What is the recommended follow-up care for a healthy male newborn at one week postnatal?

One-Week Follow-Up for a Healthy Male Newborn

A healthy male newborn should be examined by a qualified healthcare professional within 3-5 days (72-120 hours) after hospital discharge, with the specific timing determined by when the infant was discharged from the hospital. 1

Timing of Follow-Up Visit

The American Academy of Pediatrics provides clear guidance on follow-up timing based on discharge age 1:

• If discharged before 24 hours of age: See by 72 hours (3 days) 1
• If discharged between 24-47.9 hours: See by 96 hours (4 days) 1
• If discharged between 48-72 hours: See by 120 hours (5 days) 1

For infants discharged before 48 hours, two follow-up visits may be required: the first between 24-72 hours and the second between 72-120 hours, particularly if risk factors for hyperbilirubinemia or other problems are present. 1

Essential Components of the One-Week Visit

Growth and Feeding Assessment

Weight measurement and calculation of percent change from birth weight are mandatory. 1 The visit must include:

• Actual weight in grams or pounds/ounces and percentage of weight loss or gain from birth weight 1
• Assessment of hydration status through physical examination 1
• Feeding pattern evaluation, including frequency and duration of feeds 1
• For breastfed infants: Direct observation of breastfeeding position, latch quality, and swallowing effectiveness 1
• Stool and urine output patterns: Document frequency and characteristics to confirm adequate intake 1

Jaundice Evaluation

Jaundice assessment is critical at this visit, as severe hyperbilirubinemia peaks during the first week of life. 1

• Visual inspection for jaundice is insufficient, particularly in darkly pigmented infants 1
• Measure total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) if any doubt exists about the degree of jaundice 1
• Do not rely on clinical estimation alone, as this leads to errors 1
• Risk factors requiring heightened vigilance include: exclusive breastfeeding with poor intake, gestational age 37-38 weeks, East Asian race, previous sibling with jaundice, and male gender 1

Physical Examination

Perform a complete head-to-toe examination assessing 1:

• General appearance: Activity level, tone, color, and responsiveness 1
• Umbilical cord: Assess for signs of infection, bleeding, or delayed separation 1
• Skin: Evaluate for rashes, birthmarks, or lesions 1
• Genitalia: For male infants, confirm normal appearance and document any concerns 1

Laboratory and Screening Review

Review all outstanding laboratory results from the birth hospitalization 1:

• Newborn metabolic screening results 1
• Hearing screening results 1
• Any other state-mandated screenings 1
• Perform additional testing as clinically indicated, such as serum bilirubin if jaundice is present 1

Parental Education and Support

Reinforce critical safety and care information 1:

• Sleep safety: Supine positioning for all sleep, avoidance of bed-sharing/co-sleeping, and appropriate sleep surface 1
• Car seat safety: Proper installation and use, rear-facing positioning 1
• Signs of illness: Fever (rectal temperature ≥38°C/100.4°F), poor feeding, lethargy, increased jaundice, respiratory distress 1
• Feeding guidance: Continue breastfeeding support or formula preparation as appropriate 1

Maternal Well-Being

Screen for maternal postpartum depression at this visit, as maternal mental health directly impacts infant care quality and outcomes. 1

Medical Home Establishment

Confirm that a medical home has been established with clear instructions for emergency contact and scheduled future well-child visits. 1

Common Pitfalls to Avoid

Do not discharge families from the hospital without a confirmed follow-up appointment if the infant was discharged before 48 hours of age. 1 If follow-up cannot be ensured, discharge should be delayed. 1

Do not skip bilirubin measurement if there is any clinical concern for jaundice, as visual assessment is unreliable and severe hyperbilirubinemia can cause permanent neurological damage (kernicterus). 1

Do not assume adequate feeding based solely on parental report—directly observe breastfeeding technique and assess objective markers like weight change and elimination patterns. 1

Risk Stratification

Earlier or more frequent follow-up is indicated for infants with 1:

• Gestational age 35-38 weeks
• Jaundice in the first 24 hours of life
• Blood group incompatibility or known hemolytic disease
• Exclusive breastfeeding with concerns about intake
• Cephalohematoma or significant bruising
• Previous sibling who received phototherapy
• East Asian ethnicity
• Discharge before 48 hours of age

These infants may require follow-up as early as 24-48 hours after discharge rather than waiting the full 3-5 days. 1