This blog is written by Aliza Carr from Bumpnbub.
Whether you give birth to your little one in hospital, at a birth centre or at home, there are a few screening tests that are offered for your baby in the postpartum period, as well as expectations for weight gain, output, and follow-ups with health professionals. This is a brief explanation of information related to your newborn for the first days and weeks of their life.
Neonatal Screening Test (NNST) is a heel prick test done 48-72 hours after your baby is born. This is performed only with your consent and is a simple test that can detect 25 rare conditions before any obvious symptoms are displayed. Some conditions the NNST tests for include: cystic fibrosis, congenital hypothyroidism and amino acid disorders. NNST is a screening test only, meaning if any abnormal cells are detected in the blood, further tests will need to be carried out for it to be confirmed. Early diagnosis and treatment can reduce the effects of these conditions.
The NNST is normally done by your midwife in hospital. If you are discharged early from hospital or have a home birth, your midwife should visit you at home to undertake the test. If you are not eligible for home visits, you can attend a pathology centre or a community clinic that can do it for you.
A hearing screen should be offered to you for your baby while you are in hospital. This short hearing test is undertaken when your baby is in a deep sleep. All Australian states and territories, along with New Zealand, have a hearing screening program that aims to test all babies by one month of age. If they do not pass the hearing screen or you are unable to do it as an inpatient after birth, most hospitals have an outpatient audiology clinic you can attend for a repeat test or follow-up.
Weighing your baby after birth is normally done on day 2 or 3 of life and then on discharge from hospital (depending on how soon you go home). Often you will have a midwife visit you at home for the day 3 weight if you discharge early. It is normal for your baby to lose up to 10% of their birth weight by day 3, although losing under 8% is ideal. Your baby’s weight loss at this age is due to fluid they lose after birth and the fact they are only getting small amounts of colostrum until your milk comes in. It is recommended to also get your baby weighed at one week and two weeks of age to ensure they are gaining adequate weight, with returning to birth weight by week 2 of life. Weight gain per week for your baby should be around 200 grams. If there are any concerns regarding weight gain, continue with weekly weights and consult a healthcare professional to review bubs feeding and output. Common places to weigh your baby include a community midwife, child health clinic, GP, lactation consultant or pharmacy.
Your baby’s output will tell you a lot in those first two weeks and should be closely monitored. Lots of parents ask, ‘how do I know if my baby is getting enough milk?’, and the biggest way to determine this is by their output (what goes in must come out!). The number of wet nappies or wees your baby does is the main indicator of hydration. On day one of life, they should do 1 wet nappy, on day 2 you want to see 2 wet nappies, day 3 is 3 wet nappies, going up by one every day of life. Then from day 7 onwards, your baby should do 7 wet nappies every day. Around day 2-3, just before your milk comes in, you may see an orange or red colour in your baby’s wee; this is called urates. Urate crystals are essentially concentrated urine and are quite common. Urates will be flushed out as your milk comes in, but it is important to keep feeding bub as much as possible to keep them hydrated. Please seek professional advice if urates are present after day 7 of life or if your baby is not having enough wet nappies.
Even though poos are not a marker of hydration, it is important to monitor the colour of your baby’s stool. After birth, your baby will clear out the black tar-looking meconium in their bowel. As the days go on and your milk comes in, your baby’s poo will turn a greenish-black, then a brown and transition to yellow by day 7. This change in colour is a sign they are consuming enough milk.
Hygiene tips for your baby in those first few weeks
- Nappy changes: changing your baby’s nappy when it is dirty or at every feed will help reduce the chance of nappy rash and discomfort. For girls, make sure you wipe from front to back, so faeces do not contaminate the vagina. Girls can also have some white or pink discharge present due to hormones; this will clear itself. For boys, you don’t need to clean in the foreskin, just wipe the outside.
- Bath time: your baby doesn’t get very dirty as a newborn so bathing is only recommended every 2-3 days. Ensure the bath water is warm, around 37 degrees and deep enough so your baby’s body is submerged. Support their head with your wrist and gently grasp around their shoulder with your thumb and finger. Talk to bub and keep them calm, so bath time is enjoyable for you and them.
- Umbilical cord care: keep your baby’s umbilical cord out of the nappy to help the drying process and avoid getting urine on it. Also, monitor the stump for any signs of infection, redness or pus. Before the umbilical cord falls off it is normal to be a little bit smelly, just ensure it is not too red. Once it has fallen off, a scab will form at the belly button and will heal over the coming weeks.
Don’t forget there is lots of support and professional advice if you need it during your postpartum journey with your little one. Follow-ups should include a midwife or child health nurse at 1 week of age, weighing bub as recommended above, a lactation consultant if you need, and seeing your GP, OB or paediatrician at 6 weeks, as well as a women’s health physiotherapist review.
This blog is general advice only and does not replace the need for medical advice. For any questions or concerns, contact your healthcare provider.