Routine care of the healthy newborn — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar. Tommy is 6 hours old, born at 36+2 weeks to a first-time mother with diet-controlled gestational diabetes. Delivery was uncomplicated. The midwife describes the latch as variable during the first feed. Vitamin K has not yet been administered. Parents are keen to go home tomorrow and have questions about cord care and sleeping arrangements. You have 12 minutes with the family and 5 minutes for examiner discussion. [1]

Information available on request

• Gestation 36+2 weeks, birth weight 3.1 kg (appropriate for gestation), SVD, Apgar 9 at 1 min and 9 at 5 min. [9]
• Skin-to-skin was done for 40 minutes after birth. Delayed cord clamping for 90 seconds was completed. [9]
• Maternal glucose in labour was well controlled. [1]
• First breastfeed at 2 hours of life; latch variable, one audible swallow heard. [1]
• Vitamin K consent form is in the chart but the nurse has not yet given it. [6]
• Parents have read conflicting online information about vitamin K and co-sleeping. [6] [4]

Tasks

1. Identify the key risk factors that change Tommy's routine care plan and explain why. [1]
2. Address the vitamin K question and ensure prophylaxis is completed or a documented refusal pathway exists. [6]
3. Assess feeding adequacy and describe your plan for ongoing monitoring. [1]
4. Counsel on safe sleep and address the co-sleeping question. [4]
5. Determine whether discharge tomorrow is appropriate and outline the follow-up plan. [19]

Marking anchors

Must-hit

• Recognises late-preterm (36+2) and infant of diabetic mother as dual risk for hypoglycaemia and feeding difficulty. [1]
• Screens blood glucose per AAP at-risk algorithm; feeds, rechecks, escalates if needed. [1]
• Addresses vitamin K with evidence: IM is standard, most reliable; if declined, oral requires full adherence with residual risk. [6]
• Safe sleep: alone, on back, firm flat surface, room-share, no bed-sharing, no soft objects. Addresses co-sleeping concern. [4]
• Does NOT recommend discharge at 24 hours for a late-preterm infant; confirms feeding established, weight stable, glucose and jaundice monitored. [19]
• Follow-up plan: closer monitoring (48 to 72 hours), assess feeding, weight, jaundice and parental confidence. [19]

Merit

• Explains the interaction between late-preterm status and hyperbilirubinemia risk; plans predischarge bilirubin with hour-specific nomogram. [3]
• Uses teach-back for safety-net and safe sleep advice. [4]
• Engages lactation support proactively given variable latch. [1]
• Documents vitamin K discussion and decision regardless of outcome. [6]

Fail

• Agrees to 24-hour discharge without recognising late-preterm risk. [19]
• Does not screen glucose in an infant of a diabetic mother born at 36+2 weeks. [1]
• Advises co-sleeping or side-sleeping as acceptable. [4]
• Omits vitamin K entirely or dismisses parental concerns without counselling. [6]
• Leaves feeding adequacy unassessed with a variable latch at 36+2 weeks. [1]