Newborn Visit

The newborn visit occurs within the first 24 hours of birth. If there was no prenatal visit, discuss the topics that are ideally covered during the prenatal visit at the newborn visit.

Assess

• infant feeding, including observation of breastfeeding or formula feeding particularly if the mother is a first-time mother or was unsuccessful in breastfeeding prior children
  • As many as 44% of primiparous mothers experience milk delay (ie, full breasts after 72 hours after birth), although 98% of mothers eventually produce adequate supply by 7 days after delivery. 
    • Reasons for delay include unnecessary formula supplementation, mother-baby separation or missed feedings
    • If an infant does not empty a full breast, serotonin is released, which is a feedback inhibitor of milk production. Expressing milk to empty the breast can stimulate increased milk production
    • Brief delays are more likely to occur in women who are
      
      • Older
      • have obesity, diabetes, or hypertension
      • have undergone cesarean delivery
      • have a history of infertility
      • have infants who did not nurse well in early days after delivery
      • increased postpartum fluid balance and postpartum edema
  • Identifying the cause of delayed milk production and treating the primary problem are key.
    
    • Initiating breast milk expression for infants who are not feeding well, or the brief use of supplementation for the infant until the mother’s milk is in, may preserve breastfeeding. 
  • Primary lactational failure caused by inadequate glandular tissue or hormonal factors is rare.
• adequacy of intake by assessing stool output, urine output, and degree of jaundice.
  
  • Newborns lose up to 10% of their body weight because of fluid loss after birth
  • Parents can expect a minimum of 1, 2, and 3 wet and soiled diapers on days 1, 2, and 3 after birth, respectively.

Discuss

• Newborn metabolic screen, which if positive, affects nutrition choices
• Feeding technique, frequency, and amount of milk
  
  • Ask about concerns with breastfeeding technique and, if present, consider referral to a lactation consultant
  • Tell parents that breastfed newborns feed 8 to 12 times in 24 hours usually clustered before and after longer intervals of sleep.
  • Formula intake is approximately 20 oz per day after the first few days (2 to 3 oz every 2 to 3 hours)
  • Increase amount and frequency as the newborn’s appetite increases
    •  Discuss how to recognize hunger cues
    • Emphasize feeding infants only when they are hungry
• Supplements
  
  • Provide breastfed infants 400 IU of vitamin D supplementation daily
  • Advise parents that no additional water or juice is needed for infants (whether fed breastmilk or formula)