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June 18, 2008 > Baby's First Visit with the Pediatrician

Baby's First Visit with the Pediatrician

Pediatric Hospitalists Evaluate Every Newborn in the Hospital

For parents of babies born at Washington Hospital, a visit with the pediatrician may be sooner than you imagined. And that's a good thing for both parents and baby.
Pediatric hospitalists at Washington Hospital are in-house specialists who are available 24 hours a day, seven days a week to provide seamless care to young patients. And one of their most important roles is evaluating the health of babies born in the hospital.
"An exam is essential in the first 24 hours to make sure that the newborn has no congenital abnormalities, is feeding adequately and is bonding with the mother," according to Pediatric Hospitalist Program Medical Director Lyn Dos Santos, M.D.
During a newborn's first visit, Dr. Dos Santos or one of her colleagues will perform a general head-to-toe physical exam. The hospitalists also answer new mothers' questions - most importantly relating to breastfeeding - and talk to new moms about what to expect during their hospital stay.
"At Washington Hospital, we are lucky enough to have the majority of first newborn exams done within 12 hours of birth, as there is a hospitalist in house 24/7," she notes. "In case of any potential abnormality, the newborn will have an exam done within minutes of birth."
After their initial exam, babies are seen by a hospitalist once a day until they go home with their family. On an average day, the on-duty pediatric hospitalist will examine about 15 newborns, including between three and seven new babies for their first exams.
Hospitalists perform new baby exams in the room with the parents present, which gives parents the opportunity to ask questions and voice any concerns they may have, Dr. Dos Santos says.
During exams, the hospitalists are looking for congenital abnormalities that need to be addressed, checking vital signs and evaluating babies' weight and hydration status.
If the hospitalist does discover something life threatening, the newborn is immediately transferred to the Lucille Packard Level II Special Care Nursery on the Washington Hospital campus for closer monitoring and treatment, Dos Santos says. Babies that have been identified by the hospitalists as being at risk for infection or having difficulty breathing or feeding are quickly moved to the level II nursery, which is staffed by three full-time neonatalogists that specialize in taking care of sick newborns.
In cases when a newborn has an abnormality that does not need immediate attention but can be addressed later, the pediatric hospitalist will discuss the care with the parents while their newborn continues to receive routine care while remaining in the room with them.
Dr. Dos Santos notes that newborns in the state of California are required by state mandate to undergo screening to detect newborn metabolic disorders, as well as common hematologic (blood-related) and endocrine disorders. At Washington Hospital, the hospitalists also screen every newborn for jaundice at the same time that the newborn screen is done. If jaundice is diagnosed, the hospitalists will arrange appropriate follow up care they deem necessary according to the level of jaundice. Additionally, all newborns at Washington Hospital receive a hearing test and those that do not pass this screen are referred for further outpatient testing.
Vaccinations are important
Once babies leave the hospital, Dos Santos stresses that parents should follow up with a pediatrician for continuing care.
"It is important for parents to follow up with their pediatrician to obtain the vaccinations recommended by the American Academy of Pediatrics (AAP) in a timely manner and to make sure the baby is growing adequately and achieving both physical and social milestones," she says.
According to Dr. Dos Santos vaccinations are important for newborn infants for a variety of reasons.
"Newborns are particularly vulnerable to communicable diseases because they are not born with immunity; the latter develops with vaccinations and with age," she says. "Newborns are born only with immunity that is passed on to them by their mothers passively through the placenta, which wanes by 3 months of age and makes them particularly susceptible to infections and less likely that they will be able to overcome these infections by themselves without antibiotics and antiviral medications."
Infants and toddlers should receive most of their vaccinations at their pediatrician's office, with the exception of the hepatitis B vaccination, the first dose of which has been recommended by the Centers for Disease Control and Prevention (CDC) for all infants before they leave the hospital since 2006.
To see a list of immunization schedules provided by the AAP, visit for more information.
To learn more about Washington Hospital's services and programs, visit and click on "Services & Programs."

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