Neonatal and Infant Care
Neonatal items test the first hours and weeks: transition, screening, feeding, jaundice, and the complications of prematurity.
Delivery room and transition
- APGAR at 1 and 5 minutes (Appearance, Pulse, Grimace, Activity, Respiration). It describes status; it does not drive resuscitation - begin resuscitation before the 1-minute score is assigned.
- Dry, warm, stimulate; skin-to-skin and delayed cord clamping for stable term infants.
- Thermoregulation: newborns lose heat by evaporation, conduction, convection, and radiation; dry immediately and place a hat.
Routine newborn care
- Vitamin K 0.5–1 mg IM within 1 hour of birth.
- Erythromycin 0.5% eye ointment within 1 hour to prevent gonococcal ophthalmia.
- Hepatitis B vaccine within 24 hours; if the mother is HBsAg-positive, also HBIG within 12 hours.
- Newborn screening heel stick at 24–48 hours, before discharge.
Common problems
- Hypoglycemia: screen at-risk infants; treat <40 mg/dL in the first 4 hours with feeding or IV glucose.
- Jaundice: plot bilirubin on the hour-specific nomogram; phototherapy above threshold. A rapidly rising level suggests hemolysis.
- Breastfeeding: 8–12 feeds per 24 hours, at least 6 wet diapers per day by day 5.
- Prematurity: surfactant for RDS, caffeine for apnea of prematurity, human milk fortification for growth.
Worked example
A 36-hour-old, 38-week, breastfed infant has a total bilirubin of 14 mg/dL. Age in hours and gestational age determine risk, not the raw number. Plot on the hour-specific nomogram; at 36 hours this is above the phototherapy threshold for a 38-week infant with risk factors - start phototherapy, continue breastfeeding, and recheck in 4–6 hours.
Traps
- Using APGAR to decide whether to resuscitate.
- Missing the timing of the repeat screening.
- Reassuring a parent that “all newborns are jaundiced” without a bilirubin level.