Newborn Care
Core concepts
Focus on transition, thermoregulation, feeding, jaundice, and screening. Apgar scores summarize tone, respiratory effort, heart rate, reflexes, and color at 1 and 5 minutes; they describe status and response to resuscitation and must never dictate resuscitation or be used to diagnose asphyxia.
Newborns lose up to 7–10% of birth weight in the first days and regain by about 2 weeks; greater loss warrants feeding assessment. Physiologic jaundice appears after 24 hours and peaks around days 3–5; interpret bilirubin against an hour-specific nomogram and treat with phototherapy based on age in hours, gestational age, and risk factors. Jaundice within the first 24 hours is always pathologic.
Universal newborn care includes vitamin K prophylaxis (IM), erythromycin ophthalmic ointment, hepatitis B vaccination before discharge, and newborn screening after 24 hours of age. Recognize hypoglycemia risk (preterm, growth-restricted, infant of a diabetic, large or small for gestational age), GBS sepsis risk, and safe sleep. Distinguish caput succedaneum (crosses sutures) from cephalohematoma (does not).
Traps
Questions conflate breastfeeding jaundice (early, from inadequate intake) with breast-milk jaundice (later, benign). Kernicterus risk depends on bilirubin level, age, and gestational age-not on appearance alone. Do not delay feeding for a low glucose without checking and treating per protocol.
Worked example
A 36-hour-old, 38-week infant with bilirubin above the phototherapy line for age in hours: begin phototherapy, ensure feeding, recheck in 12–24 hours, and evaluate for hemolysis.
Rule of thumb
Jaundice before 24 hours is never physiologic.