Congratulations on the birth (or upcoming birth) of your baby!

Your baby has been referred to me by your obstetrician. This may be for a number of reasons – the circumstances of the birth (e.g. a Caesarean section), a problem being identified on your antenatal scans, your obstetrician’s preference that the baby’s routine care be provided by a paediatrician, or at your own request. There are out of pocket fees associated with my services and more information regarding these costs can be found in your baby’s registration documentation.

I am a paediatrician with additional training in the management of newborn babies (neonatal paediatrician or neonatologist). While your baby is in hospital, I will be responsible for his/her medical management 24 hours per day. I will perform your baby’s newborn examination and document it in the Green Book. I will visit every day to check on your baby’s progress with feeding, check that his/her umbilical cord is healing well, and to assess for jaundice. Before you go home, I will perform a pre-discharge examination to make sure that your baby has not developed a heart murmur or unstable hips. Following my initial visit, one of my colleagues may be covering for me but I will let you know if this is the case in advance. Similarly, in the event of an emergency with your baby in the evening or overnight, one of my colleagues may be covering my practice.

During your stay in hospital

Vitamin K (also called Konakion) - In the first few hours after birth, your baby will receive an injection of vitamin K into the muscle of the thigh. This treatment is to prevent a rare condition called ‘vitamin K deficiency bleeding’. During pregnancy, only small amounts of vitamin K are passed across the placenta into the developing baby. In addition, breast milk contains very little vitamin K. This results in all newborn babies being low in vitamin K, a vitamin that is important in the function of certain clotting factors in the blood. A single dose of vitamin K has been shown to be safe and very effective at preventing this rare disease.

Hepatitis B immunisation - Before the birth, you will be asked whether you consent for your baby to receive hepatitis B immunisation. This is a very safe and effective vaccine which is part of the recommended schedule by the NHMRC. I recommend it for all babies.

Feeding - Breastfeeding is the best, cheapest and safest way to feed your baby. In the first few days after birth, you will learn to attach your baby at the breast (your midwife will help you with this). If the baby finds it difficult to attach, the midwives will show you how to express your colostrum by hand and give it to the baby with a syringe (it is better to feed babies who are to be breastfed this way). If attachment continues to be a problem for your baby, the staff will show you how to express your breast milk into a bottle with an electric pump. Some mothers may need to continue to express when they get home; suitable pumps are available for hire or purchase from pharmacies and baby shops. For most mothers, their breast milk does not ‘come in’ (i.e. the breasts do not fill with milk) until at least 72 hours after birth. In some babies (particularly those who are premature and those who weigh less than 2.5 kg), it may be necessary to supplement a mother’s breast milk with formula.

Breastfeeding is not for everyone and some mothers choose to formula feed. This is also a safe and effective way of feeding your baby. There are many formulas available, all governed by strict rules on what they may contain. Most babies tolerate a simple cow’s milk-based formula (e.g. Aptamil, Bellamy’s, Nan, S26). There is no benefit to swapping between these brands for constipation, irritability etc. No benefit has been shown from using ‘Gold’ formulas except in premature infants. I do not recommend ‘AR’ (anti-reflux) formulas but regular formula may be thickened for very troublesome reflux.

Weighing/measuring - At 48 hours of age, babies are reweighed and, if their length and head circumference were not measured at birth, this is also done. Almost all babies lose weight in the first few days; this is quite normal and is no cause for concern unless the loss is greater than 10% of the baby’s birthweight.

Newborn screening test - On day 3 of life, the midwife looking after your baby will collect a few drops of blood onto a card for the newborn screening test. The card is sent to the Murdoch Children’s Research Institute and the blood is tested for hypothyroidism (an under-active thyroid gland), phenylketonuria (PKU; a rare metabolic disease), cystic fibrosis and for some inborn errors of metabolism. If the result is abnormal, the hospital will be notified and they will contact you; if you have heard nothing by the time your baby is five weeks old, then the results were normal.

Jaundice - 60% of all newborn babies become jaundiced (go yellow) in the first few days of life. In most cases, this is quite normal, requires no treatment, and goes away by the time a baby is two weeks old. Jaundice can make babies sleepy. Your midwife may use a transcutaneous bilirubinometer (TcB) to estimate the jaundice level on the skin of your baby’s forehead; if the baby is very jaundiced, a blood test (serum bilirubin; SBR) may be arranged to assess whether treatment is required.

Vitamin D deficiency - Breastfeeding babies are at risk of becoming deficient in vitamin D because it crosses the placenta poorly and because there is very little of it in breastmilk; this can increase the risk of allergy. If you are breastfeeding, even if you are also giving formula, your baby should receive a vitamin D supplement. Please buy OsteVit-D3 Oral Drops from a pharmacy (a prescription is not required) and, once you leave hospital, give your baby two drops every day until the age of six months. If your baby is only receiving formula, supplemental vitamin D is not required.

Admission to Special Care Nursery (SCN) - Some babies require admission to SCN rather than being nursed on the ward with their mothers. Common reasons include prematurity (birth prior to 37 weeks of pregnancy), a birthweight less than 2500g, breathing difficulties, suspected infection, twins, and infants of diabetic mothers.

Transfer to Park Hyatt or Grand Hyatt - If you and your baby are well, you may be eligible to be transferred to one of the Hyatt Hotels. Your baby will be closely monitored by the midwives there who will notify me if there are any concerns. I do not routinely see babies at the hotels unless specifically asked to do so by the staff.

After discharge from hospital

When you are discharged from hospital, the Maternal and Child Health Nurse from your local council will be informed. She will come and visit you at home in the first week after discharge from hospital to check on your baby. If this does not happen, you should contact your local council. Subsequently, she will arrange regular checks on your baby making sure he/she is feeding well and putting on weight. 

If your nurse is concerned about your baby, she may recommend that you see either your local GP or come back to see the paediatrician who saw your baby in hospital. 

If there is a problem with your baby, please ring our friendly clerical staff to make an appointment with the paediatrician.  The follow-up appointments are associated with a separate fee.  Prior to seeing your paediatrician, he/she may be able to provide support by email/SMS; there is no charge for this service. The referral from your obstetrician lasts for 3 months from the date of your baby's birth. 

Your baby may need an ultrasound of the hips, kidneys or brain after discharge. If this is required, I will let you know, and staff from my office will make the appointment and email you with the details. I do not usually arrange to see most babies again after they are discharged from hospital. However, all babies need a check at six to eight weeks of age and this should be done by your general practitioner. Your baby may need to see me again but I will let you know if this is the case. If you do need to bring your baby to see me, please ring to make the appointment as soon as possible after you go home.

Most babies who get sick with whooping cough (pertussis) in the first three months of life, catch it from their parents or another adult carer. Both parents, and any adult looking after your baby more than once per week (e.g. a grandparent), should be receive the Boostrix vaccine from a local GP. Your baby’s first immunisations should be done at six weeks of age by your local council or GP.

If there are any problems in the first three months of your baby’s life, please let me know straightaway.