ROUTINE DISCHARGE EXAMINATION OF BABIES: IS IT NECESSARY?

Abstract

The Maternity Services Advisory Committee recommended a routine neonatal discharge examination in 1985. However, this has not been generally accepted and the 1989 report of the joint Working Party on Child Health Surveillance recommended only a repeat examination of hip stability on discharge or within 10 days after birth. This altered recommendation was partly a response to the welcome trend towards early discharge which makes it increasingly difficult to ensure that a second examination is carried out. Moss et al addressed this problem with an audit assessing the value of the second neonatal examination. The examination, performed on 97.3% of 1795 newborn infants, was done on the day of discharge on 1428 infants (79.6%). Because of early discharge, 38.5% of babies were examined on or before day 2, the median time of the discharge examination being 4 days of age. The second examination uncovered previously undetected problems in 63 infants (3.6%). However, 49 abnormalities were minor, such as superficial infection and jaundice not requiring phototherapy; in seven babies the abnormality was not new and should have been detected by the first examination. Only seven infants had a new or potentially important abnormality: jaundice, a transient heart murmur, a distended abdomen which resolved spontaneously, and—most significantly—dislocatable hips in four infants. An important finding was therefore detected in only 0.5% of second examinations. The study concluded that a full second examination cannot be justified, but a test for hip stability should be performed. The Hall report discusses the key role of parents in the detection of defects but stresses that some defects are unlikely to be recognised even by the most astute parents and require a special search by health professionals. In this category congenital dislocation of the hip and congenital heart disease require special consideration.