What risk factors do you screen for in a 3-day-old infant during a well-child exam?

Risk Factors to Screen for in a 3-Day-Old Well Child Exam

At a 3-day-old well child exam, you should screen for newborn metabolic disorders, congenital anomalies, feeding issues, and social risk factors that could impact infant morbidity and mortality. These screenings are essential for early detection of potentially life-threatening conditions.

Newborn Screening Tests

• Metabolic/Genetic Disorders: Verify newborn screening was completed before discharge and results are pending or normal 1

  • Ensure screening for inborn errors of metabolism (IEMs) such as phenylketonuria, maple syrup urine disease, and fatty acid oxidation disorders
  • Follow up on any abnormal results requiring confirmatory testing

• Congenital Heart Disease: Assess for signs of congenital heart defects

  • Listen for murmurs (though many are innocent)
  • Check femoral pulses
  • Observe for cyanosis, respiratory distress, or poor feeding

Physical Assessment Risk Factors

• Jaundice: Assess skin and sclera for yellowing, which could indicate hyperbilirubinemia
• Weight Loss: More than 10% weight loss from birth weight requires further evaluation
• Developmental Dysplasia of the Hip: Perform Ortolani and Barlow maneuvers
• Birth Trauma: Check for cephalohematoma, fractured clavicle, or brachial plexus injury
• Anatomical Abnormalities: Examine for cleft lip/palate, imperforate anus, or other congenital anomalies

Feeding and Nutrition Risk Factors

• Breastfeeding Issues: Assess latch, frequency of feeds (8-12 times/day), and maternal comfort
• Formula Feeding: Verify proper preparation and adequate intake
• Elimination Patterns: Confirm appropriate number of wet diapers (at least 6/day) and bowel movements

Social and Environmental Risk Factors

• Family Structure: Identify individuals living in the home 1

• Housing Conditions: Screen for water damage, mold problems, or unsafe conditions 1

• Exposure to Tobacco, Toxic Substances, or Drugs: Document any exposures 1

• Family History: Screen for:

  • Sudden unexplained death in family members before age 35 1
  • History of apparent life-threatening events in siblings 1
  • Long QT syndrome or arrhythmias 1
  • Congenital heart disease in first-degree relatives (3% risk) 2

• Maternal Factors: Assess for:

  • Signs of postpartum depression
  • Substance use
  • Domestic violence
  • Previous child protective services involvement 1

Preventive Measures to Address

• Vitamin K Administration: Confirm administration of 0.5-1 mg IM vitamin K within one hour of birth to prevent hemorrhagic disease of the newborn 3
• Safe Sleep Practices: Educate on back sleeping position, firm mattress, and avoiding co-sleeping
• Car Seat Safety: Verify proper rear-facing car seat use

Brief Resolved Unexplained Events (BRUE) Risk Factors

If the infant has experienced any concerning episodes, assess for BRUE risk factors:

• Age less than 2 months
• Prematurity (especially <32 weeks gestation)
• Multiple events
• Events lasting >1 minute
• Need for CPR by medical providers 1

Documentation and Follow-up

• Document all findings clearly
• Ensure appropriate follow-up for any identified risk factors
• Schedule next well-child visit (typically at 2 weeks of age)

Remember that early identification of risk factors can significantly impact morbidity and mortality outcomes through timely intervention and management.