Chapter 1 – Newborn Check-ups

From the very first moments of the baby’s life, the birth center staff performs a quick assessment of the newborn’s health status: five parameters—heart rate, respiratory rate, muscle tone, reflexes, and skin color—are evaluated to assign a score from 0 to 10, known as the Apgar score. The name is an acronym for Appearance, Pulse, Grimace, Activity, and Respiration — i.e., skin color, heart rate, response to nasal stimulation, muscle tone, and breathing.

A score between 8 and 10 indicates that the transition to life outside the womb is proceeding normally. These are crucial checks that healthcare professionals carry out promptly and carefully so as not to disturb the intimacy of the first moments between mother and baby. This evaluation is repeated at 5 minutes of life, assessing the same parameters.

Next, the newborn is weighed and undergoes a more thorough examination. The neonatologist examines every part of the baby’s body: the shape of the head, nose, mouth, ears, palpates the abdomen, listens more carefully to breathing and heartbeat, and inspects the genitals. Then, they treat the umbilical cord stump and return the baby to the loving care of the parents.

In the following days, before discharge from the facility, the newborn undergoes further checks. At 24 hours of life, the neonatologist measures blood oxygenation with a non-invasive device through the skin. This test helps identify possible congenital heart defects that may have gone undetected during prenatal ultrasounds. A small blood sample is taken to determine the baby’s blood type and detect possible anemia due to iron deficiency, which may require supplementation.

In the first 2–5 days of life, the newborn’s skin may take on a yellowish tint — neonatal jaundice. This is a generally physiological phenomenon caused by a buildup of bilirubin, a waste product from red blood cell metabolism. During fetal life, the mother’s body disposes of this bilirubin. In adults, the liver performs this task, but in newborns, the liver is not yet fully functional, leading to increased bilirubin concentration and the onset of jaundice. The condition usually resolves spontaneously within a week.

An excessive increase in bilirubin levels, however, can cause neurological damage. Therefore, bilirubin levels are measured non-invasively through the skin before discharge. To treat hyperbilirubinemia (excess bilirubin in the blood), the baby is exposed to light from special lamps—harmless to delicate skin—that break down bilirubin. If jaundice is too pronounced, the neonatologist may prescribe a few sessions of phototherapy before discharge.

Another check in the first days is the Barlow-Ortolani maneuver to assess proper hip function.

The hip is a ball-and-socket joint formed by the top of the thigh bone (femur head) rotating freely in a cup-shaped cavity of the pelvic bone. In some newborns, the femur head is displaced from its natural socket. This defect affects about 2–3% of newborns and is usually correctable within a few months with simple interventions. If undiagnosed, this condition—known as congenital hip dysplasia or hip dislocation—can interfere with leg development and cause future walking issues. The Barlow-Ortolani maneuver involves gently bending and spreading the baby’s legs to check for smooth femur head movement without clicks. If an abnormality is found, the neonatologist prescribes a hip ultrasound for further evaluation.

Since hip dysplasia may not be present at birth but develop later, the maneuver is repeated during early pediatric check-ups. Many pediatricians and birth centers recommend a hip ultrasound at 4–6 weeks, regardless of the maneuver’s outcome.

To correct the condition, during the first months, the baby should keep their legs bent and spread like a “frog.” Parents can use special diapers available at medical supply stores or simply double-diaper the baby. Holding the baby often in a baby carrier or wrap can also help—provided the legs are well spread and the thighs supported in the classic “M” position.

Other screening tests required by law in all Italian regions, are also carried out: Red Reflex Test: This checks the clarity of the eye through the pupil to the retina. A beam of light is shone into the baby’s eye, and a red reflection should be visible—like the red-eye effect in photos. A missing, white, uneven, or asymmetric reflex may signal conditions that require immediate diagnosis.

Otoacoustic Emissions Test: This test checks the baby’s hearing and detects early issues that could affect neuro-sensory development and learning. Unlike hearing tests for older children, it does not require the baby’s cooperation, is non-invasive, and is done while the baby sleeps. A small probe placed on the ear emits sounds and records the corresponding vibrations of inner ear structures.

Heel-Prick Test (within 72 hours of birth): A few drops of blood are collected from the heel for rare metabolic disease screening.

The sample is sent to a specialized lab and analyzed for molecules linked to congenital metabolic disorders. Each of these diseases is rare, but collectively they affect 1 in 1,500–2,000 babies. All are serious, some life-threatening, but if diagnosed early—before symptoms appear—intervention can save lives and prevent irreversible damage or severe disabilities.

Until recently, screening in Italy only included congenital hypothyroidism, cystic fibrosis, and phenylketonuria. Now, the list has expanded to include dozens of metabolic diseases. Not all regions are fully aligned yet, but the situation is improving.

The metabolic screening test has high sensitivity—if negative, one can reasonably rule out the diseases tested. However, false positives or unclear results are relatively common. Parents may be called back after discharge for a repeat test. In most cases, the second test is negative. If not, a specialist takes over for in-depth evaluation.

In addition to the tests and check-ups, newborns routinely receive two other medical treatments at birth: An intramuscular injection of vitamin K, to prevent hemorrhagic disease in newborns, and administration of antibiotic eye drops to protect against conjunctivitis from bacteria encountered during delivery.