How do you organise the ”well baby checks” from the delivery / maternity unit?

January 21Jan 21

We are discussing a lot around how to organise the ”well baby checks”, ie the medical assessment of all infants discharged home from the delivery/maternity unit?

How is this set up in your various contexts? Is it a doctor or midwife doing it? What exactly is included in the exam/assessment?

Jan 21Jan 21 Stefan Johansson changed the title to How do you organise the ”well baby checks” from the delivery / maternity unit?
2 weeks later...

January 30Jan 30

I am just wondering if you are referring to the neonatal check before discharge home? Or the six week baby check that is done by the GP?

January 30Jan 30

Author

@PHutchings I am referring to the first neonatal check before discharge home

February 5Feb 5

In USA, it is common practice to see babies daily, since birth. If delivered Vaginally , these babies get discharged along with mother in 2 days and if c-section delivery then 3 days.

February 6Feb 6

In Buenos Aires, babies discharged with their mothers, with low risk, are monitored at one week of age

February 7Feb 7

We have started with midwife-examinations for early discharge (6-12h from birth), followed by a physician eaxmination within 2 days. For infants staying at the maternity ward they will be examined once by a physcian before discharge, unless there are indications for more exams (murmurs, tachypnea, hypotonus etc.). This would be at 12-36 hours of age. Indications for staying in the maternity ward could be first born child, risk of infection, maternal health or other, but many choose early discharge with their second child.

The midwives will do a basic exam but not listen to the hearth though, only do a pre-post-ductal saturation check, and they are not trained in finding more subtle finds associated with disease. I believe that for most babies it will be alright, but for some babies this could mean severe consecuenses, although they might be too few for it to be statistically significant upon review.

On the other end of the spectrum I spoke with a couple of collegeues visiting from a country in south east Europe where every infant stayed for at least 5 days, and 7 days if there was a c-section. All the babies were examined once daily, and the well baby check shifts could be pretty hard in the weekends.

Right now were are aiming at combining the maternity ward with our NICU at our smaller rural hospital, to be able to offer CPAP-care skin to skin and aiming at zero separation between mother and child. We have implemented this with some success at our post-op after c-sections and thereby been able to keep some newborns with TTN out of our intensive care unit.

1 month later...

April 3Apr 3

In the NHS, the postnatal-ward-Midwives will decide whether a doctor is needed to review the child. If one is bleeped to review a child, we have use the standard neonatal-examination-checklist [versions available online]. If we notice any concerning abnormalitesh we then document in the redbook. We also provide a brief non-alarming explanation to the mother. At six weeks, the mother wills present to the GP practice for vaccination, the redbook will be reviewed and updated. Usually, a healthvisitor supports the mother in the first week post discharge. The level of support being determined by any concerns that the midwives/Consultants have e.g. feeding, maternal mental health issues. As a junior doctor, if I notice anything abnormal I will escalate to a Consultant for a formal review.

I am curious as to whether your country has a Register for neonatal epidemiological purposes?

Examination-of-the-Newborn-.pdf

3 weeks later...

April 23Apr 23

Many places in UK now have midwives undertaking many of the newborn baby checks, and it is included in their undergraduate training. Some places will have a checklist of which checks can be reviewed by a trained midwife, and those that are considered more 'complex' or 'at risk' will be seen by a junior doctor or by an advanced neonatal nurse practitioner, including reviews of babies on antibiotics etc. Advanced neonatal nurse practitioners often also perform NIPEs (newborn infant physical examinations) as well, have baby check 'clinics' etc

April 23Apr 23

Author

Thanks @Vicky Payne for sharing, IMHO this would be the preferred process also here in Sweden. Is there any research (numbers please!) what level of diagnostic accuracy you have with this setup? The argument here in Sweden is that doctors are needed to do all this, to avoid that cases of XYZ are missed. Which I disagree with, as we all know, not even doctors live in the perfect world.