Pediatric Primary Care Read Online Free PDF

transcutaneous (TcB) bilirubinometer and nomogram.
C.  Newborn hearing screening. To be done no later than 1 month of age. Most hospitals offer this screening for newborns prior to discharge. Risk factors for infants include family history of sensorineural hearing loss, in utero infections (TORCH), craniofacial anomalies, hyperbilirubinemia, post natal bacterial meningitis, findings indicative of a syndrome with hearing loss, neurodegenerative disorders, sensory motor neuropathies, parental concerns for hearing, head trauma, and recurrent/persistent otitis media. If infant fails the hearing screening, an audiologic evaluation needs to be done as follow up by 3 months of age.
VI. MEETING WITH THE PARENT
A.  Introduce self, sit by bedside. Describe your role. Answer parent's questions, describe the general process of how you will be working with them over the next day or so.
B.  Praise parents, compliment baby.
C.  Call baby by name.
D.  Determine mother's health/wellness/contact with infant so far.
E.  Review your findings, briefly.
F.  If male, determine if baby is to be circumcised. Discuss pros and cons.
G.  Ask about method of feeding, car seat, help when home, concerns.
VII.  NUTRITION
A.  Breastfeeding is encouraged for all newborns (see Chapter 5 ). Late preterm infants may not be as vigorous an eater as expected and may need close monitoring of weight. Obtain a breastfeeding consult and encourage nursing every 2 hours around the clock until infant is nursing at least 20 minutes during feedings.
1.  No breastfeeding if HIV infected, active herpes of breast, untreated tuberculosis, maternal debilitating disease (cancer), illicit drug use by mother, infant galactosemia.
B.  If bottle-feeding, reassure that baby will grow and thrive on formula.
1.  Only commercially prepared, iron-fortified formulas should be used: powder, concentrate, ready-to-feed. Do not dilute ready-to-feed; do not reuse if > 4 hours since opened.
2.  Mix formulas with bottled water for first month, continue if on well or unsure of water quality. Store in refrigerator if open no longer than 24 hours.
3.  Specialized formulas have similar preparation directions. Goat's milk, whole cow's milk, rice milk have inadequate amounts of vitamins and minerals.
4.  Serve formula at room temperature. Do not microwave to heat. Do not let formula sit out at room temperature to warm for more than 15-20 minutes.
C.  Clean technique is sufficient for mixing formulas. Clean off cans with soap and water before opening. Use hot soapy water and bottlebrush to clean nipples and bottles or clean in dishwasher.
D.  Hold during feedings; burp every 1-2 oz.
E.  Hold in upright, semi-reclined position for feedings. No bottle propping.
F.  Newborn will suckle 0.5-1 oz of formula/feeding every 2-3 hours for first 24 hours (60-100 mL/kg/day). Volume increases to 12-24 oz/day and interval between feedings > 3-4 hours in first month. May be days when baby takes more or less, depending on sleep pattern. Baby should take in 90% of feeding in first 20 minutes.
VIII.  ELIMINATION
A.  Meconium stools in first 48 hours, transition stools green-brown, change to yellow pasty after 2-3 days of oral feeding.
B.  Infant should have 1-6 yellow pasty stools for 24 hours.
C.  Breastfed baby may have upper range of frequency, bottle-fed may have less.
D.  Void every 1-3 hours or with each feeding and diaper change.
IX.  SLEEP
A.  Awake for feedings; feed every 2-4 hours. Should be alert, nurse vigorously for 15-20 minutes, then fall back to sleep. Respirations may be slightly irregular.
B.  Babies should sleep on back in their crib. No pillows/toys in the crib that baby could get face against and be smothered.
C.  Babies should sleep in own cribs, not with parents, to minimize potential for rollovers, suffocation, and falls.
X.  GROWTH AND DEVELOPMENT
A.  Newborn can lose up to 10% of body weight in first 10 days of life. Should regain