This episode describes how to prepare for a newborn’s first outpatient visit after they have been discharged from the birth hospital, including the information that you need to obtain from the medical record before the visit, the topics you need to discuss during the visit, and how to approach the physical examination in a newborn.

Introduction

Socio-emotional state of parents

Before the visit, you should review

• Prenatal history


• Delivery history, gestational age


• Physical exam at time of birth


• Preventative treatments


• Course in newborn nursery or NICU


• Type of feeding


• Concerns for infection


• Bilirubin


• Screening tests

Newborn visit

• Parental questions and concerns


• Feeding history and any problems with feeding


• Elimination 


• Sleep and safe sleep


• Social history and parental support system


• Review of systems – irritability, fever, rashes. 

Normal newborn vital signs

Infant growth parameters and weight trajectory

Physical exam

• General


• Head size and shape


• Eyes – pupil shape, red light reflex, scleral icterus


• Cardiovascular – murmurs, capillary refill


• Respiratory


• Abdominal


• Genitourinary – testicles, hernias/hydroceles, circumcision, vaginal discharge


• Musculoskeletal-  clavicles, hip 


• Skin – jaundice, birthmarks, sacral dimples


• Neurological: tone, reflexes

Anticipatory guidance

• Fever


• Safe sleep


• Prevention of shaken baby syndrome


• Postpartum depression


• Appropriate feeding

Next follow up appointment depends on weight, bilirubin level

Resources/Links:

https://peditools.org/bili2022/ - resource for management of hyperbilirubinemia