I. Purpose
To conduct regular health check-ups for newborns, promote scientific knowledge of child-rearing, guide parents in feeding, caring and disease prevention for newborns, and detect abnormalities and diseases at an early stage for timely treatment and referral. To reduce the rate of disease and mortality of newborns and promote the healthy growth of newborns.
II. Service targets
Newborns living in the district.
III. Content and methods
(A) Number of visits
1, normal full-term newborns The number of visits is not less than 2 times.
(1) The first visit: within 7 days after discharge from the hospital. If problems are found, the number of visits should be increased as appropriate, and referral should be made when necessary.
(2) Full-term visit: 28 to 30 days after birth. After the newborn is 28 days old, combined with the second dose of hepatitis B vaccination, follow-up visits will be made in township health centers and community health service centers.
2, high-risk newborns According to the specific situation, the number of visits should be increased as appropriate, and the first visit should be made within 3 days after the discharge (or home delivery) report of the high-risk newborns. Newborns that meet one of the following high-risk factors are high-risk newborns
(1) Preterm infants (gestational age < 37 weeks) or low birth weight infants (birth weight < 2500 g).
(2) Intrauterine, intrapartum or postpartum asphyxia, hypoxic-ischemic encephalopathy and intracranial hemorrhage.
(3) Hyperbilirubinemia.
(4) Severe infections such as neonatal pneumonia and sepsis.
(5) Newborns with various birth defects that affect their ability to live (such as cleft lip, cleft palate, congenital heart disease, etc.) and inherited metabolic diseases.
(6) The mother has a history of abnormal pregnancy and childbirth, advanced childbirth (≥ 35 years old), and those with disabilities (visual, hearing, intellectual, physical, mental) that affect the ability to raise a child.
(B) Visiting content
1.Consultation
(1) pregnancy and birth: the mother’s pregnancy and drug use, gestational week, mode of delivery, whether double (multiple) fetuses, the presence of asphyxia, birth injuries and deformities, birth weight, length, whether the newborn hearing screening and newborn genetic metabolic disease screening.
(2) General condition: sleep, vomiting, convulsions, frequency of urination and defecation, and vaccination status.
(3) Feeding condition: feeding method, number of times of milk consumption, milk quantity and other problems exist.
2.Measurement
(1)Weight
1. Preparation before measurement: The zero point of the scale should be corrected before each weight measurement. Newborns need to empty their bowels, take off their outer clothes, socks and diapers, and wear only single clothes and pants, and pay attention to keep the room warm in winter.
2.Measurement method: When weighing, the newborn should be in the lying position and should not touch other objects. When weighing with a lever scale, place the weight close to the weight of the newborn, and quickly adjust the swimmer so that the lever is centered and the readings shown by the weight and the swimmer are added together; when weighing with an electronic scale, wait for the data to stabilize before reading. The weight of clothes should be removed when recording. The weight is recorded in kilograms (kg) to 2 decimal places.
(2) Body temperature
1.Preparation for measurement: Before measuring the body temperature, the mercury column of the thermometer is below 35 degrees Celsius (℃).
2.Measurement method: Measure with axillary table and hold it for 5 minutes and then read it.
3.Physical examination
(1) General condition: mental status, facial color, sucking, crying.
(2) Skin mucosa: presence of yellow stain, cyanosis or pallor (mouth, lips, finger and toe nail beds), rash, bleeding spots, vesicles, pustules, sclerosis, edema.
(3) Head and neck: size and tension of fontanelle, cranial suture, presence of hematoma, and presence of masses in the head and neck.
(4) Eyes: appearance with or without abnormalities, conjunctiva with or without congestion and secretion, sclera with or without yellowing, check light stimulation reaction.
(5) Ear: appearance of abnormalities, presence of abnormal secretions in the external auditory canal, and eczema in the external auricle.
(6) Nose: whether there is any deformity in appearance, whether there is smooth breathing, and whether there is nasal flapping.
(7) Oral cavity: whether there is cleft lip and palate, and whether there is abnormality of oral mucosa.
(8) Chest: whether there is any deformity in appearance, whether there is dyspnea and chest depression, counting the number of breaths per minute and heart rate; whether there is murmur in heart auscultation and whether there is symmetry and abnormality in respiratory sounds in the lungs.
(9) Abdomen: abdomen with or without bulge and mass, liver and spleen with or without enlargement. Focus on observing whether the umbilical cord is detached and whether there is redness, swelling and oozing at the umbilicus.
(10) External genitalia and anus: for any deformities, check the position and size of the boy’s testicles, and for any scrotal edema and masses.
(11) Spinal limbs: whether there are any deformities, whether the skin pattern of the buttocks, groin and both lower limbs are symmetrical, and whether both lower limbs are equal in length and thickness.
(12) Nervous system: mobility, symmetry, muscle tone and primitive reflexes of the limbs.
4.Guidance
(1) living environment: the bedroom of the newborn should be quiet and clean, air circulation, sufficient sunlight. Indoor temperature at 22 to 26 ℃ is appropriate, the humidity is appropriate.
(2) Breastfeeding: Observe and evaluate the position of breastfeeding, the newborn’s sucking position and sucking, etc. Encourage exclusive breastfeeding. For preterm babies with weak sucking power, the mother’s milk can be squeezed in a cup and fed with a dropper; the mother can wash her hands before feeding and put her fingers into the newborn’s mouth to stimulate and promote the establishment of the sucking reflex so that she can actively suck on the nipple.
(3) Care: Dress loosely, with soft texture, and keep the skin clean. Before the umbilical cord falls off, wipe the umbilicus with 75% alcohol once a day to keep it dry and clean. If there is head hematoma, stomatitis or thrush, flushing or erosion in the skin folds, give targeted instructions. No special treatment is needed for physiological jaundice, physiological weight loss, “horse teeth”, “mantis mouth”, breast swelling and pseudomenstruation. Premature infants should pay attention to warmth, pay attention to warming the diapers first when changing diapers, and if necessary, put them in the arms of adults and keep them warm directly against adult skin.
(4) Disease prevention: Pay attention to and maintain family hygiene, wash hands before touching the newborn, reduce visits, and wear a mask when family members have respiratory infections to avoid cross-infection. Start vitamin D supplementation a few days after birth, 400 IU orally daily for full-term infants and 800 IU orally daily for premature infants. for newborns who have not received BCG vaccination and the first dose of hepatitis B vaccine, remind parents to catch up as soon as possible. For newborns who have not been screened for neonatal diseases, parents should be informed to go to a health care institution with screening conditions to make up the screening. Premature infants with a history of oxygen therapy should be referred to a designated hospital that conducts retinopathy of prematurity (ROP) screening 4-6 weeks after birth or 32 weeks after corrected gestational age to begin screening for fundus lesions.
(5) Injury prevention: pay attention to feeding position, post-feeding position, prevention of breast milk aspiration and asphyxia. Avoid burns when keeping warm to prevent accidental injuries.
(6) Promote mother-infant communication: Mothers and family members should talk, smile and have skin-to-skin contact with the newborn more often to promote the development of newborn’s sensory perception.
5.Referral
(1) Immediate referral: If a newborn has one of the following conditions, he or she should be referred to a higher-level health care institution immediately.
1.Body temperature ≥37.5℃ or ≤35.5℃.
2.Poor response with graying face and weak sucking.
3, Respiratory rate <20 times > 60 times/min, dyspnea (nasal agitation, expiratory moaning, chest depression), apnea with cyanosis.
4.Heart rate <100 beats >160 beats/min, with obvious arrhythmia.
5.Severe yellowing of the skin (palms or plantars), pallor, cyanosis and convulsive chills, hemorrhagic spots and petechiae, hard and swollen skin, skin pustules up to 5 or very severe.
6.Convulsions (repeated blinking, staring, twitching of facial muscles, spasmodic jerking or tonicity of limbs, corneal inversion, teeth clenching, etc.), high fontanelle tension.
7, no voluntary movement of the limbs, asymmetric activity of both lower limbs/both upper limbs; loss of muscle tone or inability to elicit primitive reflexes such as grip reflex.
8.Signs of dehydration such as sunken eye sockets or fontanelle, poor skin elasticity, and low urination.
9. Highly swollen eyelids, heavily congested conjunctiva, and large amount of purulent discharge; purulent discharge from the ear.
10.Significant abdominal distension with vomiting.
11.Much purulent discharge from the umbilicus with granulation or mucosa-like material, redness and swelling of the skin around the umbilical chakra.
(2) Suggested referral: If a newborn presents with one of the following conditions, it is recommended to refer to a higher-level health care institution
1. Feeding difficulties.
2.Significant yellowing of the skin on the trunk or extremities, rash, and redness and swelling around the finger and toe nails.
3. Tearing in one or both eyes, increased mucous discharge or redness.
4.A mass in the neck.
5.Heart murmur.
6.hepatosplenomegaly.
7.First time discovery of deformities of the five senses, thorax, spine, and limbs who did not visit the hospital.
During the examination, any situation found that cannot be handled should be referred.
IV. Flow chart
V. Work requirements
1. Newborn visiting staff should be professionally trained. When visiting the newborn should carry a newborn visit package, show the relevant work documents.
2, the newborn visit package should include: thermometer, neonatal lever weight scale / electronic weight scale, stethoscope, flashlight, sterilized tongue depressor, 75% alcohol, sterilized cotton swabs, neonatal visit card, pen, etc. Newborn lever weight scale / electronic weight scale maximum load of 10kg, the minimum index value of 50g.
3. Pay attention to medical safety and prevent cross-infection. Clean hands before examination, pay attention to warmth and gentle movements during examination, and pay attention not to be too high from the bed or the ground when using the lever scale.
4.Strengthen the missionary and health guidance. Inform the purpose of the visit and the content of the service, give feedback on the results of the visit, provide health guidance on feeding, care and disease prevention and control of newborns, and follow up on the screening of newborns for diseases.
5, found critical signs of newborns, should explain the situation to parents, immediately referred to higher-level health care institutions for treatment.
6.Ensure the quality of work, ask for relevant information as required, and carefully complete the measurement and physical examination. Complete and accurately fill out the record form of newborn family visit and include it in the child health file.
VI. Assessment indicators
1.Coverage rate of newborn visits = (the number of newborns receiving one or more visits in the year / the number of live births in the same period) × 100%
2, neonatal exclusive breastfeeding rate = (the number of newborns exclusively breastfed during the same period / full-term visits to the number of newborns with feeding records) × 100%