The Well Infant Visit
The purpose for this initial visit includes what important specific assessments of physical, developmental, family dynamics and educational needs?
Newborn Case study
This is a 3 day old female, birth weight of 7lbs 3 oz born at 39 weeks gestation to a 28 year-old gravida 3 para 2002 mother.
The older children are a boy that is 6 and a girl that is 3. The parents have been together for 2 years in a stable caring relationship. The father is in the military and currently deployed.
Mother reports baby is breastfeeding every 2 hours and is healthy. Mother states that the baby appears more “yellow” than she remembers either of her other children were after birth and is concerned about jaundice.
Mother also reports that her 3 year old is very clingy and non-cooperative. As you begin to examine the baby the mother asks what the bump on the left side of the baby’s head is from (cephalohematoma). She states she did not notice anything like this on her 2 other children after birth.
Physical exam:
The vital signs are temp axillary 37.2 celsius, pulse 138, resp rate 46.
Biometrics include weight at 3.2kg (45%), length 51cm (75%) and head circumference 34cm (75%) is this normal?
Yellow hue to nipple line, anterior fontanel is flat and slightly sunken. There is mild left sided cephalohematoma, soft with noted bruising is present. Sclera is mildly icteric with a very small dot of red close to the iris (scleral hemorrhage). Mild palpable edema at both breast under nipple area without any redness noted, neck is soft and supple without mass, abdomen is soft and hollow without palpable mass or HSM. Muscle tone is normal flexed position and reflexes are intact including moro, strong suck/swallow, step, grasp. diaper area and genitals normal for newborn female.
Discussion Questions:
What baseline history about the birth and neonatal course might be important for you to make an adequate assessment, diagnosis of any problems and plan of continued care for this infant and her family?
What are the possible short term or long term sequela of cephalohematoma for this infant?
What possible diagnosis could you identify?
What recommendations would you give this mother about what to expect?
What additional test might have been done at the hospital on the newborn that you need to review and follow-up?
What is “yellow” Jaundice the mother is concerned about?
What is the differential diagnosis for jaundice in a newborn?
What information about this mother and infant might be a risk factor for the jaundice getting worse?
What tests might be helpful?
What else significant about this infant did you learn from her exam?
Check out the American Association of Pediatrics (AAP) website for jaundice
