Routine care of the healthy newborn — branching viva

Station opening

Examiner: "A healthy term newborn has just been born. Walk me through your golden hour." [9]

Strong candidate (must-hit)

• Skin-to-skin on maternal chest, dry and warm with hat. [9]
• Delayed cord clamping for at least 60 seconds in the vigorous newborn — improves iron stores. [9]
• Early breastfeeding initiation within the first hour. [9]
• Apgar assessment at 1 and 5 minutes. [9]

Weak candidate

• "Clamp the cord immediately to measure cord gases." [9]
• "Bath the baby straight away to clean them up." [9]
• Omits skin-to-skin or thermoregulation. [9]

Branch A — Vitamin K refusal

Examiner: "The parents refuse intramuscular vitamin K. They read online that it is dangerous. What do you do?" [6]

Strong

• Explores reasons respectfully, identifies the specific concern. [6]
• Explains IM is the evidence-based standard; most reliable for preventing all forms of VKDB including late intracranial bleeding. [6]
• Offers oral alternative honestly: requires complete multi-dose adherence, still carries residual risk. [6]
• Documents the discussion, decision and follow-up plan without coercion. [6]

Weak

• "Either route is identical." [6]
• Refuses any engagement or threatens safeguarding reflexively. [6]
• Sends parents away with no documentation or follow-up. [6]

Branch B — Late-preterm early discharge

Examiner: "The baby is 35+4 weeks. They look well and the midwife suggests discharge at 24 hours." [1] [19]

Strong

• States late-preterm infants are NOT candidates for very early discharge. [1]
• Lists higher risks: hypoglycaemia, feeding difficulty, jaundice, temperature instability, readmission. [1]
• Proactive glucose screening, intensive feeding assessment, serial weights, bilirubin monitoring. [19]
• Discharge only when feeding clearly established and follow-up booked. [19]

Weak

• "Looks well, so 24-hour discharge is fine." [1]
• "Late-preterm is basically term." [1]
• No glucose monitoring plan. [1]

Branch C — Feeding failure on Day 3

Examiner: "It is Day 3. The baby has lost 11 percent of birth weight and is sleepy at feeds. What is your concern?" [3]

Strong

• Weight loss above 10 percent triggers medical review and serum sodium check. [3]
• Concern for hypernatraemic dehydration if sodium above 150 mmol/L. [3]
• Intensify feeding support; assess latch, transfer and output; lactation consultation. [3]
• Consider admission for supervised refeeding and monitoring if dehydrated. [3]

Weak

• "5 to 7 percent is normal so 11 percent is probably fine." [3]
• "Send home with formula and weigh next week." [3]
• Does not check sodium. [3]

Branch D — Safe sleep counselling

Examiner: "Discharge is planned. What safe sleep advice do you give?" [4]

Strong

• Alone, on back, firm flat surface, room-share without bed-share. [4]
• No soft objects, pillows, loose bedding or bumpers. [4]
• Avoid overheating, smoke exposure, alcohol and sedatives. [4]
• Uses teach-back to confirm parental understanding. [4]

Weak

• "Side-lying is fine to prevent reflux." [4]
• "Bed-sharing is safe if you do not smoke." [4]
• Does not counsel at all. [4]

Close

Examiner: "Summarise the routine care package for handover in one sentence." [19]

Strong

• "Skin-to-skin and delayed cord clamping done, vitamin K given [or documented refusal pathway], hepatitis B given, examination complete, feeding established, weight loss within limits, jaundice risk assessed, safe sleep counselled, follow-up booked." [19]