Routine care of the healthy newborn — formative SAQs

SAQ 1 — Golden hour, vitamin K refusal and discharge readiness (20 marks, ~15 minutes)

A vigorous term newborn is born to a 28-year-old first-time mother by normal vaginal delivery. The parents decline intramuscular vitamin K. They also request discharge at 24 hours of age. The mother intends to breastfeed but the first feed was at 4 hours of life due to a prolonged second stage and maternal exhaustion. ^[9]

Questions

1. List the evidence-based elements of the golden hour for this infant and explain why delayed cord clamping is recommended. (5 marks) ^[9]
2. Describe your counselling approach for the vitamin K refusal, including the evidence for IM versus oral prophylaxis and your documentation plan. (5 marks) ^[6]
3. State the discharge readiness criteria you would assess before allowing discharge at 24 hours. (5 marks) ^[19]
4. Describe the follow-up plan and safety-net advice you would give to these first-time parents. (5 marks) ^{[4] [19]}

Model answer (must-hit)

1. Skin-to-skin contact, thermoregulation (drying, warmth, hat), delayed cord clamping for at least 60 seconds, early breastfeeding initiation, Apgar assessment. Delayed cord clamping improves iron stores through 6 months per Cochrane evidence without significant maternal harm. ^[9]
2. Explore reasons respectfully; correct specific misconceptions; offer IM as the evidence-based standard (most reliable for preventing all forms of VKDB including late disease). If IM declined, offer oral regimen where available but explain it requires complete multi-dose adherence and still carries residual risk. Document discussion, decision and follow-up. Do not coerce. ^[6]
3. Feeding established with adequate latch and output; weight loss within acceptable limits (typically under 10 percent); jaundice risk assessed (predischarge bilirubin); vitamin K pathway documented; newborn examination complete; safe sleep counselled; follow-up booked. ^[19]
4. Follow-up within 48 to 72 hours by a clinician who can assess feeding, weight, jaundice and parental confidence. Safety-net: warning signs (poor feeding, temperature change, increasing jaundice, lethargy, breathing difficulty, fewer wet nappies). Teach-back to confirm understanding. Safe sleep: alone, on back, firm flat surface, room-share. ^{[4] [19]}