Common Complications and Conditions in the Low-Risk Newborn
Hyperbilirubinemia
Any jaundice in the first 24 hours is pathologic until proven otherwise. Otherwise stratify with total serum or transcutaneous bilirubin plotted on an hour-specific nomogram, plus risk factors: gestation under 38 weeks, bruising or cephalohematoma, hemolysis (ABO, Rh, G6PD), exclusive breastfeeding with poor intake, excessive weight loss, sepsis, and ethnicity. Treat with phototherapy using age- and risk-specific thresholds; exchange transfusion is reserved for severe levels or signs of acute bilirubin encephalopathy (hypertonia, retrocollis, high-pitched cry). Breastfeeding jaundice (early, intake-related) differs from breast milk jaundice (later, benign - continue nursing).
Hypoglycemia
Screen at-risk infants (infant of a diabetic mother, late preterm, SGA or LGA, sepsis, asphyxia) about 30 minutes after the first feeding. Treat below 45 mg/dL with feeding or intravenous 10% dextrose per protocol and recheck.
Other conditions
Transient tachypnea of the newborn resolves over hours to days; respiratory distress syndrome in a preterm infant shows grunting and retractions; early-onset sepsis is subtle (temperature instability, poor feeding, apnea); feeding intolerance with bilious emesis always suggests obstruction.
Traps
Estimating bilirubin visually, permanently stopping breastfeeding for benign breast milk jaundice, missing bilious vomiting, and labeling all tachypnea as transient tachypnea.
Rule of thumb
Jaundice under 24 hours is pathologic; bilious emesis is surgical until proven otherwise.