When2call Healthcare

860 SIX THE NEWBORN
Early discharge has affected both the timing of newborn

metabolic screening tests and the acquisition of subsequent
immunization. For example, the accuracy of the test for
PKU is directly related to the newborn’s age. The likelihood
of detecting PKU increases as the infant grows older, and the
infant must be at least 24 hours old for a valid test. A second
test is required in most states, usually between one week and
one month of age, to minimize the chance of a positive child
going undetected.
The nurse should teach the family all necessary care-
giving methods before discharge. A checklist may be help-
ful to determine whether the teaching has been completed
and to verify the parents’ knowledge on leaving the
birthing unit (Figure 30–13 ●). The nurse needs to review
all areas for understanding or any outstanding questions
with the mother and father, without rushing, taking time
to answer all queries. Any concerns of the parents or nurse
Figure 30–12 ● Infant car restraint for use from birth to about 12 are noted.
months of age.
COMMUNITY-BASED NURSING CARE
children up to the age of 4 is mandatory. In some states such The nurse discusses with parents ways to meet their new-
as California the age is 6. Nurses need to ensure that all par- born’s needs, ensure safety, and appreciate the newborn’s
ents are knowledgeable about the benefits of child safety seat unique characteristics and behaviors. By assisting parents
use and proper installation. in establishing links with their community-based health-
care provider, the nurse can get the new family off to a
NEWBORN SCREENING AND IMMUNIZATION good start. Parents also need to know the signs of illness,
PROGRAM how to reach the pediatrician or after-hours clinic, and the
Before the newborn and mother are discharged from the importance of follow-up after discharge. See Table 30–4 ●.
birthing unit, the nurse informs the parents about newborn Parents should also check with their clinician for advice
screening tests and tells them when to return to the about over-the-counter medications to be kept in the med-
birthing center or clinic if further tests are needed. The icine cabinet.
disorders that can be identified from a drop of blood The family should have the care provider’s phone number,
obtained by a heel stick are cystic fibrosis, galactosemia, address, and any specific instructions. Having the birthing
congenital adrenal hyperplasia, hypothyroidism, biotini- unit or nursery phone number is also reassuring to a new-
dase deficiency, phenylketonuria (PKU), and hemoglo-
binopathies. Early newborn discharge puts infants at risk
for delayed or even missed diagnosis of PKU and congeni- WHEN PARENTS SHOULD CALL THEIR
tal hypothyroidism because of decreased sensitivity of HEALTHCARE PROVIDER
screening prior to 24 hours of age. Newborns should be
retested by 2 weeks of age if the first test was done prior to Temperature above 38.4C (101F) rectally or 38C (100.4F) axillary or below
36.1C (97F) rectally or 36.6C (97.8F) axillary
24 hours of age.
Continual rise in temperature
Immunization programs against the hepatitis B virus dur-
More than one episode of forceful vomiting or frequent vomiting over a 6-
ing the newborn period and infancy are in place in many hour period
states, at least 20 countries, and high-incidence areas such as Refusal of two feedings in a row
Alaska and American Samoa. Universal vaccination of in- Lethargy (listlessness), difficulty in awakening baby
fants is recommended. Infants should receive the first dose Cyanosis with or without a feeding
of hepatitis B (Hep B) vaccine at birth to 2 months of age. Absence of breathing longer than 15 seconds
The second dose should be at least one month after the first Inconsolable infant (quieting techniques are not effective) or continuous
dose. The third dose should be administered at least 4 high-pitched cry
months after the first dose and at least 2 months after the Discharge or bleeding from umbilical cord, circumcision, or any opening
second dose, but not before 6 months of age (Centers for (except vaginal mucus or pseudomenstruation)
Disease Control, 2003). See the Drug Guide: Hepatitis B Two consecutive green, watery stools
Vaccine. Parents need to be advised whether their birthing No wet diapers for 18 to 24 hours or fewer than six to eight wet diapers per
day after 4 days of age
center provides newborn hepatitis vaccination so that an ad-
Development of eye drainage
equate follow-up program can be set in motion.

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860 SIX THE NEWBORN

Early discharge has affected both the timing of newborn

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