Newborn Care
Newborn items test normal transition, risk-based screening, and the difference between expected findings and pathology.
Transition
The first 6–8 hours include a first period of reactivity, a sleep period, and a second period of reactivity. Normal ranges are heart rate 110–160, respiratory rate 30–60, and axillary temperature 36.5–37.5 degrees Celsius. Heat is lost by evaporation (wet skin), conduction (cold surface), convection (air currents), and radiation (cold window). Infants at risk for hypoglycemia include those of diabetic mothers, large and small for gestational age infants, and preterm, late preterm, septic, or asphyxiated infants; screen according to protocol and treat before feeds when low.
Assessment
APGAR scores at 1 and 5 minutes describe appearance, pulse, grimace, activity, and respiration; they document status and response to resuscitation but do not drive resuscitation. Caput succedaneum crosses suture lines; cephalohematoma does not and can worsen jaundice. Examine fontanels, clavicles, hips, spine, and anus, and use the Ballard score for gestational age.
Jaundice
Physiologic jaundice appears after 24 hours and peaks at days 3–5. Jaundice within the first 24 hours is pathologic and suggests hemolysis, sepsis, or another process; treat per the bilirubin nomogram with phototherapy and consider exchange transfusion for severe cases.
Routine care
Give vitamin K intramuscularly, erythromycin ointment, and the hepatitis B vaccine. Collect the newborn screen after 24 hours of feeding, complete the hearing screen, promote skin-to-skin contact and feeding cues, and teach safe sleep.
Rule of thumb
A term newborn placed on a cold scale loses heat by conduction; a draft from a window is convection. Weight loss up to 10% in the first days is expected and should be regained by about 2 weeks.