What should be included in the routine assessment of mothers and newborns at discharge from the hospital and at the 6-week postpartum follow-up?

Comprehensive Assessment of Mothers and Newborns at Discharge and 6-Week Follow-up

The routine assessment of mothers and newborns at discharge and at the 6-week postpartum follow-up should include comprehensive evaluation of physical, psychological, and social factors to ensure optimal health outcomes and prevent morbidity and mortality. 1, 2

Discharge Assessment for Newborns

Physical Assessment

• Vital signs documented as stable for at least 12 hours preceding discharge:
  • Axillary temperature: 36.5°C to 37.4°C (97.7-99.3°F) in an open crib with appropriate clothing
  • Respiratory rate: below 60 per minute with no signs of respiratory distress
  • Heart rate: 100-190 beats per minute when awake (70 beats per minute acceptable while sleeping) 1

Feeding Assessment

• Documentation of at least 2 successful feedings
• For breastfeeding: evaluation of latch, swallowing, and infant satiety by knowledgeable caregiver
• For bottle-feeding: confirmation of ability to coordinate sucking, swallowing, and breathing 1

Laboratory and Screening Tests

• Review of maternal laboratory tests: syphilis, hepatitis B surface antigen, HIV status
• Review of newborn tests: blood type, direct Coombs test (if clinically indicated)
• Completion of newborn metabolic, hearing, and pulse oximetry screenings
• Plan for repeat metabolic testing if initial tests were performed before 24 hours of milk feeding 1

Follow-up Planning

• Identification of a medical home for continuing healthcare
• Scheduling of follow-up appointment:
  • Within 48 hours of discharge if discharged before 48 hours after delivery
  • Follow-up can occur in home, clinic, or hospital outpatient setting 1, 2
• Provision of emergency contact information 1

Risk Assessment

• Evaluation of family, environmental, and social risk factors
• Development of safety plan if risk factors are identified 1

Discharge Assessment for Mothers

Physical Assessment

• Vital signs, including blood pressure shortly after birth and again within 6 hours
• Defer discharge until vital signs are normal 1

Medication and Vaccination

• Administration of Tdap vaccine if not previously vaccinated
• Administration of influenza vaccine during flu season if not previously immunized 1
• Review of postpartum medication needs, especially for hypertensive disorders 1

Education

• Breastfeeding importance and technique
• Infant care: monitoring urination/stooling, umbilical cord care, skin care, temperature assessment
• Recognition of infant illness signs, particularly jaundice
• Infant safety: car seat use, safe sleep positioning, avoiding co-sleeping 1
• Maternal danger signs: headaches, visual disturbances, nausea, vomiting, epigastric pain, feeling faint, convulsions 1

Psychosocial Assessment

• Screening for postpartum depression risk factors
• Assessment of social support and resources 1

Discharge Planning

• Stay in facility for at least 24 hours, particularly after preeclamptic pregnancy 1
• Provision of written discharge instructions and follow-up appointment details 1, 2
• Contraception counseling and family planning education 1

6-Week Postpartum Follow-up

Newborn Assessment

• Growth parameters: weight, height, head circumference
• Developmental assessment
• Feeding pattern evaluation
• Immunization status review 2

Maternal Assessment

• Blood pressure measurement and control, especially following hypertensive disorders
• Physical recovery from childbirth
• Screening for postpartum depression
• Breastfeeding support and evaluation
• Contraception implementation 1, 3

Follow-up Planning

• Establishment of ongoing pediatric care schedule
• Maternal healthcare continuity planning 2

Common Pitfalls and Caveats

1. Early Discharge Risks: Early discharge (before 48 hours) is associated with increased risk of infant readmission within 28 days for conditions like jaundice, dehydration, and infections 4. Ensure proper follow-up is arranged if early discharge occurs.

2. Missed Screenings: Failure to complete or follow up on newborn screenings can lead to delayed diagnosis of treatable conditions. Establish clear protocols for ensuring completion of all required screenings 1.

3. Inadequate Feeding Assessment: Insufficient evaluation of feeding can miss early breastfeeding problems. A thorough feeding assessment by a knowledgeable provider is essential before discharge 1.

4. Overlooking Maternal Mental Health: Postpartum depression screening is often neglected but critical for maternal and infant wellbeing. Include formal assessment for maternal postpartum depression at both discharge planning and 6-week follow-up 1, 3.

5. Insufficient Follow-up Planning: Lack of clear follow-up instructions and appointments contributes to missed visits. Provide written instructions and consider reminder systems to improve adherence to follow-up schedule 2.

6. Hypertension Monitoring: Inadequate blood pressure monitoring after hypertensive disorders in pregnancy can lead to serious maternal complications. Ensure proper follow-up and medication management 1.

7. Social Risk Factors: Failure to identify and address social risk factors can compromise infant safety. Conduct thorough assessment of family, environmental, and social risk factors before discharge 1.