What are the key assessments and recommendations for a newborn's 2-week checkup?

Newborn 2-Week Checkup: Key Assessments and Recommendations

All newborns should be examined at 3-5 days after hospital discharge, with specific timing based on when they left the hospital: 72 hours for discharge before 24 hours, 96 hours for discharge between 24-47.9 hours, and 120 hours for discharge between 48-72 hours. 1, 2, 3

Growth and Physical Assessment

Weight and hydration status are mandatory assessments at the 2-week visit:

• Measure actual weight and calculate percentage change from birth weight 2, 3
• Plot weight, length, and head circumference on appropriate growth charts 2
• Assess hydration through physical examination, feeding patterns, and documentation of stool/urine output frequency 2, 3
• Perform complete head-to-toe examination including assessment of tone, posture, primitive reflexes, and spontaneous movements 2

Specific physical examination components include:

• Umbilical cord assessment for signs of infection, bleeding, or delayed separation 2, 3
• Skin examination for any abnormalities 2
• General appearance and vital signs 3
• Genitalia examination 3

Jaundice Evaluation

Do not rely on visual inspection alone for jaundice assessment—objective measurement is mandatory if any doubt exists about severity, particularly in darkly pigmented infants. 1, 2, 3

• Measure total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) if jaundice is present 1, 2, 3
• Interpret bilirubin levels according to the infant's age in hours, not days 2
• For elevated bilirubin, obtain blood type, Coombs' test, complete blood count, and smear 2

Critical red flag: Any jaundice persisting beyond 3 weeks requires:

• Measurement of total and direct/conjugated bilirubin to identify cholestasis 1, 2, 3
• Verification of newborn thyroid and galactosemia screening results 1, 2, 3
• Blood typing and Coombs test if not previously done 3
• Follow-up until complete resolution 3

Feeding Assessment

Breastfeeding mothers should be advised to nurse at least 8-12 times per day during the first several days. 1

• Assess adequacy of intake through feeding patterns and weight gain 1, 2
• Document voiding and stooling patterns 1
• Provide support for breastfeeding difficulties 1
• Do not routinely supplement non-dehydrated breastfed infants with water or dextrose water 1

Laboratory and Screening Review

Review all newborn screening results if available:

• Confirm newborn metabolic screening results 2, 3
• Verify hearing screening completion 3
• Ensure all state-mandated screenings are complete 3

For NICU graduates, note that screening timing differs:

• Initial screening on day of birth prior to interventions 3
• Repeat screening at 1 and/or 2 weeks of life 3

Blood Type and Antibody Testing

Prenatal maternal blood work should be reviewed:

• All pregnant women should have been tested for ABO and Rh(D) blood types with serum screen for unusual isoimmune antibodies 1
• If mother is Rh-negative or prenatal grouping unavailable, obtain direct antibody test (Coombs'), blood type, and Rh(D) type on infant's cord blood 1
• If maternal blood is group O, Rh-positive, cord blood testing is optional but surveillance and follow-up must be appropriate 1

Parent Education and Follow-Up

Provide written and verbal information including:

• Explanation of jaundice and how to monitor for it 1
• Signs requiring immediate medical attention 1
• Feeding guidance and expectations 1

Schedule next visit according to standard periodicity:

• Follow-up at 1 month, then 2,4,6,9, and 12 months of age 2, 3

Common Pitfalls to Avoid

• Never estimate jaundice severity by visual inspection alone—this leads to errors, especially in darkly pigmented infants 1, 2
• Do not interpret bilirubin levels without considering the infant's age in hours—this can lead to misdiagnosis 2
• Do not discharge infants with inadequate follow-up plans—if appropriate follow-up cannot be ensured in the presence of elevated risk for hyperbilirubinemia, delay discharge until follow-up is secured or the period of greatest risk (72-96 hours) has passed 1
• Do not miss prolonged jaundice beyond 3 weeks—this requires evaluation for cholestasis and other serious conditions 1, 2, 3