Newborn Discharge

Question 1

Describe Metabolic Screening.

Indication, Protocol

Answer 1

• Heel stick on blot paper
• Helps with early detection for genetic or chromosomal abnormalities
• Cystic fibrosis, PKU, sickle cell disease
• Standard for all newborns in the US
• Diseases being screened for may differ in each state

heel stick - blood collection from a newborn’s heel

Question 2

Describe Critical Congenital Heart Disease (CCHD) Screening.

When is it done? Indication? What is a negative screening?

Answer 2

• Done between 24-48 hours of life
• Preductal and postductal oxygen saturation
• Negative screen: Pulse ox of 95% or greater in right hand or either foot and difference less than 3% between hand and foot

Question 3

What medications are given at birth?

Answer 3

• Erythromycin ointment to prevents bacterial infection in eyes
• Vitamin K shot to promote production of clotting factors

Question 4

What vaccinations are given at birth?

Answer 4

Hepatitis B

Question 5

Describe Bilirubin testing.

Answer 5

• Heel stick or transcutaneous testing
• Look for signs of jaundice - yellow sclera, yellow skin, dark urine
• Physiological vs pathological jaundice (timing and level)

Question 6

Describe Glucose testing.

How is it tested? When should you test?

Answer 6

• Heel stick
• Test if mother had gestational diabetes, LGA, SGA

Question 7

Describe Infection testing?

How is it tested? When should you test?

Answer 7

• Urine sample, blood work/culture
• Test if mom has STI, systematic infection/fever, preterm/prolonged rupture of membranes, chorio

Question 8

Describe Blood typing/testing.

When should you test?

Answer 8

• If mom is O and/or Rh negative
• Sickle cell, CF

Question 9

Describe Bathing teaching.

Answer 9

• Check temperature of the water
• Wait until umbilical cord falls off before full bath
  
  • Use washcloth to bathe until cord falls off / circumcision to heal (~5 days)
• Never leave baby unattended near water or in bathroom

Question 10

Describe Umbilical Cord teaching.

Answer 10

• Stump will fall off ~14 days
• Clean around stump with warm water, no alcohol
• Keep stump dry (fold diaper underneath it, sponge baths only)
• Notify provider if red, swelling, foul odor, discharge

Question 11

Describe Circumcision teaching.

Answer 11

• Wash hands prior to diaper changes
• Use Vaseline gauze on tip of penis to prevent sticking to diaper for a few days, use water to clean, no wipes
• Do not wipe away yellow exudate that forms on the penis
• Monitor for excessive bleeding or signs of infection
• Ensure infant urinates after procedure

Question 12

Describe Swaddle teaching.

Answer 12

• Used to stifle the startle reflex and provide snug uterine-like environment
• Snug across arms, looser around hips
• Stop swaddling once baby can roll (typically around 8-12 weeks)

Question 13

Describe Safe Sleep teaching.

Answer 13

• Always place infant on back to sleep
• Nothing in sleep environment (no blankets, pillows, toys, bumpers, etc.)
• Sleep alone on a firm mattress
• No smoking in the home and pacifiers reduce risk of SIDS
• Dress baby in temperature-appropriate cloths (onesie and sleep sack, PJs and sleep sack, etc.)
• AAP recommends room sharing for first 6 months

Question 14

Describe Car Seat Safety teaching.

Answer 14

• Always use an approved car safety seat in the backseat when traveling in a motor vehicle
• Rear face the seat as long as weight/height permit
• Position infant at a 45-degree angle in the car seat to prevent airway obstruction
• Car seat should have a 5-point safety harness
• In the event of an accident, a new car seat must be purchased due to the integrity being questionable
• Car seats should not be purchased used due to unknown accident history
• Infant car seat challenge recommended by AAP for infants who are born less than 37 weeks gestation (monitor infant for apnea, bradycardia, and decrease in O2 saturation)