Chapter 28: Care of the Newborn

The initial assessment prioritizes establishment of airway patency, thermal stability, and prevention of heat loss through evaporation, radiation, convection, and conduction. The Apgar score, evaluated at one and five minutes post-birth, quantifies the newborn's physiological status across five domains: cardiac rate, respiratory effort, muscle tone, reflex responsiveness, and skin perfusion. Physical examination encompasses assessment of fontanel characteristics, identification of benign cutaneous findings such as vernix caseosa and lanugo, evaluation of umbilical cord vessel anatomy, and systematic elicitation of primitive reflexes including rooting, sucking, and the Moro response. Vital sign parameters establish baseline ranges for heart rate, respiratory rate, and core temperature. The chapter addresses critical physiological transitions including hepatic maturation and bilirubin metabolism, distinguishing between physiological jaundice occurring after twenty-four hours and pathological jaundice requiring urgent intervention. Vitamin K prophylaxis prevents hemorrhagic disease, while erythromycin ophthalmic prophylaxis prevents gonococcal ophthalmia neonatorum. The chapter covers variations across gestational age spectrum, including preterm newborns with immature systems and respiratory compromise, postterm newborns demonstrating parchment-like skin and metabolic instability, and growth-discordant infants at risk for hypoglycemia. Major complications addressed include respiratory distress syndrome from surfactant deficiency, meconium aspiration, hyperbilirubinemia managed through phototherapy, and erythroblastosis fetalis from maternal-fetal blood group incompatibility. The chapter discusses maternal-fetal infectious transmission including HIV, syphilis, and substance exposure conditions such as neonatal abstinence syndrome and fetal alcohol spectrum disorders. Care of newborns with maternal diabetes focuses on glucose monitoring and early feeding initiation. Safety protocols emphasize abduction prevention through identification verification and parental education regarding cord care, circumcision management, and feeding techniques. Emergency interventions for airway obstruction and cardiopulmonary resuscitation in infants complete the chapter's scope.