Recommended Tests for 1-Week Newborn Check-up
At the 1-week newborn check-up, essential tests include a complete physical examination with growth parameter assessment, jaundice evaluation, and review of newborn screening results. 1
Physical Examination Components
- Complete head-to-toe examination with careful attention to growth parameters (weight, length, head circumference) plotted on appropriate growth charts 2
- Assessment of umbilical cord healing, especially if a ligature or rubber cord ring was used instead of a clamp to prevent trauma 1
- Evaluation of skin for jaundice, which should be quantified with transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) measurement if present 1
- Neurological assessment including tone, posture, primitive reflexes, and spontaneous movements 2, 3
- Cardiovascular examination with attention to heart murmurs, which are common in the immediate newborn period and often represent transition from fetal to neonatal circulation 3
Laboratory Tests
- Review of newborn screening test results if already available 2, 4
- For jaundiced infants:
- No routine blood tests are recommended for healthy infants without concerning symptoms 5, 6
Special Considerations
- For infants with jaundice beyond 3 weeks or sick infants, measure total and direct/conjugated bilirubin to identify cholestasis 1
- Check results of newborn thyroid and galactosemia screening in infants with prolonged jaundice 1
- For premature infants, growth assessments should be corrected for gestational age 1
- If there are any birth trauma wounds, ensure they are properly covered with cling film or a non-adherent dressing to prevent further trauma 1
Common Pitfalls to Avoid
- Visual estimation of jaundice without objective measurement can lead to errors, particularly in darkly pigmented infants 1
- Failing to interpret bilirubin levels according to the infant's age in hours 1
- Overlooking subtle findings that may indicate serious conditions; the vast majority of infants are healthy, but findings predictive of future health problems can be subtle 7
- Unnecessary repeated examinations - research shows that a second thorough examination in the early neonatal period identifies important findings in only 0.5% of cases, though hip examination remains important 5
Follow-up Recommendations
- Schedule the next well-child visit at 1 month of age 2
- Provide anticipatory guidance on basic infant care including feeding, skin care, and temperature measurement 2
- Ensure caregivers understand developmental expectations for the next period 2
Remember that the 1-week check-up is primarily focused on assessing the infant's transition to extrauterine life, evaluating growth, and identifying any early concerns that require intervention.