Chapter 26: Care of the Newborn

The foundational assessment begins with the Apgar score, a rapid evaluation tool administered at one and five minutes after birth that measures respiratory effort, heart rate, muscle tone, reflex irritability, and skin color to guide immediate care decisions. Physical examination encompasses systematic evaluation of vital signs, skin integrity, head and fontanel characteristics, and documentation of developmental reflexes including the rooting, Moro, Babinski, grasp, and tonic neck responses, each indicating intact neurological function. Thermoregulation emerges as a critical priority, with interventions such as radiant warmers and skin-to-skin contact preventing heat loss and the dangerous cascade of cold stress. The chapter addresses essential nursing protocols including umbilical cord hygiene, infection prevention through identification systems and abduction precautions, and promotion of early feeding and maternal-infant bonding. Routine screening procedures such as phenylketonuria testing, bilirubin measurement, and glucose monitoring identify metabolic and hematologic abnormalities requiring intervention. The chapter extensively examines common neonatal complications including respiratory distress syndrome and meconium aspiration, which compromise oxygenation; hyperbilirubinemia managed through phototherapy; metabolic disturbances such as hypoglycemia; and infectious processes including sepsis and congenital infections from the TORCH group. Additional high-risk conditions discussed include necrotizing enterocolitis affecting gastrointestinal integrity, neonatal abstinence syndrome resulting from maternal substance exposure, fetal alcohol spectrum disorders with lasting developmental implications, erythroblastosis fetalis from maternal-fetal blood incompatibility, and complications specific to preterm and post-term infants. Neonatal resuscitation protocols and infant-specific cardiopulmonary resuscitation techniques are detailed to prepare nurses for emergency scenarios. Throughout, the chapter emphasizes evidence-based practice and clinical reasoning essential for providing safe, developmentally appropriate care to vulnerable newborn populations.