Information

  • Recording the child’s birth information allows clinicians to:
    • access a child’s consistent personal health history as they grow and develop
    • ensure any postnatal appointments are actioned and followed up

Health check recommendations

  • All mothers of newborn babies during first postnatal visit

1. Procedure

  • Transfer all discharge summary and child’s Personal Health Record (PHR) booklet (baby book) information to the child’s medical record as per Table 1.
  • Ensure any concerns, appointments or abnormalities are being actioned or followed-up. If not, refer and place the baby on a recall register

Table 1. Birth information and questions for 1–6 weeks of age

Information and questions

Explore

Discharge summary received

  • If not received contact the referring or birth hospital

Birth weight

  • See Body measurements (child)

Birth length

Birth head circumference

Gestation

  • < 37 weeks is premature

Apgar score 1 minute

  • Scale from 1 (not responding) to 10 (alert/active)
  • Measured at 1 and 5 minutes after delivery

Apgar score 5 minute

Method of delivery

  • Normal vaginal birth (NVB), caesarean section (CS), forceps or vacuum extraction

Newborn hearing test attended

  • Yes or no

Immunisation status current

  • Hepatitis B, vitamin K and/or tuberculosis vaccines

Neonatal Screening test (NNST) attended

  • If not performed at birth hospital ensure that the test is attended to in the community

Was the baby treated for jaundice?

  • If “yes” monitor and provide brief intervention

Did the baby have problems with breathing or convulsions at birth?

  • If “yes” ensure MO/NP has reviewed, parental concerns addressed and any follow-up is actioned

Was the baby ventilated

  • If “yes” ensure MO/NP has reviewed, parental concerns addressed and any follow-up is actioned

2. Results

  1. Gestation 1,2
    • For baby born premature (< 37 weeks), be mindful that:
      • the baby is at increased risk of vaccine preventable diseases
      • the baby’s immunisation schedule will alter
      • body measurements need to be corrected. See Body measurements (child)
  2. Method of delivery
    • Caesarean wounds require monitoring particularly in those who are overweight or obese
    • Forceps delivery may leave marks on the sides of the baby’s head
    • Vacuum extraction leaves a cone or large bump on the top of the baby’s head
  3. Hearing test
    • Follow-up and action abnormal hearing test results, appointments or referrals
    • For ongoing monitoring see Ears and hearing (child)
  4. Neonatal screening test (NNST)
    • The birthing hospital will notify the parent of any abnormal test results and arrange follow-up appointments. Always check
  5. Jaundice 3,4
    • As blood cells and haemoglobin is produced and destroyed, bilirubin is released
    • Bilirubin is removed via the placenta before birth and by the liver after birth
    • In an immature liver, bilirubin levels can rise causing the skin and mucous membranes to turn yellow; jaundice
    • Jaundice is common in newborns, usually 48 to 72 hours after birth
    • Jaundice appears on the face and head first, then body, then finally the palms of hands and soles of feet
    • Test by gently pressing a fingertip on the baby’s nose or forehead. When the finger is lifted the skin should be white if normal, or yellow if jaundiced. See Table 2.
    • Those with darker skin are harder to assess. Always refer if unsure
    • If jaundice is not addressed, hearing problems or brain damage may result
    • Filtered light in a naturally well lit room at home, not direct sunlight, and breastfeeding helps the baby to eliminate bilirubin and thus reduce jaundice
    • Jaundice should disappear by 2 weeks of age

Table 2. Kramer’s rule to estimating jaundice in babies 3,4

Zone

Effect on child

Action

1

  • Limited to head and neck
  • Encourage 3 hourly breastfeeding and filtered light. Observe

2

  • Upper trunk
  • Baby may be tired

3

  • Lower trunk and thighs
  • Baby will be tired and listless
  • Continue to encourage 3rd hourly breastfeeding and filtered light
  • Refer urgently

4

  • Over arms, legs and below knees
  • Baby will be tired and listless
  • At risk of cerebral palsy, deafness and brain damage

5

  • Hands and feet
  • Baby will be tired and listless
  • At risk of cerebral palsy, deafness and brain damage

3. Brief intervention

  • Provide the parent with anticipatory guidance for the coming months including:
    • breastfeeding or infant formula feeding
    • safe sleeping and SIDS
    • infant reflexes and vision and hearing information
    • nutritionally unsafe practices e.g. soft drinks, juice, coconut milk or tea in bottles
    • milestones in the coming months
  • Praise successes

4. Referral

  • Refer to MO/NP for:
    • abnormal hearing test results
    • abnormal neonatal screening test results
    • jaundice that is not resolving or continues to progress. See Table 2.
    • caesarean wounds that do not heal
  • Ensure all referrals are actioned by parents

5. Follow-up

  • Place the child on a recall register if required
  • Ensure all referrals are actioned
  • Provide the parent with details for the next scheduled follow-up appointment

6. References

Last updated: November 2024

Back to top