Latest / Bryan Health Podcasts / Why Does My Baby Need That Medication? Vitamin K, Hepatitis B and Erythromycin Explained

Transcript

Why Does My Baby Need That Medication? Vitamin K, Hepatitis B and Erythromycin Explained · Bryan Health Podcasts

• 0:03
  Melanie Cole, MS (Host): Welcome to Bryan Health Podcast.
• 0:05
  I'm Melanie Cole.
• 0:06
  And today, we're talking about routine newborn medications.
• 0:10
  Joining me is Dr.
• 0:11
  Amanda Knapp.
• 0:12
  She's a pediatrician at Lincoln Pediatric Group.
• 0:15
  Dr.
• 0:16
  Knapp, thank you so much for joining us today.
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  Give us a little bit of an intro to routine newborn medications.
• 0:22
  What do our little newborns receive?
• 0:25
  Tell us about those.
• 0:26
  Dr. Amanda Knapp:
• 0:26
  Yeah.
• 0:27
  Thanks for having me.
• 0:27
  I'm really excited to be here and be able to chat with you and educate
• 0:31
  families about kind of the things that happen for babies after they're born.
• 0:35
  The routine newborn medications that we typically think of are in
• 0:41
  the hospital, we kind of shorthand call them the eyes and thighs.
• 0:45
  So basically, it's an erythromycin antibiotic eye ointment,
• 0:50
  and then two injections.
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  One is a vitamin K injection in the thigh, and the other is a
• 0:55
  hepatitis B vaccine in the thigh.
• 0:58
  And then, additionally, during the winter season, there's an opportunity
• 1:02
  to get an RSV antibody, which is also another injection that helps
• 1:08
  prevent RSV infections in infants.
• 1:12
  Melanie Cole, MS: Well, thank you for that.
• 1:13
  So, let's get into these a little bit.
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  Now, before we get into vitamin K, many parents wonder why do they
• 1:19
  need all of these medications?
• 1:21
  Can they wait?
• 1:22
  So, why don't you start with vitamin K, and why do we need it, and
• 1:28
  how is it given, and is it safe?
• 1:30
  Dr. Amanda Knapp:
• 1:30
  So, I think first to understand kind of why we need it is to understand
• 1:33
  what vitamin K does in the body.
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  Vitamin K is a really essential vitamin that is the key to unlock what's
• 1:43
  called the clotting cascade, which allows the body to form blood clots.
• 1:48
  without vitamin K, the blood can't clot, and then therefore
• 1:52
  the body can't stop bleeding.
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  Babies are not born with an adequate supply of vitamin K, and that's mostly
• 2:02
  just because it doesn't transfer through the placenta very well.
• 2:06
  And so when they're born, they don't have much vitamin K, which puts them
• 2:10
  at high risk for this spontaneous bleeding because their blood can't clot.
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  Bleeding can happen outside the body like you think of, but it also can happen
• 2:23
  inside the body where it's not visible.
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  So, babies could spontaneously start bleeding into their intestines
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  or into their brain, and that can happen before parents even realize
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  that there's anything wrong.
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  So, babies need it because it's a nutrient that newborns just naturally
• 2:42
  need because they don't have enough.
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  vitamin K is given with just a single intramuscular injection into
• 2:49
  the thigh just shortly after birth.
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  It's a really tiny dose, and the most common issue is just the
• 2:55
  discomfort of the actual injection.
• 2:57
  Melanie Cole, MS: Well, thank you for going over that.
• 2:59
  It's a really important one.
• 3:01
  Now, tell us about erythromycin eye ointment.
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  Tell us what that is and why it's used.
• 3:07
  Dr. Amanda Knapp:
• 3:07
  So, erythromycin, it's an antibiotic.
• 3:10
  we put a small amount of that antibiotic ointment into the baby's
• 3:14
  eyes just shortly after birth, and that helps prevent eye infections.
• 3:19
  The main reason we use it is to prevent an infection from a bacteria called
• 3:23
  Neisseria gonorrhoeae, which is most commonly known as gonorrhea if moms
• 3:28
  have an untreated infection, then the baby can be exposed during delivery.
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  in a newborn, that infection can cause a severe eye infection.
• 3:37
  And in the worst cases, then that infection can damage the
• 3:41
  cornea and cause blindness.
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  the challenge is that moms may not know they have an infection, because
• 3:47
  they may have no symptoms, and then the consequences of missing that particular
• 3:51
  infection can be kind of serious.
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  So, universal prophylaxis has really dramatically reduced the disease of
• 4:00
  gonorrhea eye infections in infants.
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  That's the main reason it's given, but kind of as an added bonus is
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  that it can help prevent infections from bacteria that colonize the
• 4:11
  birth canal, not just gonorrhea.
• 4:13
  Melanie Cole, MS: Well, so thank you, because I'd love
• 4:15
  for you to expand on that then.
• 4:18
  An example, if you would, Dr.
• 4:19
  Knapp, of infections that mom can pass on to baby.
• 4:24
  Dr. Amanda Knapp:
• 4:24
  There's prenatal testing for many types of infections.
• 4:27
  Mothers will get tested for hepatitis B, gonorrhea, chlamydia, HIV, et cetera.
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  So certainly, there is risk that if a mother has an infection that it can
• 4:40
  pass to the baby through either prenatal passage through the placenta or as the
• 4:46
  baby's going through the delivery process.
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  Melanie Cole, MS: Well, Dr.
• 4:50
  Knapp, many parents might wonder if mom had that prenatal care and
• 4:54
  testing, does the baby then still need these types of medications?
• 5:01
  Dr. Amanda Knapp:
• 5:01
  Yeah, I think that's a really good question.
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  And my answer would be yes, because prenatal testing, it's
• 5:06
  really just a snapshot in time.
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  And at that moment of the test, it may be negative, but infections
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  can happen after testing.
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  It's also positive for some of these that you could have a false
• 5:18
  negative or it's rare, but test results could be miscommunicated or
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  there might be some gaps in testing.
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  So, I do think prenatal screening is super important because it
• 5:29
  identifies babies at highest risk.
• 5:31
  But really, doing these other medications despite negative
• 5:35
  testing is kind of helping to provide an additional safety net.
• 5:38
  Melanie Cole, MS: So, tell us about hep B, because we've heard about
• 5:42
  this, we've heard about the vaccine.
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  Tell us a little bit about what that is and why the vaccination is
• 5:49
  really important to happen at birth.
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  Dr. Amanda Knapp:
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  Hepatitis B is a virus that affects the liver.
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  And some people who get hepatitis B, they can clear the infection and
• 6:00
  not wind up with chronic illness.
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  But when infection occurs in infancy, there's actually a really high likelihood
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  that it becomes a chronic infection.
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  up to 90% of kids who develop or contract hepatitis B, it turns
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  chronic for them, unlike adults who have much less likelihood of that.
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  So, chronic infection, it really is pretty serious.
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  It can lead to liver damage and liver cancer, and it actually can
• 6:29
  be fatal in about 25% of cases.
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  So, it's not just like childhood illness that we're trying to
• 6:35
  prevent for the next few weeks.
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  It's trying to prevent a potentially lifelong infection.
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  And I will say that one of the most common questions I get about this as
• 6:45
  a pediatrician is, you know, "Why does my baby need it right after birth?
• 6:48
  Mom had negative testing."
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  But reality is that it's like the previous erythromycin gonorrhea conversation.
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  A negative test is just a snapshot in time, and it's possible that
• 7:00
  mom could have contracted hepatitis B in the time after the testing.
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  Hepatitis B is transmitted through blood, body fluids, open
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  wounds, contaminated surfaces.
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  So, you really could potentially get infected by a household contact
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  who doesn't even know that they are a carrier of hepatitis B.
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  Because a lot of times, in adults, it's asymptomatic.
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  So, that's kind of the risk as far as, you know, if mom was a negative,
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  why does the baby need it right away?
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  Mom could have gotten infected in the meantime.
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  But also, we know that not all cases of childhood hepatitis
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  B come from moms at birth.
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  Same story as where it can come from household contacts or grandma or
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  grandpa or aunts or uncles who are visiting who don't know they have
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  hepatitis B, and then it subsequently gets through to the baby somehow just
• 7:53
  through normal household contacts.
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  And then, kind of again too, it's uncommon, but there could
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  be gaps in testing or errors in reporting or communication.
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  giving this to newborns at delivery is kind of another safety net to
• 8:06
  make sure that we don't miss cases.
• 8:09
  People will often ask Okay.
• 8:11
  You know, I don't want to do it now, but maybe we can give it in a few weeks."
• 8:13
  And, to me, I think that's sort of like saying you're going to hold off
• 8:17
  on putting your baby in their car seat.
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  You know, odds of you getting in a car accident on your way home
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  from the hospital when you're being very careful are very low.
• 8:26
  But really, we have the ability to do it from day one, and waiting is
• 8:30
  just really kind of an unnecessary risk that we can really minimize.
• 8:34
  Melanie Cole, MS: Dr.
• 8:34
  Knapp, when you mentioned that people might have it and not even know it, is
• 8:38
  it worth it if someone is pregnant or getting ready to deliver a baby to have
• 8:43
  the members of the household tested?
• 8:45
  Dr. Amanda Knapp:
• 8:45
  The risk is pretty low.
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  And so, at this point, that's not the recommendation to get
• 8:49
  the entire household tested.
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  I think it's much easier and it's a very safe thing to just
• 8:55
  provide protection to the baby.
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  Melanie Cole, MS: Well, that's so important then.
• 8:59
  Tell us about that first dose.
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  How's it given?
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  Are there any side effects?
• 9:05
  Dr. Amanda Knapp:
• 9:05
  Yeah.
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  So, the AAP recommends that the hep B dose is given within 24 hours
• 9:10
  of birth, and it's given just as a single injection after delivery.
• 9:15
  But then, it's followed by additional doses called boosters
• 9:18
  that are given during infancy to kind of complete the series.
• 9:22
  There are different schedules depending on like baby's birth weight or if the mom
• 9:26
  does have a positive hepatitis B testing.
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  So, that's something that the pediatric team individualizes in those cases.
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  It is safe.
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  It's been really studied extensively and really has an excellent safety record.
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  It's been around for a really, really long time.
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  We give it to tiny preemie babies, and it's really well-tolerated.
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  Most common side effects, they're very rare, but maybe a little bit of
• 9:51
  soreness where the shot was given, just kind of like you'd expect from any
• 9:55
  vaccine and sometimes a low-grade fever.
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  But really, with hepatitis B vaccine, that's also a really uncommon side effect.
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  So, I think an interesting fact is that, over an 11-year period, 2006
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  to 2017 in the United States, there were 185 million doses of hepatitis B
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  vaccine given and only 160 significant complications from it out of those
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  millions of doses that were given.
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  So, the risk of the vaccine is very, very, very low.
• 10:28
  Melanie Cole, MS: At the beginning, Dr.
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  Knapp, you mentioned RSV.
• 10:32
  Tell us a little bit about what that is and the vaccine or the
• 10:36
  medication that we're looking at now.
• 10:38
  Dr. Amanda Knapp:
• 10:38
  RSV is respiratory syncytial virus, and that's a virus
• 10:43
  that is a common cold virus.
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  it's out in the community.
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  It's highly prevalent in young children and adults or toddlers and adults.
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  It often just looks like a cold because after the first few times
• 10:58
  you get RSV, then your body has developed some immunity to it.
• 11:02
  But for babies, they don't have that immunity when they're born because
• 11:06
  they've never been exposed to it.
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  And so, there is an opportunity to provide some protection with an
• 11:13
  RSV monoclonal antibody injection.
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  Or alternatively, if moms get the RSV vaccine two weeks prior to birth,
• 11:23
  that's enough time for moms to then make antibodies and pass it to the baby.
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  But for moms who maybe didn't get that RSV vaccine, then we have this product
• 11:34
  that is basically like passive antibody.
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  So, instead of mom's antibody, it's just a shot with antibody
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  that helps protect against RSV.
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  And it's recommended for all babies eight months or under during RSV season.
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  And here, we consider RSV season to kind of start October 1st
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  and run through April 1st.
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  So, it's been really a game-changer as far as decreasing
• 12:00
  how sick babies get from RSV.
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  It really gives them instant protection from that serious illness.
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  Melanie Cole, MS: Dr.
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  Knapp, you've given us so much great information and a lot to think about.
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  I'd love for you to offer your best advice as we wrap up for parents
• 12:16
  who are about to have a baby and are faced with all of these decisions.
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  What would you like them to know about talking to their pediatrician and their
• 12:24
  OB-GYN about whether it's, you know, things that they get before they deliver
• 12:30
  or what happens once they deliver their baby and you're in the picture?
• 12:35
  Give us your best advice and what you tell parents every day about these.
• 12:40
  Dr. Amanda Knapp:
• 12:40
  My biggest advice is just to ask your questions.
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  I mean, that's exactly what we're here for.
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  Your pediatrician, your OB-GYN, we all have the same goal.
• 12:47
  We all want your baby to be healthy.
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  I do think these are much easier conversations to have before you're
• 12:53
  exhausted in the delivery room and asked to make decisions, you know?
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  So, I'd encourage you to try to meet with your pediatrician or
• 13:01
  ask your questions ahead of time.
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  That can be really helpful.
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  And then, I also think just making sure that you're paying attention to where
• 13:08
  you're getting your information, because there's so much information online, and
• 13:12
  unfortunately, not all of it's accurate.
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  So, I would say that a couple of resources that I really like and trust
• 13:17
  is the AAP website healthychildren.org
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  is a great resource.
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  And then, also, the Children's Hospital of Philadelphia has a
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  vaccine education center website.
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  And those are good resources.
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  I really trust them, and they're based on evidence.
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  And the websites are designed to not only help parents, like, know
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  what the recommendations are but to also understand and answer
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  really commonly asked questions.
• 13:45
  And then, finally, I guess I would say that these newborn interventions
• 13:47
  are recommended because we've looked carefully at the risks and the
• 13:51
  benefits, and the recommendations come from decades of evidence, and
• 13:56
  they're very safe, and they're from organizations like the AAP, whose
• 14:00
  goal is really to keep children safe.
• 14:03
  Melanie Cole, MS: Thank you so much, Dr.
• 14:05
  Knapp, for joining us today and really sharing your expertise.
• 14:08
  Our pediatricians are really the gold standard in who we look to to help
• 14:13
  keep our babies happy and healthy.
• 14:16
  Thank you again.
• 14:17
  And I'd like to thank our Bryan Foundation partner, Samson Construction.
• 14:21
  To listen to more podcasts from our experts, you can always
• 14:24
  visit bryanhealth.org/podcasts.
• 14:27
  That wraps up this episode of Bryan Health Podcast.
• 14:29
  Please remember to subscribe, rate, and review Bryan Health Podcast on Apple
• 14:34
  Podcasts, Spotify, iHeart, and Pandora.
• 14:37
  I'm Melanie Cole.
• 14:38
  Thank you so much for joining us today.