Newborn preventive care and screening — formative SAQs

SAQ 1 — Early discharge with incomplete package (20 marks, ~15 minutes)

A well term newborn is planned for discharge at 20 hours of life. Examination is documented. Intramuscular vitamin K was given. There is no record of dried bloodspot collection, hearing screening or CCHD pulse-oximetry. The family lives 90 minutes from hospital. Mother says she has no car until tomorrow evening. [8]

Questions

1. List the core components of the newborn preventive package and state the status of each in this infant. (4 marks) [8]
2. Explain why early discharge changes risk for CCHD detection, bloodspot validity/timing and jaundice surveillance. (5 marks) [4] [14]
3. Write a safe disposition plan, including what must be completed before leaving or how incomplete items will be owned. (6 marks) [8]
4. State the safety-net advice you would give and how you would check understanding. (5 marks) [14]

Model answer (must-hit)

1. Examination done; vitamin K done; bloodspot incomplete; hearing incomplete; CCHD oximetry incomplete; jaundice/DDH risk not yet closed. Package is incomplete. [8]
2. CCHD algorithms often prefer testing after transition; very early discharge can force deferred or early testing with more false positives if done too soon. Bloodspot has programme timing windows. Jaundice risk needs hour-specific assessment and timed follow-up, harder when travel is delayed. [4] [14]
3. Prefer complete critical screens before discharge when feasible. [8] If service policy allows deferred completion, name owner, exact venue/time, transport plan, and do not rely on “attend GP sometime.” Consider keeping the infant until bloodspot/hearing/oximetry can be completed if follow-up is not realistic today. [8]
4. Red flags: poor feeding, colour change, breathing difficulty, increasing jaundice, sleepiness, fewer wet nappies. Where and how to return. Teach-back. [14]

SAQ 2 — Failed CCHD screen and hearing refer (20 marks, ~15 minutes)

A 30-hour-old term infant fails CCHD pulse-oximetry on algorithm. The infant is pink while crying, settles to SpO2 values still in the fail range, and is feeding. Hearing screen is bilateral refer. Bloodspot has been collected. [3] [11]

Questions

1. What is your immediate management of the CCHD fail? (6 marks) [4]
2. List non-cardiac differentials for failed oximetry. (4 marks) [5]
3. How do you counsel and manage the hearing refer? (5 marks) [11]
4. What must the discharge summary contain if the infant later transfers? (5 marks) [8]

Model answer (must-hit)

1. Senior review now; do not discharge; monitor; support physiology; arrange echocardiography pathway; consider gas/glucose/four-limb BP as adjuncts; early cardiology/retrieval if local echo unavailable. [4]
2. Lung disease, sepsis, PPHN, probe error, cold extremities, transitional delay, haemoglobin issues. [5] [4]
3. Refer ≠ deafness; book diagnostic audiology on pathway; avoid clap-test false reassurance; mention residual risk factors for later loss. [10] [11]
4. Each screen status, vitamin K, examination findings, pending results, appointments, family contacts, transport limits. [8] [4]