“Newborns! Part A: From birth until you go home” – with Dr. Tracy Agnese

In a recent Healthful Woman episode, “Newborns! Part A: From Birth Until You Go Home,” host Dr. Nathan Fox speaks with Dr. Tracey Agnese, a pediatrician at Pediatric and Adolescent Medicine on Manhattan’s west side. Dr. Agnese walks through exactly what happens to a baby in the hospital’s first 24 hours, from the head-to-toe exam to the tests every newborn receives before discharge.

The First Exam: Head to Toe

Pediatricians typically meet a newborn for the first time during morning rounds, within 24 hours of birth. Before they even walk in, Dr. Agnese reviews the prenatal history, including any maternal medications, the mother’s GBS status, and the blood types of both mother and baby to flag a jaundice risk.

The exam itself follows the same pattern for most pediatricians. “I think all of us kind of do it similarly, where we go from head to toe,” Dr. Agnese explains. That means checking the fontanelles and sutures, the mouth and palate for a cleft, the clavicles, the hips for looseness, the umbilical cord, and the baby’s back and skin once flipped onto its stomach. Most of what turns up is completely normal. A common newborn rash called erythema toxicum, for example, “looks like pimples on the body” but isn’t harmful at all, just something parents need reassurance about.

The Standard Newborn Tests

Every baby born in a New York City hospital goes through a set of routine screenings. Nurses perform a heel-prick blood test that screens for dozens of metabolic and congenital conditions, a hearing screen, and a pulse oximetry check for congenital heart disease. Every baby is also assessed for jaundice using a forehead scan that estimates bilirubin levels, since a newborn’s immature liver and shorter red blood cell lifespan can send those numbers climbing in the first week of life.

Hearing screens, Dr. Agnese notes, aren’t infrequently inconclusive at first. “There’s so much debris in the ear canals… so sometimes babies will not pass that in the nursery,” but that’s usually resolved with a repeat test at the pediatrician’s office. Newborns are also typically offered the hepatitis B vaccine and a vitamin K shot before they leave the hospital.

What Could Delay Going Home

Two things most commonly keep a baby in the hospital past the standard 24 hours: jaundice that crosses the threshold for phototherapy, or concern about infection, which usually means a transfer to the NICU for monitoring or a short course of antibiotics. Beyond that, Dr. Agnese says, babies rarely stay longer for other reasons, though as Dr. Fox jokes, “the babies usually stay longer if the mommies stay longer,” since hospitals won’t discharge a newborn without its mother.

What Every Parent Hears Before Leaving the Hospital

Dr. Agnese covers a short list of essentials with every family before discharge. Feeding comes first, with guidance to nurse every two to three hours, alternating breasts for 15 to 20 minutes each, and reassurance that losing up to 10% of birth weight is normal before babies start regaining it around days three to five. Diaper counts follow the same logic: one wet diaper on day one, two on day two, and so on through day five, while stool consistency (Dr. Agnese’s memorable comparison is couscous) tells parents just as much as the number of poops does.

Fever is the other big one. In the first two months of life, a rectal temperature of 100.4 or higher means calling the doctor, no exceptions. “Most of the time, things are just fine,” Dr. Agnese says, but because babies can’t communicate what’s wrong, a fever is often the only signal parents and doctors have to go on.

Listen to the Full Episode

Dr. Agnese also shares how she built her own platform for new parents, including a YouTube channel and an Instagram account, @babydocmama, both linked from traceymd.com. To hear the full conversation, listen to “Newborns! Part A” on the Healthful Woman podcast.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!