Newborn Visit

Assess

Newborn 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 and 30% of all 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 a newborn 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 newborns who did not nurse well in early days after delivery
    • Have increased postpartum fluid balance and postpartum edema
• Identifying the cause of delayed milk production and treating the primary problem are key.
  • Initiating human (breast) milk expression for newborns who are not feeding well, or the brief use of formula supplementation for the newborn until the mother’s milk volume increases, may preserve breastfeeding. 
  • The use of galactagogues is not well supported.
• 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.

Screen for food insecurity using the validated 2-question Hunger Vital Sign tool

• 1 in 7 children live in a household experiencing food insecurity.
• Rates of food insecurity are higher in households with children younger than 6 years, single-parent households, and immigrant, Black, or Latinx families.
  • Provide resources for families experiencing food insecurity. (Table 3)

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 (2–3 oz every 2–3 hours).
  • Increase amount and frequency as the newborn’s appetite increases.
  • Discuss how to recognize hunger cues.
  • Emphasize feeding newborns only when they are hungry.

Supplements

• Provide breastfed newborns 400 IU of vitamin D supplementation daily until one year of age.
  • Preterm neonates, especially those <27 weeks’ gestation or with birth weight <1,000 g with a history of multiple medical problems, are at high risk of rickets.
• Advise parents that no additional water or juice is needed for newborns (whether fed human milk or formula).
• A persistent serum phosphorus concentration less than ∼4.0 mg/dL should be monitored; consider phosphorus supplementation. 

Calculations

Estimated energy requirements (kcal/d) for infants 0 to 2.99 months (weight in kg; height in cm)

• Males: −716.45 − (1.00 × age) + (17.82 × height) + (15.06 × weight) + 200
• Females: −69.15 + (80.0 × age) + (2.65 × height) + (54.15 × weight) + 180