Care of the Normal Newborn

Arrival & First Hugs - Welcome to the World!

• Immediate care:
  • Dry baby thoroughly, provide warmth (skin-to-skin or radiant warmer).
  • Clear airway only if obstructed (gentle suction: mouth then nose).
  • Assess APGAR score at 1 & 5 minutes.
• Essential Prophylaxis:
  • Vitamin K (1 mg IM for term; 0.5 mg for preterm <1kg) prevents VKDB.
  • Eye care: antibiotic ointment (e.g., tetracycline) for ophthalmia neonatorum.
• Initiate breastfeeding within 1 hour.

⭐ APGAR: Appearance, Pulse, Grimace, Activity, Respiration (each 0-2). Score <7 at 5 min indicates need for further assessment/intervention.

Tiny Human Checkup - Head to Toe!

• Vitals: HR 120-160/min, RR 40-60/min, Temp (Axillary) 36.5-37.5°C.
• Measurements: Wt 2.5-3.5 kg (physiologic loss ≤10% 1st wk), L 48-52 cm, HC 33-35 cm.
• Skin: Vernix, lanugo, milia, erythema toxicum, Mongolian spots. Jaundice.
• Head: Fontanelles (anterior/posterior), sutures. Caput (crosses sutures) vs. Cephalohematoma. Eyes: Red reflex.
• Chest: Clavicles. Lungs, Heart (murmurs?).
• Abdomen: Umbilical cord (2 arteries, 1 vein). Palpate. Femoral pulses.
• Hips/Neuro: Ortolani/Barlow for DDH. Primitive reflexes (Moro, suck, grasp).

⭐ A single umbilical artery (SUA) is found in ~1% of newborns; screen for renal anomalies.

Milk Bar Open! - First Feasts

• Initiate breastfeeding: Within 1 hour of birth.
• Colostrum ("liquid gold"): First 3-4 days. Rich in IgA, lactoferrin, growth factors, Vitamin A.
• Feeding: On-demand, 8-12 times/24 hrs. Exclusive breastfeeding (EBF) for 6 months.
• Adequacy signs:
  • Urine: 6-8 wet diapers/day (by day 5).
  • Stools: 3-4/day; meconium → transitional → yellow, seedy.
  • Weight: Regains birth weight by 10-14 days.

⭐ Colostrum is crucial: high protein, low fat, rich in antibodies (secretory IgA), and laxative effect helping pass meconium.

Little Hiccups & Checks - Keeping Tabs

• Common Minor Issues:
  • Erythema toxicum, milia, Mongolian spots.
  • Caput (crosses sutures) vs. Cephalhematoma (no cross).
• Physiological Jaundice:
  • Onset >24h; peaks day 3-5 (term), 5-7 (preterm).
  • TSB usually <15 mg/dL.
  • Adequate feeds; phototherapy if TSB high.

• Routine Checks:
  • Weight: Max 10% loss (term), regain by 10-14d.
  • Hearing Screen: OAE/AABR.
  • NBS: CH, CAH, G6PD (key).
  • CCHD screen: Pulse oximetry (24-48h).

⭐ Universal screening for Congenital Hypothyroidism (CH) is crucial; incidence in India is ~1 in 1172 to 2500.

Ready for Home - Homeward Bound!

• Discharge Criteria: Stable vitals, good feeding (exclusive breastfeeding), passed urine/stool, normal exam.
• Immunizations (Birth Dose - NIP): BCG, OPV-0, Hepatitis B.
• Parental Counselling:
  • Feeding techniques, cord care, hygiene.
  • Danger signs: poor feeding/lethargy, fever (>38°C or <36.5°C), ↑RR, jaundice (soles/palms), seizures.
• Follow-up: Within 48-72 hours.

⭐ Exclusive breastfeeding for the first 6 months is crucial for optimal growth and development.

High‑Yield Points - ⚡ Biggest Takeaways

• APGAR score assesses newborn vitality at 1 and 5 minutes post-birth.
• Administer Vitamin K (1mg IM) at birth to prevent Hemorrhagic Disease of the Newborn (HDN).
• Initiate breastfeeding within one hour of birth; promote exclusive breastfeeding for 6 months.
• Maintain newborn temperature (36.5-37.5°C); Kangaroo Mother Care (KMC) for stable LBW infants.
• Screen for congenital hypothyroidism, PKU, G6PD deficiency, and hearing loss.
• First meconium passage typically within 24-48 hours; first urine within 24 hours.
• Physiological jaundice appears after 24 hours of life; caput succedaneum crosses suture lines, cephalohematoma does not.