Hepatitis B Vaccine
What is Hepatitis B?
Hepatitis B is a serious disease that can be prevented. It is a disease of the liver caused by a virus. Most people who get the virus feel better in a few months. However, some people who get Hepatitis B carry the virus all their lives. Babies and young children who become infected with Hepatitis B are at very high risk for chronic infection and serious liver disease later in life.
How do you get Hepatitis B?
You can get Hepatitis B through contact with the blood of someone who has the virus. For instance, young children with Hepatitis B can pass it to unvaccinated children through biting and sharing toys they have put in their mouths. In households where there is an infected person, the virus can be passed to unvaccinated people by sharing personal things like razors and toothbrushes. You can also get it through having sex with a person who has the virus. A baby can get Hepatitis B at birth from a mother who has the virus. One-third of people with Hepatitis B do not know how they got the virus.
How do you know if you have Hepatitis B?
Sometimes people who get Hepatitis B feel tired and sick. Their skin or their eyes may become yellow. Many people who have the virus never look or feel sick. They may not even know they have it. But they can still develop serious liver disease, and they can still pass the virus on to others. The only way to know for sure if you have Hepatitis B is to have a blood test. Most women are tested for Hepatitis B during pregnancy.
How can I protect my baby against Hepatitis B?
There is a vaccine to protect against Hepatitis B. Babies can be protected by receiving three shots of the Hepatitis B vaccine. It is important to protect babies before they have contact with the virus.
Your baby should receive the first shot of vaccine before leaving the hospital. The second and third shots will be given at ages one to two months and at six to 18 months by your baby’s pediatric care provider. The vaccine is provided free of charge by the Massachusetts Department of Public Health.
Is the vaccine safe?
The Hepatitis B vaccine is very safe. The most common side effect is soreness in the thigh, where the shot was given. No serious illness has been related to the vaccine. This is an important opportunity to protect your baby.
Your pediatric care provider will speak with you about giving your baby the Hepatitis B vaccine and will answer any questions you may have. The vaccine is given as an injection in your baby’s thigh. Your nurse will give you an immunization record booklet that will include the date that the vaccine was given. Be sure to bring this booklet with you whenever your baby visits the pediatric care provider.
Circumcision Care
Circumcision is the surgical removal of part of the foreskin of the penis. The decision regarding circumcising a son is a personal one, and parents are encouraged to discuss this decision with their obstetric and pediatric healthcare providers.
If you are interested in a ritual circumcision, your obstetric care provider will be happy to help you arrange the type of service you prefer. Please plan the service as early as possible so that your obstetric care provider may arrange a convenient time for the hospital and your family. If you wish, your own rabbi may be invited to say the prayers while a member of our medical staff performs the circumcision. You must sign a permission form before the procedure.
After the circumcision has been completed, your doctor will wrap your baby’s penis with a gauze dressing. This dressing should be removed after the baby’s first urination or four hours after the circumcision, whichever occurs first. A new Vaseline® gauze (dressing) is then applied. The nurse will show you how to do this. For the next 48-72 hours, apply a clean dressing to your baby’s penis every time you change his diaper.
We will send you home with the following supplies:
If your baby was circumcised within two to six hours of discharge, also take home one 4” x 4” gauze to use in case bleeding occurs.
Care at Home:
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Wash your hands.
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Open a package of 2” x 2” gauze pads, and open one pad up to its 4” x 2” size.
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Squeeze a line of Vaseline® onto the pad.
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Fold the pad in half lengthwise and press so that Vaseline® seeps through the gauze pad. Add a second line of Vaseline® and wrap the Vaseline® side around the circumcision site.
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When it is time to remove your baby’s dirty diaper, use a wet cloth to clean your baby’s bottom and dry the area. Remove the old circumcision dressing. Wrap the new dressing, Vaseline® side down, around your baby’s penis, but not over the opening at the tip. Put a clean diaper on your baby. Wash your hands.
If your baby is circumcised the day you go home:
Be sure he urinates within six hours. Try to feed him at least twice during this time. If he does not urinate, tell your pediatric care provider. Watch for bleeding. A small amount of bright red blood is normal. However, if the amount of bleeding on the diaper is more than the size of a quarter, fold a 4” x 4” gauze pad into thirds, wrap it around your baby’s penis and, with your fingers, apply pressure for several minutes. Put on a diaper so that it is tight, and call your pediatric care provider.
Signs of Infection:
After a circumcision, the circumcised area of your baby’s penis will look very red and, for two to three days may have some yellow drainage. If the drainage persists, turns green, or develops an odor, call your pediatric care provider. Healing takes about one to two weeks.
Pain Management:
Prior to the circumcision and at the time of the first dressing change, your baby will be given a small amount of sucrose to lessen any pain he may have. To relieve pain during circumcision, your baby will have a dorsal penal nerve block (DPNB). This is a local anesthetic that is injected under the skin at the base of the penis and numbs the area for the procedure. The anesthesia lasts about two hours. The American Academy of Pediatrics recommends that newborns receive acetaminophen two hours before the procedure and up to 24 hours after. Your pediatric care provider will prescribe this for your baby as needed.
Other measures that can be used to comfort your baby after his circumcision include:
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Holding him close to you to provide skin-to-skin contact;
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Non-nutritive sucking (sucking on fingers or pacifier);
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Swaddling (wrapping the baby tightly).
If your baby cries continuously for a significant period of time and is difficult to console, please contact your pediatric care provider. Circumcision discomfort should subside within the first 24 hours.
Jaundice
One condition common among infants is jaundice, a word derived from the French word jaune, which means yellow. Jaundice means your baby’s skin has a yellowish color. Newborn jaundice is temporary and common. About 60 percent of infants develop it, typically within three days after birth.
Jaundice is caused by the natural process of red cell breakdown. As the level of bilirubin rises in your baby’s body, a yellow color can move from your baby’s face down the torso to the legs. High levels of bilirubin can lead to a condition called kernicterus that results in neurologic problems.
If you think your baby may have jaundice, monitor his or her skin under natural light, such as light from a window. If your baby is discharged from the hospital less than 24 hours after birth and you notice a yellow color in your baby’s eyes and face, call your pediatric care provider.
If your baby is more than 24 hours old, active and eating well, compare any yellow you may see in your baby’s face to the rest of his or her body. If the color on the legs is yellow like the face, call your pediatric care provider.
If your baby looks jaundiced, a small sample of blood will be taken from your baby’s heel to check your baby’s bilirubin level.
If you and your baby have different blood types, your baby’s bilirubin level may be high.
Depending on the level of bilirubin in the blood, your baby may need phototherapy, which eliminates the bilirubin. She or he will be placed under special fluorescent lights or wrapped in a special blanket that contains high intensity fiber optic lights. To expose as much of your baby’s skin to the light as possible, your baby will be clothed in a small diaper and his or her position will be frequently changed. A mask will protect your baby’s eyes when necessary.
Some babies respond to phototherapy within 24 hours; others require several days of treatment. You may take your baby home when, following phototherapy, the level of bilirubin drops and remains low. It is important that your baby is feeding well and that he or she is well hydrated.
When you go home, you may be asked to return to the laboratory a day or two later to have your baby’s bilirubin levels re-checked. In addition, your pediatric care provider may suggest an earlier check-up than the regularly scheduled one. If you are discharged before your infant, you are welcome to return to the nursery to be with your baby.
