By Dr. Anthony Policastro

The recent changes to newborn care suggested by the federal government have created confusion for parents about what the goals are for newborn infection prophylaxis prevention.

There are three things that we routinely do in the newborn period for disease prevention. They have been so effective that we sometimes even forget that the things they can cause can be serious.

The first of those is something called ophthalmia neonatorum. It is an eye infection that newborns can get if the mother has a sexually transmitted disease like Chlamydia or Gonorrhea. In most cases, testing of the mother can detect this. However, that is not foolproof.

Around the world, the incidence of this disease varies by country. However, in general it affects between one and 12 percent of babies in third world countries.

In the United States, because of infection detection in the mothers and use of an antibiotic eye ointment at birth, the incidence is about 1.5 in 100,000 deliveries.

A second thing is Hepatitis B prevention. Again, mothers are checked for hepatitis B before delivery. Again, testing is not foolproof.

In order to prevent Hepatitis B infection, a dose of hepatitis vaccine has been given to every newborn in the United States. Recent recommendations from the federal government have suggested that this is not necessary because other countries do not do this.

With the current immunization practices, there are between 10 and 25 cases of newborn Hepatitis B each year. That is from an estimated 1,000 to 1,200 infants exposed at birth. That is because the vaccine is not 100 percent effective.

The real impetus for the vaccine is the incidence of chronic Hepatitis B in babies. About five to 10 percent of adults with Hepatitis B get chronic liver disease from it. For infants who get it, about 90 percent will have chronic liver disease.

One of the reasons we changed the recommendation was that other countries do not do the same thing. Other countries have better prenatal care. They can be sure that the mother is tested before birth. In addition, the number of actual cases of Hepatitis B in those countries is low compared to the United States. Those two reasons make it a logical move on their part. However, it is not as logical for us.

The third thing that newborns are given is a Vitamin K injection. It is used to prevent something called Vitamin K Deficiency Bleeding. Newborns are deficient in Vitamin K. The injection provides them with enough for their blood clotting.

Without the injection, somewhere between 1 in 60 and 1 in 400 newborns will get Vitamin K Deficiency Bleeding. For those that do, about 14 percent will die. About 63 percent will have brain bleeding.

The most recent problem is that parents are confusing the Hepatitis B immunization with the Vitamin K injection and refusing both. The result is that the refusal rate has about doubled to five percent of newborns.

Once again, the actual numbers of infected individuals tend to be low. The result is that since parents have not heard of these diseases, they figure no one actually gets them. However, the reason that they have not heard of them is the effectiveness of these newborn programs.