What are the key assessments and interventions for a 2-day newborn follow-up?

2-Day Newborn Follow-Up Assessment

For a 2-day-old newborn, perform a comprehensive assessment focusing on weight and feeding adequacy, jaundice evaluation with objective bilirubin measurement if any doubt exists, hydration status through stool/urine patterns, and maternal well-being including postpartum depression screening. 1, 2

Critical Physical Assessments

Weight and Growth Parameters

• Weigh the infant and calculate percent change from birth weight 1, 2
• Document weight loss pattern (up to 7-10% is typically acceptable for breastfed infants, but clinical judgment is essential)
• Assess overall hydration status through skin turgor, mucous membranes, and fontanelle appearance 1, 2

Jaundice Evaluation

• Assess for presence and degree of jaundice visually, but obtain objective measurement (total serum bilirubin or transcutaneous bilirubin) if there is ANY doubt about the degree 1, 2
• Visual estimation alone is unreliable, particularly in darkly pigmented infants 1
• Risk stratify based on major risk factors: jaundice in first 24 hours, blood group incompatibility, gestational age 35-36 weeks, previous sibling requiring phototherapy, exclusive breastfeeding with poor intake, and East Asian race 2
• If bilirubin is at exchange transfusion level or ≥25 mg/dL, this is a medical emergency requiring immediate hospital admission 1

Vital Signs Documentation

• Axillary temperature: 36.5°C to 37.4°C (97.7–99.3°F) 1
• Respiratory rate: <60 breaths per minute without distress 1
• Heart rate: 100-190 beats per minute when awake (70 acceptable during quiet sleep if no circulatory compromise) 1

Feeding Assessment and Support

Breastfeeding Evaluation

• Directly observe a complete breastfeeding session, assessing position, latch, and swallowing 1, 2
• Verify infant is nursing 8-12 times per day 2
• Assess for signs of adequate intake: infant appears satisfied after feeding, appropriate alertness between feeds 1, 2
• Provide or arrange lactation support referral if evaluation is not reassuring 1, 2

Bottle-Feeding Assessment

• Document that infant coordinates sucking, swallowing, and breathing during feeding 1
• Verify completion of at least 2 successful feedings since discharge 1

Elimination Patterns

• Obtain historical evidence of adequate stool and urine patterns 1, 2
• By day 2-3, expect at least 3 stools per day for breastfed infants 3
• Verify adequate urine output (at least 6 wet diapers per day by day 5-7) 2

Laboratory and Screening Review

Maternal and Infant Laboratory Results

• Review maternal syphilis, hepatitis B surface antigen, and HIV status 1, 2
• Verify umbilical cord or newborn blood type and direct Coombs test if clinically indicated 1, 2
• Confirm newborn metabolic screening completion per state regulations 1, 2
• If metabolic screening was performed before 24 hours of milk feeding, ensure system is in place for repeat testing 1, 2
• Verify hearing screening and pulse oximetry screening completion 1, 2

Physical Examination Components

Head and Neurological

• Examine fontanelles, head shape, and any abnormalities 4
• Assess muscle tone, posture, and primitive reflexes 4
• Evaluate for appropriate alertness and responsiveness 1, 2

Eyes

• Perform red reflex testing bilaterally 4
• Assess pupillary response and fixation behavior 4

Cardiovascular and Respiratory

• Auscultate heart for rate, rhythm, and murmurs 4
• Auscultate lungs for air entry and abnormal sounds 4

Abdomen and Umbilical Cord

• Assess umbilical cord site for healing and absence of infection 1, 2, 4
• Palpate for organomegaly or masses 4

Genitourinary and Musculoskeletal

• Examine external genitalia 1, 2
• Assess hips for developmental dysplasia 4

Skin

• Evaluate skin color, perfusion, and any rashes or lesions 4

Maternal and Family Assessment

Maternal Well-Being

• Screen for maternal postpartum depression 1, 2
• Assess maternal confidence and ability to care for infant 1

Social Risk Factors

• Screen for risk factors requiring social services intervention: untreated parental substance use, history of child abuse or neglect, parental mental illness, lack of social support, housing instability, domestic violence history 1, 2
• Evaluate barriers to adequate follow-up care (transportation, telephone access, language barriers) 1
• Assess mother-infant attachment and infant behavior 1, 2

Education and Anticipatory Guidance

Safety Education

• Reinforce safe sleep practices: supine positioning, avoid co-sleeping, firm sleep surface 1, 2
• Verify proper car safety seat use (for travel only, not positioning at home) 1, 2
• Provide guidance on skin-to-skin care with monitoring 2

Illness Recognition

• Educate on signs of illness, particularly worsening jaundice 1, 2
• Teach temperature assessment and thermometer use 1, 2
• Review expected urination and stooling patterns 2

Routine Care

• Provide guidance on umbilical cord care, skin care, and genital care 1, 2
• Reinforce benefits of breastfeeding for mother and infant 2

Follow-Up Planning

Medical Home Establishment

• Verify that a medical home has been identified for ongoing care 1, 2
• Provide emergency contact information and instructions 1, 2

Subsequent Follow-Up Timing

• For infants discharged before 48 hours, this 2-day visit fulfills the requirement for examination within 48 hours of discharge 1, 2
• Schedule next visit based on clinical findings and risk factors 1, 2
• Consider earlier or more frequent follow-up for those with risk factors for hyperbilirubinemia 1

Immunization Verification

Maternal Immunizations

• Verify mother received Tdap vaccine immediately postpartum if not previously vaccinated 1, 2
• Confirm influenza vaccination if delivery occurred during flu season and mother not previously immunized 1
• Encourage close contacts to receive Tdap if not previously vaccinated 1

Infant Immunizations

• Verify hepatitis B vaccine administration, particularly for infants born to HBsAg-positive mothers who should have received both vaccine and hepatitis B immune globulin 2, 4

Common Pitfalls to Avoid

• Never rely on visual assessment alone for jaundice - always obtain objective measurement if any clinical concern exists 1
• Do not discharge or delay follow-up if adequate follow-up cannot be ensured in the presence of elevated hyperbilirubinemia risk 1
• Avoid missing social risk factors that may require intervention before problems escalate 1, 2
• Do not assume feeding is adequate without direct observation of technique 1, 2