot tests show no health problems. If that’s the case, the results are sent to your health visitor, who’ll discuss them with you at the next routine check. If a possible health problem is found, we’ll contact you directly.
If you decide not to have your baby tested for one, some or all of the conditions, you’ll be asked to sign a form confirming that the reasons for testing have been explained to you, and that you understand the possible effects of your baby not being screened. Please note it’s only possible to test for all six inherited metabolic disorders at once.